Paradoxical Vocal Cord Motion Presenting as Acute Stridor

doi:10.1016/S0196-0644(97)70205-1

Annals of Emergency Medicine

Volume 29, Issue 6, June 1997, Pages 815-817

https://doi.org/10.1016/S0196-0644(97)70205-1 Get rights and content

Abstract

We report the cases of two patients who presented with acute-onset stridor that did not respond to standard medical therapy. Both were eventually found to have paradoxical vocal cord motion (PVCM). The ED management of these patients is reviewed. [Dinulos JG, Karas DE, Carey JP, Del Beccaro MA: Paradoxical vocal cord motion presenting as acute stridor. Ann Emerg Med June 1997;29:815-817.]

Section snippets

INTRODUCTION

Paradoxical vocal cord motion (PVCM) results from a conversion disorder leading to paradoxical vocal cord adduction during inspiration. The condition is usually associated with emotional stress. Although uncommon, this entity is recognized as an important cause of stridor.¹ PVCM has a broad range of presentations and may mimic a variety of upper and lower respiratory tract illnesses, including asthma, epiglottitis, and allergic reactions. Patients with PVCM often present to the ED with acute

CASE REPORTS

Case 1 An 11-year-old girl with a history of asthma, diagnosed early in childhood, experienced acute shortness of breath that did not respond to treatment with her usual betamethasone and albuterol metered-dose inhalers. She was transported to the ED of a local hospital, where significant inspiratory stridor was noted.

Physical examination revealed an afebrile patient with a respiratory rate of 32, pulse of 109, blood pressure of 125/74 mm Hg, and oxygen saturation of 96%. Findings of

DISCUSSION

PVCM is an uncommon but important cause of stridor in the pediatric population. Failure to recognize this entity can lead to significant cost and morbidity. Unnecessary and costly diagnostic evaluations and improper medical and surgical therapy have been instituted in patients with PVCM.² Intubation, tracheostomy, and admission to the ICU have been instituted in some patients.2, 3, 4 Indeed, our patients were seen in several EDs, and in one helicopter transport was used.

Although PVCM is a

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Cited by (17)

Inspiratory muscle training in exercise-induced paradoxical vocal fold motion
2005, Journal of Voice
Citation Excerpt :
The diagnosis of PVFM may be extremely difficult, and it is often one of exclusion.4,5 The failure to recognize PVFM has led to prolonged and unnecessary drug use (such as anti-inflammatory agents, inhaled or oral corticosteroids, leukotriene modifier agents, and bronchodilators), hospitalization, intubation, and even tracheostomy.12–16 Medical intervention for PVFM typically involves patient education, termination of unnecessary medications, and prescription of medications to treat contributory conditions.
The purpose of the study was to determine if inspiratory muscle training (IMT) would result in increased inspiratory muscle strength, reduced perception of exertional dyspnea, and improved measures of maximal exercise effort in an athlete with exercise-induced paradoxical vocal fold motion (PVFM). The participant, an 18-year-old woman, had a 2-year history of acute dyspnea with exertion during soccer games. Spirometry, transnasal flexible laryngoscopy, and patient history supported a PVFM diagnosis. The ABAB within-subject withdrawal design study comprised IMT treatment and withdrawal phases, each lasting 5 weeks. The participant trained 5 days per week, completing five sets of 12 breaths at 75% maximum inspiratory pressure (MIP) per session. Data consisted of MIP, exertional dyspnea ratings, and maximal exercise measures. IMT resulted in increased MIP and decreased dyspnea ratings across both treatment phases. No change in MIP or dyspnea ratings occurred in response to treatment withdrawal. The maximal exercise test revealed minimal changes across phases. At end of the study, the participant reported experiencing no PVFM symptoms when performing the outcome measurement tasks and when playing soccer. Transnasal flexible laryngoscopy, after strenuous exercise and during rapid breathing and phonation tasks, revealed normal laryngeal findings. The findings suggest that IMT may be a promising treatment approach for athletes with exercise-induced PVFM.
Paradoxical vocal cord motion - A case report
2005, Auris Nasus Larynx
Paradoxical vocal cord motion (PVCM) is an unusual cause of stridor, which is associated with some underlying causes, such as central nervous system lesion, gastroesophageal reflux or psychogenic problem. Once a diagnosis of PVCM is made, acute management with reassurance and sedation instead of aggressive airway intervention is required. Speech therapy, psychotherapy combination with anti-reflux medication is considered to be useful in long-term management. We present a 58 year-old male patient who had suffered from several episodes of acute onset of stridor, short of breath and tachypnea since one year ago. He was initially treated as an asthmatic patient with poor response. Aneurysm of ascending aorta by angiography, and mild gastroesophageal reflux with hiatal hernia by panendoscopy were noted. Then, the paradoxical vocal cord motion during inspiration phase was confirmed by flexible fiberoptic nasopharyngoscope after the consultation with an otolaryngologist. The emergency of his air-hunger was relieved quickly after psychological intervention. Now, he is free of stridor attack under anti-reflux therapy and psychotherapy.
Vocal cord dysfunction: An uncommon cause of stridor
2005, Journal of Emergency Medicine
Paradoxical vocal cord motion: An often misdiagnosed cause of postoperative stridor
2004, Journal of Clinical Anesthesia
This conference reports a case of acute functional airway obstruction occurring in the postoperative anesthesia care unit, which was diagnosed by fiberoptic laryngoscopy and successfully treated with intravenous midazolam after other more common causes of stridor were ruled out. The presentation, etiology, diagnosis, and treatment of paradoxical vocal cord motion as it relates to the care of the postoperative patient are discussed.
Paradoxical vocal fold motion: Presentation and treatment options
2000, Journal of Voice
Paradoxical vocal fold motion is a rare disorder in which adduction of the folds occurs on inspiration. The disorder presents with signs of airway obstruction and often airway distress, so proper diagnosis by the otorhinolaryngologist is critical to subsequent management. We present a retrospective review of 10 patients with the diagnosis of paradoxical vocal fold motion seen over a 6-year period. Eight patients were females, and 6 required an acute airway intervention at presentation; 3 patients eventually underwent tracheotomy for respiratory decompensation. Six patients had a prior diagnosis of asthma, and this was determined to contribute to their respiratory status. Five patients were treated with botulinum toxin and 2 with flexible nasolaryngoscopic biofeedback, which improved the outcome. A review of the literature confirms a female predominance of patients presenting with paradoxical adduction and airway distress, often with a history of asthma and psychopathology. Our experience with botulinum toxin and biofeedback suggests that these procedures are viable treatment options in the management of patients with this disorder.
Functional Outcomes after Behavioral Treatment of Paradoxical Vocal Fold Motion in Adults
2018, Folia Phoniatrica et Logopaedica

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^☆: From the Department of Pediatrics^* and Department of Otolaryngology, Head and Neck Surgery,^‡ University of Washington School of Medicine and Children's Hospital and Medical Center, Seattle, WA; and the Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT.^§

^☆☆: Address for reprints:Mark A Del Beccaro, MD Children's Hospital and Medical Center 4800 Sand Point Way Northeast Seattle, WA 98105 Mail Stop CH-04

^★: Reprint no. 47/1/81674

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Paradoxical Vocal Cord Motion Presenting as Acute Stridor☆,☆☆,★

Abstract

Section snippets

INTRODUCTION

CASE REPORTS

DISCUSSION

J Adolesc Health

Gen Hosp Psychiatry

Spectrum of presentation of paradoxical vocal cord motion in ambulatory patients

Ann Allergy Asthma Immunol

Paradoxical vocal cord motion: an important cause of stridor

Laryngoscope