Paradoxical vocal cord movement: a rare condition that is likely to be misdiagnosed and mistreated

Idiopathic laryngeal spasm: management and long-term outcome

Idiopathic laryngeal spasm (ILS) is an uncommon disorder characterised by brief episodes of stridor, occurring at any time. Subsequent outpatient ENT examination is normal. These episodes cause considerable anxiety for both patient and physician. Little is known about the initiating event(s) in this condition or the long-term outcome. Using a combination of telephone and postal questionnaires with case note review, we have reviewed a cohort of 21 patients with this diagnosis managed by the senior author over the last 15 years. None of the 19 patients who responded were worse; 13 (68%) described improvement or complete resolution of symptoms. ILS is difficult to classify in the spectrum of vocal cord disorders, but appears distinct to those previously described. The condition responds well to a conservative management approach of reassurance and counselling.

Paradoxical vocal cord motion—A case report

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.

Severe obstructive airway disorders and diseases: vocal fold dysfunction

Vocal Fold Dysfunction is a syndrome characterized by abnormal adduction of the focal folds during inspiration and is the cause of a wide spectrum of clinical manifestations ranging from mild inspiratory stridor to an inability to move any air. Patients present with varying degrees of intermittent respiratory difficulty, the most severe caused by intense laryngospasm. Distinguishing Vocal Fold Dysfunction from Refractory Asthma is important to avoid unnecessary pharmacotherapy and intubation. The diagnosis of Vocal Fold Dysfunction can only be made with certainty by flexible fiberoptic laryngoscopy while the patient is symptomatic. Pulmonary function studies and a lack of response to bronchodilators may provide clues to the diagnosis. Most patients with the condition can be managed by speech therapy and the use of breathing strategies that eliminate the abnormal vocal fold movement. Chronic laryngeal irritation may be a trigger for Vocal Fold Dysfunction and conditions such as laryngopharyngeal reflux disease should be aggressively managed in this patient population.