Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- previous treatment for asthma without response to bronchodilators
- episodic shortness of breath: rapid onset and resolution
- difficulty inhaling
- cough
- inspiratory stridor
- increased sensitivity to non-specific triggers after initial exposure
- palpable laryngeal tension
- loss of consciousness
Risk factors
- laryngopharyngeal reflux (LPR)
- GORD
- asthma
- occupational/environmental irritant exposure
- female sex
- competitive athletics
- anxiety
- multi-system atrophy (MSA)
- muscle tension dysphonia
- adductor laryngeal breathing dystonia
- surgery
Diagnostic investigations
1st investigations to order
- flexible fibre-optic nasendoscopy
- PFTs/flow-volume plot
Investigations to consider
- sinus CT
- laryngeal sensory discrimination testing
Treatment algorithm
unstable, undiagnosed patient with stridor
stable patient with stridor suspected to be secondary to PVFM
without acute stridor
Contributors
Authors
Sherri K. Zelazny, MA, RSLP, CCC-SLP
Senior Clinical Speech Language Pathologist
Surrey Voice Clinic
Abilities Neurological Rehabilitation
Surrey
British Columbia
Canada
Disclosures
SKZ has received income from Northern Speech Services for educational webinar production on Paradoxical Vocal Fold Motion and Chronic Cough. SKZ is President of Speech and Hearing BC (2017-2019), and on the Board of Directors of Parkinson Society BC.
Susan L. Thibeault, PhD
Assistant Professor
Director of Voice and Swallowing Clinic
Division of Otolaryngology - Head and Neck Surgery
University of Wisconsin School of Medicine and Public Health
Health Sciences Learning Center
Madison
WI
Disclosures
SLT declares that she has no competing interests.
Acknowledgements
Ms Sherri K. Zelazny and Dr Susan L. Thibeault would like to gratefully acknowledge Dr Michael Johns, a previous contributor to this topic. MJ declares that he has no competing interests.
Peer reviewers
Julina Ongkasuwan, MD
Associate Professor
Otolaryngology - Head and Neck Surgery
Baylor College of Medicine
Texas Children’s Hospital
Houston
TX
Disclosures
JO receives book royalties from Springer and Elsevier.
Janet Wilson, BSc, MD, FRCSEd, FRCSEng
Professor of Otolaryngology - Head and Neck Surgery
Newcastle University
Honorary Consultant Otolaryngologist
Freeman Hospital
Newcastle-Upon-Tyne
UK
Disclosures
JW declares that she has no competing interests.
Ryner Jose Dela Cruz Carrillo, MD, MSc, FPSOHNS, FPAHNS
Associate Professor
Department of Otorhinolaryngology
Department of Anatomy
University of the Philippines
College of Medicine
Manila
Philippines
Disclosures
RJDCC declares that he has no competing interests.
Tom Murry, PhD
Professor of Speech Pathology
Department of Otolaryngology - Head and Neck Surgery
Clinical Director of the Voice and Swallowing Center
College of Physicians and Surgeons
Columbia University at New York Presbyterian Hospital
New York
NY
Disclosures
TM declares that he has no competing interests.
Differentials
- Asthma
- Laryngomalacia
- Vocal fold paresis/paralysis
More DifferentialsGuidelines
- Inducible laryngeal obstruction: an official joint European Respiratory Society and European Laryngological Society statement
- Inducible laryngeal obstruction: an official joint European Respiratory Society and European Laryngological Society statement
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer