The importance of recognizing paradoxical vocal fold dysfunction: A case report of a 13-year-old girl presenting with stridor

The present report details the case of a 13-year-old girl who presented to the emergency department with stridor. Treatment for presumed reactive airway disease was attempted with antibiotics, nebulized adrenaline masks and high-dose corticosteroids. Over the next month, she presented repeatedly in a similar fashion and was admitted to hospital on three separate occasions. Ultimately, she was referred to the Centre for Paediatric Voice and Laryngeal Function at The Hospital for Sick Children (Toronto, Ontario) for a speech-language pathology evaluation and direct laryngoscopy. The patient was diagnosed with paradoxical vocal fold dysfunction. After a brief treatment session with a speech-language pathologist, her stridor completely resolved and paradoxical inspiratory vocal fold adduction was no longer visualized on direct laryngoscopy. The present case highlights the fact that paradoxical vocal fold dysfunction can mimic other entities that present with stridor, and misdiagnosis can result in significant morbidity. Investigation into a patient's social history and stressors can facilitate the diagnosis, and can avoid unnecessary and potentially harmful medical and surgical interventions.