Paradoxical vocal fold motion: Presentation and treatment options

Paradoxical vocal fold motion is a rare disorder in which adduction of the folds occurs on inspiration. The disorder presents with signs of airway obs truction and often airway distress, so proper diagnosis by the otorhinolary ngologist is critical to subsequent management. We present a retrospective review of 10 patients with the diagnosis of paradoxical vocal fold motion s een over a 6-year period. Eight patients were females, and 6 required an ac ute airway intervention at presentation; 3 patients eventually underwent tr acheotomy for respiratory decompensation. Six patients had a prior diagnosi s of asthma, and this was determined to contribute to their respiratory sta tus. Five patients were treated with botulinum toxin and 2 with flexible na solaryngoscopic biofeedback, which improved the outcome. A review of the li terature confirms a female predominance of patients presenting with paradox ical adduction and airway distress, often with a history of asthma and psyc hopathology. Our experience with botulinum toxin and biofeedback suggests t hat these procedures are viable treatment options in the management of pati ents with this disorder.