Characterization and Management of Paradoxical Vocal Fold Motion in Neonates: A Case Report

BACKGROUND Paradoxical vocal fold motion (PVFM) is characterized by inappropriate adduction of the vocal folds during inspiration, causing inspiratory stridor and feeding challenges. Its nonspecific symptoms and frequent co-occurrence with other conditions make diagnosis challenging. While PVFM is described in older children, neonatal cases remain rare and poorly understood. Limited data exists regarding its incidence, clinical features, and optimal management strategies, and no universally accepted guidelines exist for diagnosing neonatal PVFM. CASE REPORT This case describes a term Hispanic male neonate diagnosed with PVFM at 18 days of life. The patient presented with persistent feeding difficulties, inspiratory stridor, and inadequate weight gain, requiring NICU admission. Flexible fiberoptic laryngoscopy (FFL) confirmed intermittent PVFM without structural anomalies. Management included an interdisciplinary care team, who facilitated anti-reflux therapy, gavage feeding, and eventual gastrostomy tube placement for feeding safety and failure to thrive. Despite continued stridor, gradual improvement occurred, with near-complete oral intake by 2 months. Repeat FFL at 68 days after diagnosis demonstrated normal vocal fold mobility. CONCLUSIONS This case underscores diagnostic challenges and management complexities of neonatal PVFM. FFL remains critical for confirmation, and supportive care with anti-reflux therapy can facilitate resolution. While the precise etiology remains unclear, associations include gastroesophageal reflux disease (GERD), neurological immaturity, and irritant exposure. These factors, combined with lack of definitive etiology, complicate clinical assessment and long-term planning. Standardized guidelines and further research into demographic and clinical predictors of PVFM are needed, especially for neonatal patients.