Breathing disorder that is frequently mistaken for asthma.
Accurate diagnosis is made by a multidisciplinary team, which can include a speech language pathologist, a primary care physician, an asthma/allergy specialist, a pulmonologist, a psychologist, a psychiatrist, a sports medicine specialist, an athletic trainer, and a gastroenterologist.
Diagnosis is established through the case history, laryngeal visualization, and pulmonary function studies.
Behavioral therapy by a speech language pathologist is the standard treatment.
Paradoxical vocal fold motion (PVFM), also called paradoxical vocal cord dysfunction, is a breathing disorder characterized by approximation rather than abduction/opening of the vocal folds during inspiration. This can result in upper-airway obstruction and stridor. Diagnosis is most often based upon exclusion of other differentials.
History and exam
Key diagnostic factors
- history of laryngopharyngeal reflux or GERD
- previous treatment for asthma without response to bronchodilators
- episodic shortness of breath: rapid onset and resolution
- difficulty inhaling
- inspiratory stridor
- increased sensitivity to nonspecific triggers after initial exposure
- palpable laryngeal tension
- loss of consciousness
- laryngopharyngeal reflux (LPR)
- occupational/environmental irritant exposure
- female sex
- competitive athletics
- multisystem atrophy (MSA)
- muscle tension dysphonia
- adductor laryngeal breathing dystonia
1st investigations to order
- flexible fiberoptic nasendoscopy
- PFTs/flow-volume plot
Investigations to consider
- sinus CT
- laryngeal sensory discrimination testing
unstable, undiagnosed patient with stridor
stable patient with stridor suspected to be secondary to PVFM
without acute stridor
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