A CLASSIFICATION SCHEME FOR PARADOXICAL VOCAL CORD MOTION

Paradoxical vocal cord motion (PVCM) is characterized by the inappropr iate adduction of the true vocal cords during inspiration, Multiple ca uses have been proposed for this group of disorders, which share the c ommon finding of mobile vocal cords that adduct inappropriately during inspiration and cause strider by approximation, Management of this gr oup of disorders has been complicated by the lack of a classification scheme to include all types of PVCM, We propose that PVCM be classifie d according to its underlying etiology and recognize the following cau ses of the disorder: 1. brainstem compression; 2. cortical or upper mo tor neuron injury; 3. nuclear or lower motor neuron injury; 4. movemen t disorder; 5. gastroesophageal reflux; 6. factitious or malingering d isorder; 7. somatization/conversion disorder. Case reports are present ed to illustrate the characteristic features and diagnostic evaluation used in assessing patients with PVCM, Management varies depending on the cause of PVCM and entails speech therapy, pharmacologic therapy, b ehavioral modification, and/or surgical intervention, Recognition of t he multiple causes of PVCM allows otolaryngologists to formulate well- directed diagnostic evaluation and treatment.