Summary
Definition
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
- cough
- inspiratory stridor
- increased sensitivity to nonspecific triggers after initial exposure
- palpable laryngeal tension
- loss of consciousness
Risk factors
- laryngopharyngeal reflux (LPR)
- GERD
- asthma
- occupational/environmental irritant exposure
- female sex
- competitive athletics
- anxiety
- muscle tension dysphonia
- adductor laryngeal breathing dystonia
- surgery
Diagnostic tests
1st tests to order
- flexible nasolaryngoscopy
- PFTs/flow-volume plot
Tests 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/ILO
without acute stridor
Contributors
Authors
Rita Patel, PhD, CCC-SLP
Associate Professor
Department of Speech, Language and Hearing Sciences
Indiana University Bloomington
Bloomington
IN
Disclosures
RP is on the Board of Trustees for the American Speech-Language-Hearing Foundation, Editor-In-Chief for the American Journal of Speech-Language Pathology, an educational course content developer for Northern Speech Services, and has received grants or pending grants from the National Institutes of Health, and employment at Indiana University.
Susan L. Thibeault, PhD
Professor
UWHealth Medical Director of Speech and Hearing Services
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
Dr Rita Patel and Dr Susan L. Thibeault would like to gratefully acknowledge Dr Michael Johns and Ms Sheeri K. Zelazny, previous contributors to this topic. MJ and SZ declare that they have 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 Differentials
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer