Paradoxical vocal fold movement: A case report

doi:10.1016/S0892-1997(97)80017-3

Journal of Voice

Volume 11, Issue 3, September 1997, Pages 368-372

https://doi.org/10.1016/S0892-1997(97)80017-3 Get rights and content

Summary

We present a case of one patient with respiratory stridor that was resolved by speech therapy. Paradoxical vocal fold movements were observed by flexible fiberoptic videolaryngoscopy in this patient during episodes of wheezing and dyspnea. Otherwise, normal vocal fold movement was observed in normal conditions of breathing (out of the crisis) and during phonation. Many different terms have been used to describe this entity in the literature, and it is crucial that clinicians recognize the subtle signs of functional stridor. Paradoxical vocal fold motion has to be considered as an important cause of respiratory disease. Its recognition and treatment are discussed in this report.

References (25)

GallivanG.J. et al.
Episodic paroxysmal laryngospasm: voice and pulmonary function assessment and management
J Voice
(1996)
StarkmanM.N. et al.
Functional upper airway obstruction: a possible somatization disorder
Psychosomatics
(1984)
SimT.C. et al.
Functional laryngeal obstruction: a somatization disorder
Am J Med
(1990)
NagaiA. et al.
Functional upper airway obstruction: psychogenic pharyngeal constriction
Chest
(1992)
PattersonR. et al.
Munchausen's stridor: nonorganic laryngeal obstruction
Clinical Allergy
(1974)
RogersJ.H. et al.
Paradoxical movement of the vocal cords as a cause of stridor
J Laryngol Otol
(1978)
CormierY.R. et al.
Non-organic acute upper airway obstruction: Description and diagnostic approach
Amer Rev Respir Dis
(1980)
AppelblattN.H. et al.
Functional upper airway obstruction-a new syndrome
Arch Otolaryngol Head Neck Surg
(1981)
KellmannR.M. et al.
Paradoxical vocal cord motion: an important cause of stridor
Laryngoscope
(1982)
KattanM. et al.
Stridor caused by vocal cord malfunction associated with emotional factors
Clin Pediatr
(1985)

ChristopherK.L. et al.

Vocal cord dysfunction presenting as asthma

N Engl J Med

(1983)

HammerG. et al.

Postoperative complications due to paradoxical vocal cord motion

Anesthesiology

(1987)

Cited by (20)

