Use of botulinum toxin type A to avoid tracheal intubation or tracheostomyin severe paradoxical vocal cord movement

Paradoxical vocal cord movement (PVCM) is characterized by paradoxical addu ction of the vocal cords during inspiration and/or expiration. Patients wit h severe forms of PVCM can present with acute dyspnea, In this article, we describe a patient with severe PVCM who had required tracheal intubation or tracheostomy at multiple occasions and who presented with acute hypercapni c respiratory failure, Using sedation and intralaryngeal injection of botul inum toxin type A, we could avoid more invasive intervention, Our observati on shows that botulinum toxin type A should be considered in the acute care setting for severe PVCM.