Paradoxical vocal fold motion

Background

• Also known as "vocal cord dysfunction"
• Occurs from abnormal adduction of the vocal cords during inspiration
• Lack of familiarity may lead to delayed diagnosis and unnecessary intubation or surgical airway procedures

Evaluation

Diagnosis

• Gold standard is laryngoscopy (ideally with flexible fiberoptics)

Management

• Reassurance and breathing techniques to resolve stridor:
  • Jaw thrust while breathing
  • Pursed lip breathing through straw or endotracheal tube
  • Inhale through nose for 3 seconds and exhale through pursed lips for 3 seconds
  • "Pant like a dog" - rhythmic breathing with mouth open and tongue protruding forward
  • 3 sniffs - take 2 quick then 1 slow inhalational sniffs through the nose, exhale slowly through mouth
• Mild sedatives (eg benzodiazepines) may be effective in cases refractory to breathing techniques