title: Paradoxical vocal fold motion disorder in the elite athlete: experience at a large division I university.
abstract: OBJECTIVE
  To review our experience at a large division I university with the diagnosis and management of paradoxical vocal fold motion disorder (PVFMD) in elite athletes.
  
  
  METHODS
  A single institution retrospective review and cohort analysis.
  
  
  METHODS
  All elite athletes (division I collegiate athletes, triathletes, and marathon runners) with a diagnosis of PVFMD were identified. All patients underwent flexible fiberoptic laryngoscopy (FFL) to confirm the diagnosis of PVFMD. The type of PVFMD therapy was identified and efficacy of treatment was graded based on symptom resolution.
  
  
  RESULTS
  Forty-six consecutive athletes with PVFMD were identified. A total of 30/46 (65%) were division 1 collegiate athletes and 16/46 (35%) were triathletes or marathon runners. In comparison to a nonathlete PVFMD cohort, athletes were less likely to present with a history of reflux (P < 0.01), psychiatric diagnosis (P < 0.01), dysphonia (P < 0.01), cough (P = 0.02), or dysphagia (P < 0.01). The use of postexertion FFL provided additional diagnostic information in 11 (24%) patients. Laryngeal control therapy (LCT) was recommended for 45/46. A total of 36/45 attended at least one LCT session and 25 (69%) reported improvement of symptoms. Additionally, biofeedback, practice-observed therapy, and thyroarytenoid muscle botulinum toxin injection were required in three, two, and two patients, respectively.
  
  
  CONCLUSIONS
  The addition of postexertion FFL improves the sensitivity to detect PVFMD in athletes. PVFMD in athletes responds well to LCT. However, biofeedback, practice-observed therapy, and botulinum toxin injection may be required for those patients with an inadequate response to therapy.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Marcinow
authors.forename: Jennifer
authors.initials: J
authors.lastname: Thompson
authors.forename: Tendy
authors.initials: T
authors.lastname: Chiang
authors.forename: L Arick
authors.initials: LA
authors.lastname: Forrest
authors.forename: Brad W
authors.initials: BW
authors.lastname: deSilva
mesh_terms: D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis* / Q000453:epidemiology; D001250:Asthma, Exercise-Induced / Q000175:diagnosis* / Q000453:epidemiology; D056352:Athletes / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D015897:Comorbidity; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013177:Sports; D014495:Universities; D064706:Vocal Cord Dysfunction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult
keywords: Paradoxical vocal fold dysfunction; athlete; dyspnea; laryngeal control therapy