Paradoxical Vocal Fold Motion
Other Alternative Nomenclature
Emotional Laryngeal Wheezing
Episodic Paroxysmal Laryngospasm
Factitious Asthma
Functional Stridor
Hysterical Croup
Inspiratory Vocal Cord Adduction
Irritable Larynx Syndrome
Laryngeal Dyskinesia
Munchausen’s Stridor
Paradoxical Vocal Cord Motion
Periodic Occurrence of Laryngeal Obstruction
Pseudoasthma
Psychogenic Stridor
Epidemiology
Association with Asthma
Epidemiology : up to 75% of asthmatics have co-existent vocal cord dysfunction
Etiology
Psychiatric Disease
Neurologic Disease
Herpes Simplex Virus-Associated Polycranial Neuropathy
Post-Cervical Spine Surgery
Post-Thyroid Surgery
Other
Asthma (see Asthma , [[Asthma]])
While paradoxical vocal fold motion may be misdiagnosed as asthma, it may occur concomitantly with asthma [MEDLINE ]
Exercise : exercise is a precipitant of paradoxical vocal fold motion in 14% of cases
Occurs mainly in young, female athletes
Irritants : onset is usually within 24 hrs of exposure to irritant
Aerosolized Machining Fluids
Ammonia (see Ammonia , [[Ammonia]])
Cleaning Chemicals
Construction Dust
Smoke (see Smoke Inhalation , [[Smoke Inhalation]])
Soldering Fumes
Laryngopharyngeal Reflux (see Gastroesophageal Reflux Disease , [[Gastroesophageal Reflux Disease]])
Post-Extubation : paradoxical vocal fold motion may occur shortly after extubation
Post-operative dyspnea/stridor is more commonly caused by laryngospasm than by paradoxical vocal fold motion
Laryngospasm is usually a brief, acute onset episode of sustained vocal fold adduction which occurs on emergence from general anesthesia (see Laryngospasm , [[Laryngospasm]])
Physiology
Paradoxic medial motion of vocal cords during inspiration : unclear etiology
Diagnosis
Arterial Blood Gas (ABG) (see Arterial Blood Gas , [[Arterial Blood Gas]])
Pulmonary Function Tests (PFT’s) (see Pulmonary Function Tests , [[Pulmonary Function Tests]])
Spriometry/Lung Volumes : usually normal (although restriction may be seen in some cases)
Flow-Volume Loop : during episode, extrathoracic obstruction on flow-volume loop (flattened inspiratory limb) is seen
If paradoxical vocal fold motion occurs during expiration, expiratory flow limitation will be seen
Methacholine Challenge : may trigger paradoxical vocal fold motion (likely via an irritant mechanism)
Normal methacholine challenge (with normal flow-volume loop) does not exclude paradoxical vocal fold motion
Bronchoscopy (see Bronchoscopy , [[Bronchoscopy]])
Paradoxic Medial Motion (Adduction) of Vocal Cords DuringIinspiration
Flexible Laryngoscopy (see Flexible Laryngoscopy , [[Flexible Laryngoscopy]])
Paradoxic Medial Motion (Adduction) of Vocal Cords DuringIinspiration
Exercise Testing (see Exercise Test , [[Exercise Test]])
Clinical Manifestations
General Comments
Duration of Episodes : episodes requiring emergency department evaluation have been shown to last several hours-several days
In Contrast, Laryngospasm Usually Lasts Seconds-Minutes (see Laryngospasm , [[Laryngospasm]])
Gastrointestinal Manifestations
Dysphagia (see xxxx , [[xxxx]]): less common
Reflux Symptoms (see xxxx , [[xxxx]]): less common
Otolaryngologic Manifestations
Choking Sensation
Dysphonia (see xxxx , [[xxxx]])
Acute Rhinosinusitis (see Acute Rhinosinusitis , [[Acute Rhinosinusitis]]): less common
Stridor (see xxxx , [[xxxx]]): may be inspiratory, expiratory, or both
Throat Tightness
Pulmonary Manifestations
Acute Respiratory Failure (see Respiratory Failure , [[Respiratory Failure]])
Cough (see xxxx , [[xxxx]])
Dyspnea (see xxxx , [[xxxx]])
Obstructive Symptoms (see Obstructive Lung Disease , [[Obstructive Lung Disease]]): may mimic asthma
Lack of Responsiveness to Bronchodilators : characteristic
Treatment
Intubation : leads to prompt resolution of dyspnea (with normal static and dynamic compliance observed during mechanical ventilation)
References
Paradoxical vocal fold motion dysfunction in asthma patients. Respirology. 2009 Jul;14(5):729-33 [MEDLINE ]
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