Paradoxical vocal fold motion
Contents
- 1 Background[1]
- 2 Clinical Features
- 3 Differential Diagnosis
- 3.1 Stridor
- 3.1.1 Trauma
- 3.1.2 Infectious Disorders
- 3.1.3 Abscesses
- 3.1.4 Neoplastic Disorders
- 3.1.5 Allergic and Auto-Immune Disorders
- 3.1.6 Metabolic, Storage Disorders
- 3.1.7 Biochemical Disorders
- 3.1.8 Congenital, Developmental Disorders
- 3.1.9 Psychiatric Disorders
- 3.1.10 Anatomical or Mechanical
- 3.1.11 Vegetative, Autonomic, Endocrine Disorders
- 3.1.12 Poisoning
- 3.1.13 Chronic Pediatric Conditions
- 3.1 Stridor
- 4 Evaluation
- 5 Management
- 6 Disposition
- 7 See Also
- 8 External Links
- 9 References
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
Stridor
Trauma
- Larynx fracture
- Tracheobronchial tear/injury
- Thyroid gland injury/trauma
- Tracheal injury
- Electromagnetic or radiation exposure
- Burns, inhalation injury
Infectious Disorders
- Bacterial tracheitis
- Diphtheria
- Tetanus
- Tracheobronchial tuberculosis
- Poliomyelitis, paralytic, bulbar, or acute
- Fungal laryngitis
Abscesses
- Retropharyngeal abscess
- Epiglottitis, acute
- Peritonsillar abscess
- Laryngotracheobronchitis (croup)
- Retropharyngeal abscess
Neoplastic Disorders
- Neoplasms/tumors
Allergic and Auto-Immune Disorders
- Spasmodic/tracheobronchitis
- Angioedema/Angioneurotic edema
Metabolic, Storage Disorders
- Cerebral Gaucher's of infants (acute)
- Tracheobronchial amyloidosis
Biochemical Disorders
Congenital, Developmental Disorders
- Angioedema/Angioneurotic edema, hereditary
Psychiatric Disorders
- Somatization disorder
Anatomical or Mechanical
- Foreign body aspiration
- Acute gastric acid/aspiration syndrome
- Airway obstruction
- Neck compartment hemorrhage/hematoma
- Paradoxical vocal fold motion [2]
Vegetative, Autonomic, Endocrine Disorders
- Esophageal free reflux/GERD syndrome
- Laryngospasm, acute
- Bilateral vocal cord paralysis
- Hypoparathyroidism
Poisoning
Chronic Pediatric Conditions
- Laryngotracheomalacia[3]
- Subglottic stenosis or prior intubation
- Vascular ring (double aortic arch)
- Vocal cord dysfunction/paroxysmal vocal fold movement
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[4]
Disposition
See Also
External Links
References
- ↑ 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.
- ↑ Vocal Cord Dysfunction on Internet Book of Critical Care https://emcrit.org/ibcc/vcd/
- ↑ Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004
- ↑ Goldman J, Muers M. Vocal cord dysfunction and wheezing. Thorax. 1991;46(6):401-404. doi:10.1136/thx.46.6.401