When Inspiratory Stridor Is Not Paradoxical Vocal Fold Motion/Inducible Laryngeal Obstruction: A Case Study of Diaphragm Flutter

Purpose This case study describes the clinical course for an individual referred to a speech-language pathologist (SLP) for assessment and treatment of paradoxical vocal fold motion/inducible laryngeal obstruction (PVFM/ILO) who was ultimately diagnosed with diaphragm flutter. This case presentation describes the critical importance of a multidisciplinary approach to identify conditions in the differential diagnosis of PVFM/ILO, which may lead to timely diagnosis and treatment of such conditions. Method Using a case study format with links to pre- and posttreatment videos, the clinical course of a 20-year-old woman presenting with persistent inspiratory stridor and cough during waking time was delineated. Data used to determine the differential diagnosis included careful clinical observation, extensive medical history, and endoscopic laryngeal assessment. Results Using a multidisciplinary approach with professionals from three different treatment centers, the diagnosis of diaphragm flutter was affirmed and successful medical management with an empiric trial of Baclofen was initiated with complete resolution of the dyspnea, cough, and inspiratory stridor over 3 weeks. Conclusions This case study describes a rare condition in the differential diagnosis of PVFM/ILO called diaphragm flutter, characterized by persistent inspiratory stridor and cough that interrupted connected speech and swallowing. SLPs who specialize in the assessment and treatment of PVFM/ILO may encounter this condition. Clinician awareness of the clinical profile for diaphragm flutter is critical for rapid referral to the appropriate medical specialists to achieve timely symptom relief. Supplemental Material https://doi.org/10.23641/asha.14781867

Visual biofeedback for paradoxical vocal fold motion (PVFM)

Objectives Paradoxical vocal fold motion (PVFM) is a common condition where the vocal folds inappropriately adduct during inspiration. This results in dyspnea and occasionally significant distress. The condition is thought to be primarily functional, with behavioural therapy considered mainstay in the non-acute setting. However, practice variations and limited access to speech language pathology (SLP) services can pose management challenges. We aimed to examine the efficacy of surgeon performed visual biofeedback as first-line treatment for PVFM. Study design Prospective, non-randomized, non-comparative clinical study. Methods Adult patients referred for possible PVFM and congruent laryngoscopy findings over a two-year period were included. Patients were excluded if they presented in acute distress, had alternate diagnosis to explain symptomology and/or coexisting untreated lower respiratory pathology. Patients underwent immediate surgeon-performed visual biofeedback on the same visit day. The primary outcome of interest was change in Dyspnea Index (DI) scores pre- and post-intervention 3 months follow-up. The secondary outcome measured was change in asthma medication use from baseline to follow-up. Results Of 34 patients presenting, 25 met inclusion criteria. Of these, 72% were female with an average age of 36.9 ± 14.1. Approximately 48% of patients had a diagnosis of well-controlled asthma at presentation and co-morbid psychiatric diagnoses were common (52%). Pre- and post-intervention analysis showed significant improvement in DI scores (p < 0.001) and reduction in bronchodilator use (p = 0.003). Conclusion This is a prospective study that evaluates the role of visual biofeedback in PVFM patients. Our data suggests that visual biofeedback effectively reduces short-term subjective symptoms and asthma medication use. Level of evidence 3 Graphical abstract

Paradoxical Vocal Fold Motion Disorder in the Postanesthesia Care Unit

Supplemental Digital Content is available in the text.

Implications of Compression Race Suit on Forced Vital Capacity: Assessment Considerations for Paradoxical Vocal Fold Motion in Competitive Female Swimmers

Purpose The purpose of this investigation was to quantify the extent to which forced vital capacity (FVC) in competitive swimmers may differ from nonswimmers and determine if compression race suits reduced FVC when compared to practice swimsuits. Identification of the differences in FVC between swimmers and nonswimmers as well as pulmonary function differences secondary to swimsuit construction may inform assessment of the competitive swimmer with paradoxical vocal fold motion (PVFM). Method Using a prospective, mixed within- and between-groups, repeated measures design with 10 female competitive swimmers and 13 female nonswimmers, FVC was measured and compared between the two groups. Further FVC assessment was completed with the swimmers to identify FVC differences between a practice suit and a compression racing suit. Results FVC in swimmers was significantly larger than FVC in nonswimmers by over 1 L. The predicted FVC volumes were significantly smaller than the actual FVC volumes for swimmers. No significant differences were identified between the practice swimsuit and the compression race suit or between the predicted and actual FVCs for the nonswimmer group. Conclusions Swimmers have unique pulmonary function and physiology that require consideration during the assessment for PVFM to ascertain the extent to which the pulmonary system may be compromised from PVFM, reduced exercise intensity, or both. Knowledge of differential diagnoses and adequate characterization of pulmonary volumes in swimmers will improve assessment processes.