Inducible Laryngeal Obstruction/Paradoxical Vocal Fold Motion

Abstract

Inducible laryngeal obstruction (also known as vocal cord dysfunction and paradoxical vocal fold motion) is a heterogeneous disease process that manifests as the sensation of airway restriction at the level of the upper airway but can also occur in conjunction with voice disorders and laryngeal irritative symptoms such as throat clearing and cough. The demographic affected by this disease includes all ages from adolescence to adulthood and affects all genders. In general, there are non-exercise-induced and exercise-induced variants. The classic diagnostic finding is inappropriate vocal fold adduction during inspiration observed during laryngoscopy when symptomatic. However, patients can be observed with symptoms in the absence of overt glottic narrowing or limitation of airflow. The diagnosis is generally made by history and supported by response to behavioral therapy typically in the form of respiratory retraining. There are many confounding or contributing diagnoses which support the use of a multidisciplinary approach to diagnosis and treatment. Due to the lack of widely used objective diagnostic and outcome metrics, behavioral, medical, and surgical treatments are largely unproven. As a result, the disease presents significant opportunity for future developments in its understanding and management.