Paradoxical vocal fold motion

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  • 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



Infectious Disorders


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

Psychiatric Disorders

  • Somatization disorder

Anatomical or Mechanical

Vegetative, Autonomic, Endocrine Disorders


Chronic Pediatric Conditions




  • Gold standard is laryngoscopy (ideally with flexible fiberoptics)


  • 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]


See Also

External Links


  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. Vocal Cord Dysfunction on Internet Book of Critical Care
  3. Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004
  4. Goldman J, Muers M. Vocal cord dysfunction and wheezing. Thorax. 1991;46(6):401-404. doi:10.1136/thx.46.6.401