Paradoxical vocal fold motion

Background[1]

  • 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

Clinical Features

Differential Diagnosis

Evaluation

Workup

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[2]

Disposition

See Also

External Links

References

  1. Denipah N, Dominguez CM, Kraai EP, Kraai TL, Leos P, Braude D. Acute Management of Paradoxical Vocal Fold Motion (Vocal Cord Dysfunction). Annals of Emergency Medicine. 2017;69(1):p18-23.
  2. Goldman J, Muers M. Vocal cord dysfunction and wheezing. Thorax. 1991;46(6):401-404. doi:10.1136/thx.46.6.401