Vocal Cord Dysfunction, Paradoxic Vocal Fold Motion, or Laryngomalacia? Our Understanding Requires an Interdisciplinary Approach

Diagnosing Aerodynamic Supraglottic Collapse With Rest and Exercise Flexible Laryngoscopy

“…[8][9][10] Contrary to infants, the stridulous, dyspneic adult presents with numerous potential etiologies to include asthma, paradoxical vocal fold motion (PVFM)/vocal fold dysfunction, or narrowing of the glottic aperture from a mass. 11,12 Rarely, overly abundant or overly flexible supraglottic tissue has been identified as the source of stridor and dyspnea in an adult without prior history of dyspnea. Because of the specificity that the term ''laryngomalacia'' connotes (pediatric supraglottic collapse), a comprehensive review of the available literature is difficult to perform.…”

The Effect of Exercise on Respiratory Resistance in Athletes With and Without Paradoxical Vocal Fold Motion Disorder

“…Despite these procedural issues, the differential effects of exercise on respiratory resistance were revealed successfully with APD measures. It was hypothesized that athletes with PVFMD would demonstrate higher R i following exercise, but a change in R e was less certain because most athletes report more difficulty inhaling than exhaling when symptomatic (Christopher & Morris, 2010;Divi, Hawkshaw, & Sataloff, 2008;Hicks et al, 2008). As expected, the athletes with PVFMD exhibited a marked increase in R i and a smaller but significant increase in R e immediately after exercise, suggesting biphasic PVFMD (Newman, Mason, & Schmaling, 1995).…”

“…As mentioned in the introduction, exercise-induced laryngomalacia is considered one cause of dyspnea (Christopher & Morris, 2010;Dion, Eller, & Thomas, 2012;Heinle et al, 2003;Richter, Rutter, deAlarcon, Orvidas, & Thompson, 2008;Røksund et al, 2009;Tervonen et al, 2009). To examine the present data for laryngomalacia, the primary investigator retrospectively reviewed laryngoscopic examinations of the athletes with PVFMD after the exercise challenge to determine whether symptoms were related to prolapsed laryngeal and supralaryngeal structures.…”

“…Various mechanisms have been implicated for this disorder, the most common and most literal of which is inappropriate adduction of the vocal folds (Andrianopoulos, Gallivan, & Gallivan, 2000;Mathers-Schmidt, 2001;Sandage & Zelazny, 2004). Another documented mechanism is prolapse of laryngeal structures into the airway, also known as exercise-induced laryngomalacia (Christopher & Morris, 2010;Heinle, Linton, & Chidekel, 2003;Hicks, Brugman, & Katial, 2008). In this article, the term PVFMD will be used regardless of mechanism to be consistent with current literature, although the results will be interpreted with consideration to specific mechanism.…”

Not all who wheeze have asthma

“…These are suitable for both research and clinical purposes as they are more accurate than older methods and allow evaluation of the effect of treatment; however, they are currently more time-consuming than most other post-test evaluations. Pulmonary function testing with a fl ow-volume loop can be done either alone or with the fl exible laryngoscopy; both are potentially valuable diagnostic tools to confi rm EILO [23,33,34]. Conversely, CLE is probably too complex for use in all asthma clinics.…”