Vocal cord dysfunction (paradoxical vocal fold motion)
Vocal cord dysfunction, also called paradoxical vocal fold motion, is functional upper airway obstruction from paradoxical inspiratory adduction of the vocal cords that classically mimics or coexists with asthma. Recognizing the trigger pattern, confirming with laryngoscopy or bronchial challenge testing, and treating with speech therapy plus the comorbidities that worsen it prevents unnecessary escalation of asthma therapy.
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What this article covers
- Overview
Definition: paradoxical adduction of the vocal cords during inspiration, producing functional (non-fixed) upper airway obstruction with inspiratory breathlessness and throat tightness or voice…
- Epidemiology
Recognized asthma comorbidity: identified among the comorbidities that should be actively sought and managed during evaluation of patients with asthma, alongside gastroesophageal reflux disease…
- Risk factors
High-intensity or competitive exercise: the most frequently cited precipitant of episodes.
- Pathophysiology
Paradoxical vocal cord motion: during inspiration the vocal cords adduct instead of undergoing their normal abduction, narrowing the glottic aperture.
- Clinical features
Hallmark: inspiratory breathlessness with throat tightness or voice dysfunction occurring during discrete attacks.
- Differential diagnosis
Anaphylaxis: presents with pruritus, urticaria, angioedema, laryngeal edema, wheezing, nausea, vomiting, tachycardia, and a sense of impending doom, occasionally progressing to shock; the systemic…
- Diagnosis
Confirming basis: the diagnosis is confirmed by laryngoscopy demonstrating paradoxical adduction of the vocal cords during inspiration, captured during a symptomatic episode; this direct…
- Management
First, if the presenting episode is acute, severe, or diagnostically uncertain, evaluate for and exclude life-threatening mimics before attributing symptoms to vocal cord dysfunction: assess for…
- Complications
Diagnostic delay with unnecessary asthma escalation: misattribution of symptoms to asthma leads to step-up of controller therapy, including repeated short courses of systemic glucocorticoids, for…
- Prognosis
Generally favorable with directed therapy: episodes are expected to improve with a trial of speech therapy targeted at the paradoxical laryngeal motion.
- Prevention
Treat gastroesophageal reflux disease with a defined reassessment point: start an empiric proton pump inhibitor trial (omeprazole 20 mg orally twice daily) for 2 months; escalate to endoscopy and…
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