title: Paradoxical vocal fold motion (PVFM) in pediatric otolaryngology.
abstract: BACKGROUND
  Paradoxical vocal fold motion (PVFM) is a condition in which the vocal cords exhibit inappropriate inspiratory adduction, and it has been poorly studied in the pediatric population.
  
  
  METHODS
  Pediatric patients diagnosed with PVCM by a pediatric otolaryngologist and doctor of speech pathology from 2008 to 2012 were reviewed. Patients in whom another cause for their respiratory disturbance was eventually identified were excluded. Patient demographics, characteristics, treatment, and outcomes were reviewed. The study was approved by the Institutional Review Board at our institution.
  
  
  RESULTS
  Thirty patients met criteria for inclusion; one with chiari malformation was excluded. 17/29 (59%) were female. Body mass index (BMI) numbers ranged from 16 to 25 with a mean of 21. 9/29 (31%) competed at the highest level of a sport; only 3/29 (10%) did not participate in athletics. Average age of onset was 12.0years; average diagnosis delay was 1.3years. Mean follow up was 2.3years. 24/29 (83%) were previously treated for asthma. 23/29(79%) were previously treated for reflux. 25/29(86%) completed at least one session of respiratory and laryngeal control therapy with overall average of 2.2 sessions completed. All patients who attended a second therapy session were recorded as having improvement in symptoms.
  
  
  CONCLUSIONS
  Pediatric patients with PVFM often participate in high levels of organized sports and the frequency of concurrent asthma and reflux symptoms in this population supports the theory that laryngeal hypersensitivity contributes to the pathophysiology of PVFM. These patients were not found to have any associated psychiatric diagnoses. Pediatric patients with PVFM have an excellent prognosis when treated with speech therapy and for comorbid conditions as indicated.
authors.affiliation: Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, United States. Electronic address: smithb21@ccf.org.
authors.forename: Blake
authors.initials: B
authors.lastname: Smith
authors.affiliation: Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, United States.
authors.forename: Claudio
authors.initials: C
authors.lastname: Milstein
authors.affiliation: Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, United States.
authors.forename: Bryan
authors.initials: B
authors.lastname: Rolfes
authors.affiliation: Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, United States.
authors.forename: Samantha
authors.initials: S
authors.lastname: Anne
mesh_terms: D017668:Age of Onset; D001249:Asthma / Q000150:complications; D002648:Child; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D064706:Vocal Cord Dysfunction / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*