RATIONALE: Paradoxical vocal fold motion (PVFM), a disorder secondary to inappropriate motion of true vocal folds, is frequently misdiagnosed as asthma. Proper diagnosis is commonly delayed. METHODS: Ninety-six patients 12 years or older were referred for evaluation to the Voice Center for PVFM between 2008 and 2013. Medical records were reviewed for clinical characteristics, time to diagnosis, treatment and outcome. Institutional review board at the center approved the study. RESULTS: Of 96 patients referred, 64 met criteria for PVFM and 40 were previously treated for asthma. Forty-six patients (73%) were women. Symptoms included dyspnea (n-56), throat tightness (n-35), chest tightness (n-26), cough (n-23), wheezing (n-17), GERD (n-15) and anxiety (n-15). Symptoms occurred spontaneously (SPVFM) in 55, exercise-induced (EIPVFM) in 8, and combined in one. Median time from symptom onset to diagnosis was 1 year (mean 2.6 years). Before diagnosis, 21 patients had ED visits, 11 were hospitalized, and 5 intubated. During evaluation, 21 patients (33%) had laryngoscopic evidence of PVFM/EIPVFM with reproducible symptoms. Respiratory therapy was recommended as primary treatment (n-52); anti-reflux medications were also used in selected patients. In 44 patients with data available, 36 improved, 2 had resolved, but 6 reported no improvement. CONCLUSIONS: PVFM continues to be underdiagnosed or misdiagnosed as asthma, leading to inappropriate therapy and prolonged morbidity. Presence of inspiratory dyspnea and poor response to asthma treatment are indications of possible PVFM. Respiratory therapy remains the mainstay of treatment and often leads to satisfactory outcome.
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