Spectrum of presentation of paradoxical vocal cord motion in ambulatory patients

Paradoxical vocal cord motion (PVCM) frequently masquerades as asthma. Atypical presentations of asthma or situations in which asthma does not respond to traditional therapies mandate the consideration of PVCM in the differential diagnosis.

Evaluate the demographics and spectrum of presentation of PVCM in an ambulatory outpatient population.

Retrospective survey of medical records of 164 consecutive patients (86 males, 78 females) who underwent fiberoptic rhinolaryngoscopy over a 3-year period.

Twenty patients (16 females, 4 males) with PVCM diagnosed by direct visualization were identified. Mean age at diagnosis was 33 years (range, 14-58 years). Asthma was the most common presenting diagnosis (15/20, 75%), while the remaining 25% had other unusual presentations including two patients (10%) with PVCM masquerading as anaphylaxis. When PVCM masqueraded as asthma, 44% of those patients were inappropriately treated with oral steroids. Nine patients (45%) had a readily identifiable psychologic trigger of their PVCM.

Our data confirm previous observations indicating that PVCM is most common in young females and is often associated with psychologic problems. PVCM frequently masquerades as asthma, resulting in overtreatment with corticosteroids. PVCM may also masquerade as stridor, resulting in mimicry of anaphylaxis in the appropriate clinical setting. Thus, PVCM should be considered in any patient presenting with atypical upper and lower respiratory tract symptoms.