Paradoxical vocal cord motion: an alarming stridor for a benign condition--case reports.

Paradoxical vocal cord motion presents a challenge to medical practitioners in various specialties. Physicians in general and anesthesiologists should suspect this condition in a patient presenting with stridor or a history of choking or asthma not responding to medical treatment. Women are usually more affected than men and more often there is history of anxiety and/or a precipitating factor such as cough or hyperventilation. Accurate diagnosis relies on visualizing adduction of the vocal cords during inspiration or throughout the respiratory cycle using fiberoptic nasopharyngeal laryngoscopy or telescopic examination. The etiology varies from organic causes such as brainstem compression or lower motor neuron injury to non-organic causes such as malingering or conversion disorders. The pathophysiology is believed to be accentuation of the glottic closure reflex. Many modalities of treatment are available ranging from sedation, voice therapy and breathing exercises to Heliox administration, Botulinum toxin type A injection, intubation and at times tracheostomy.