title: A classification scheme for paradoxical vocal cord motion.
abstract: Paradoxical vocal cord motion (PVCM) is characterized by the inappropriate adduction of the true vocal cords during inspiration. Multiple causes have been proposed for this group of disorders, which share the common finding of mobile vocal cords that adduct inappropriately during inspiration and cause stridor by approximation. Management of this group of disorders has been complicated by the lack of a classification scheme to include all types of PVCM. We propose that PVCM be classified according to its underlying etiology and recognize the following causes of the disorder: 1. brainstem compression; 2. cortical or upper motor neuron injury; 3. nuclear or lower motor neuron injury; 4. movement disorder; 5. gastroesophageal reflux; 6. factitious or malingering disorder; 7. somatization/conversion disorder. Case reports are presented to illustrate the characteristic features and diagnostic evaluation used in assessing patients with PVCM. Management varies depending on the cause of PVCM and entails speech therapy, pharmacologic therapy, behavioral modification, and/or surgical intervention. Recognition of the multiple causes of PVCM allows otolaryngologists to formulate well-directed diagnostic evaluation and treatment.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The University of Iowa College of Medicine, Iowa City, U.S.A.
authors.forename: D A
authors.initials: DA
authors.lastname: Maschka
authors.forename: N M
authors.initials: NM
authors.lastname: Bauman
authors.forename: P B
authors.initials: PB
authors.lastname: McCray
authors.forename: H T
authors.initials: HT
authors.lastname: Hoffman
authors.forename: M P
authors.initials: MP
authors.lastname: Karnell
authors.forename: R J
authors.initials: RJ
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000150:complications; D001930:Brain Injuries / Q000150:complications; D001933:Brain Stem / Q000473:pathology; D002648:Child; D003291:Conversion Disorder / Q000150:complications; D003937:Diagnosis, Differential; D005162:Factitious Disorders / Q000150:complications; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D007231:Infant, Newborn; D007818:Laryngeal Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D016472:Motor Neuron Disease / Q000150:complications / Q000175:diagnosis; D009069:Movement Disorders / Q000150:complications / Q000175:diagnosis; D013117:Spinal Cord Compression / Q000150:complications / Q000175:diagnosis; D014827:Vocal Cords / Q000503:physiopathology*