Speech-Language Pathology as a Primary Treatment for Exercise-Induced Laryngeal Obstruction
2018, Immunology and Allergy Clinics of North America
Citation Excerpt :
In treating EILO, SLPs use various approaches of breathing and relaxation techniques to guide the patient through symptom prevention, control, and rescue breathing during their dyspneic episodes. The literature suggests positive patient response to behavioral intervention for EILO.1–14 It has been reported that behavioral intervention by SLPs may prevent up to 90% of patient visits to the emergency room for symptoms attributable to inducible laryngeal obstruction, although this finding is not specific to patients with exercise-induced symptoms.15
Temporal Variables in Voice Therapy
2015, Journal of Voice
Citation Excerpt :
No restrictions were in place regarding the age of the patients, type and severity of the voice disorder, or the applied treatment. This method delivered 93 qualified publications.2,4,6,12–94 In addition to the PubMed database, several international textbooks including case studies and general theory were consulted and resulted in an additional 47 qualified publications.95–115
This study analyzed temporal voice therapy data (duration and frequency) as reported in the scientific literature between 1975 and May 2013.
A PubMed search was conducted using the keywords “voice and therapy” and “therapy and dysphonia,” resulting in 93 qualified publications. This information was complemented by data reported in scientific textbooks (47 publications).
The results show that voice therapy lasts an average of 9.25 weeks distributed over 10.87 sessions of mostly 30 (36.36%) or 60 minutes (27.27%) and occurs once (34.55%) or twice (28.18%) per week. The total amount of time that a voice therapist spends face-to-face with the patient is 8.17 hours on average. Substantial geographic differences are observed, but only data from North America and Europe are sufficiently represented. For North American patients, more sessions (12.52) are reported over a shorter period (7.62 weeks), resulting in more face-to-face time (12.15 hours) between therapist and patient. However, the opposite trend is true for European patients, who average 10.99 sessions over 10.12 weeks, resulting in 7.68 hours of face-to-face time. The potential impact of diagnosis, clinical practices, prescription habits, health insurance rules, patient compliance, and study design on the representativeness of the data is discussed.
These results offer a frame of reference regarding international practices for temporal variables in voice therapy that may be useful when identifying voice therapy dosage and optimal practice.
Diagnostic criteria for the classification of vocal cord dysfunction
2010, Chest
Citation Excerpt :
Several case reports describe either arytenoid or aryepiglottic fold closure with exercise.57,88,89 Findings of arytenoid closure have likewise been reported that were unrelated to exercise.90–92 Anxiety with associated negative pressures due to ventilatory requirements (similar to exercise) has been speculated as a cause.
Vocal cord dysfunction (VCD) is a syndrome characterized by paroxysms of glottic obstruction due to true vocal cord adduction resulting in symptoms such as dyspnea and noisy breathing. Since first described as a distinct clinical entity in 1983, VCD has inadvertently become a collective term for a variety of clinical presentations due to glottic disorders. Despite an increased understanding of laryngeal function over the past 25 years, VCD remains a poorly understood and characterized entity. Disparities in the literature regarding etiology, pathophysiology, and management may be due to the historic approach to this patient population. Additionally, disorders clearly not due to paroxysms of true vocal cord adduction, such as laryngomalacia, vocal cord paresis, and CNS causes, need to be differentiated from VCD. Although a psychologic origin for VCD has been established, gastroesophageal reflux disease (GERD), nonspecific airway irritants, and exercise have also been associated with intermittent laryngeal obstruction with dyspnea and noisy breathing. VCD has been repeatedly misdiagnosed as asthma; however, the relationship between asthma and VCD is elusive. There are numerous case reports on VCD, but there is a paucity of prospective studies. Following an in-depth review of the medical literature, this article examines the available retrospective and prospective evidence to present an approach for evaluation of VCD including: (1) evaluation of factors associated with VCD, (2) differential diagnosis of movement disorders of the upper airway, and (3) clinical, spirometric, and endoscopic criteria for the diagnosis.
Vocal Cord Dysfunction, Paradoxic Vocal Fold Motion, or Laryngomalacia? Our Understanding Requires an Interdisciplinary Approach
2010, Otolaryngologic Clinics of North America
Citation Excerpt :
Endoscopy showed intermittently symmetric arytenoid motion alternating with asymmetric motion with both causing prolapse over the glottic opening. Pinho and colleagues presented an image20 in which the left arytenoid region has moved across the midline and is positioned anterior to the right. Heimdal and colleagues reported results of four patients with IARP obtained during continuous laryngoscopic endoscopy during a maximum exercise test.21
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.
Atypical expiratory flow volume curve in an asthmatic patient with vocal cord dysfunction
2001, Annals of Allergy, Asthma and Immunology
Vocal cord dysfunction can coexist with or masquerade as asthma. Vocal cord dysfunction, when coexistent with asthma, contributes substantially to the refractory nature of the respiratory problem.
To report a case of an asthmatic patient with vocal cord dysfunction and a previously unreported unique expiratory flow volume curve.
A 16-year-old female, known to have asthma, developed increased frequency of her asthma exacerbations. Spirometry, during symptoms, showed an extrathoracic airway obstruction with a reproducible unique abrupt drop and rise in the expiratory flow volume loop. Laryngoscopy showed adduction of the vocal cords during inspiration and expiration.
We report a unique expiratory flow volume curve in an asthmatic with vocal cord dysfunction that resolved with panting maneuvers. Speech and psychological counseling helped prevent future attacks.

View all citing articles on Scopus

View full text

Paradoxical vocal fold movement: A case report

Summary

J Voice

Psychosomatics

Am J Med

Chest

Munchausen's stridor: nonorganic laryngeal obstruction

Clinical Allergy

Paradoxical movement of the vocal cords as a cause of stridor

J Laryngol Otol

Non-organic acute upper airway obstruction: Description and diagnostic approach

Amer Rev Respir Dis

Functional upper airway obstruction-a new syndrome

Arch Otolaryngol Head Neck Surg

Paradoxical vocal cord motion: an important cause of stridor

Laryngoscope

Stridor caused by vocal cord malfunction associated with emotional factors

Clin Pediatr

Vocal cord dysfunction presenting as asthma

N Engl J Med

Postoperative complications due to paradoxical vocal cord motion

Anesthesiology