Paradoxical vocal fold motion (intermittent laryngeal obstruction)

Overview 
Theory 
Diagnosis 
Management 
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Case history #1

A 19-year-old female athlete has been referred by a respiratory physician for breathing attacks during running that have not responded to asthma inhalers. The physician diagnosed persistent stable asthma, with additional dyspnoea while running, suspected to be due to PVFM/ILO, seasonal allergies, and chronic sinusitis. The patient reports that her primary triggers for breathing attacks include high-intensity sprinting drills, time trials, and competitive athletics, and they do not respond to her anti-asthma inhalers. The breathing attacks did not occur in secondary school but began at university. She has lost 3 seconds off her best running time and is at risk of not making the winter travel training team. Asthma symptoms are described as coughing, wheezing, and feeling winded. She describes her breathing difficulties while running as difficulty getting air in, with general overall body tightness.

Case history #2

A 54-year-old woman with a long history of breathing attacks to multiple triggers reports a 2-year history of breathing difficulties that began after mould exposure in the workplace following water damage to the property. At the time of building repair, she started having breathing difficulties and hoarseness and has since been hospitalised twice for breathing attacks. Additional triggers are identified as smoke, perfumes, cleaners, cold, and dust. She has been diagnosed with asthma but has not been investigated with exercise bronchoprovocation or had a cardiac work-up. The patient is unable to go out in public where triggers exist.

Other presentations

Several other cases of paradoxical vocal fold motion (intermittent laryngeal obstruction) (PVFM/ILO) have been documented that were unrelated to irritable larynx, irritant exposure, athletics, or neurological illness. These include PVFM/ILO and feeding difficulty following paediatric cardiac surgery, 1 case of cough and PVFM/ILO after an inlet patch of gastric mucosa in the upper oesophagus, 2 cases of PVFM/ILO post-mitral valve replacement, several other postoperative cases of PVFM/ILO, and documentation of post-intubation phonatory insufficiency.[7][8][9][10][11][12][13][14][15][16][17] There has also been report of mass psychogenic illness in a female cohort with acute stridor.[18]

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