Glottic configuration in patients with exercise-induced stridor: a new paradigm

Area of Science:

• Laryngology
• Pulmonology
• Exercise Physiology

Background:

• Paradoxical vocal fold motion (PVFM) and exercise-induced PVFM (EIPVFM) lack definitive diagnostic criteria.
• EIPVFM is often associated with severe airway obstruction or airflow limitation during exertion.
• This study focuses on EIPVFM cases presenting with exertional dyspnea and stridor but without classic physiologic indicators.

Purpose of the Study:

• To identify and characterize patients with EIPVFM who exhibit clinical signs of exertional dyspnea and stridor.
• To investigate EIPVFM cases that do not present with the typical severe physiologic findings like glottic adduction or abnormal flow volume loops.

Main Methods:

• Retrospective review of 150 patient records undergoing continuous laryngoscopy during exercise.
• Exclusion of patients with incomplete records or extreme disease severity.
• Independent blinded evaluation of audio, video, and flow volume loops by three physicians specializing in laryngology, pulmonology, and allergy/immunology.

Main Results:

• 23 patients' records were fully evaluated.
• Five patients presented with exertional dyspnea, audible stridor, and an open glottic configuration.
• These five patients had normal flow volume loops, contradicting typical EIPVFM physiologic findings.

Conclusions:

• EIPVFM can manifest clinically without the presence of widely recognized confirmatory physiologic measures.
• There is a need for improved quantitative metrics to accurately diagnose and characterize EIPVFM.
• This highlights a subgroup of EIPVFM patients requiring further investigation and tailored diagnostic approaches.