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Diagnosis and treatment of paradoxical vocal fold motion in infants.
Int J Pediatr Otorhinolaryngol. 2018 Apr; 107:6-9.IJ

Abstract

IMPORTANCE

Paradoxical vocal fold motion (PVFM) is a disorder often misdiagnosed in children presenting with shortness of breath and stridor. In infants, little is known about the clinical course and best approach for treatment of PVFM. This retrospective study assesses the approach to treatment and outcomes for infants with PVFM.

OBJECTIVE

To investigate the clinical course of paradoxical vocal fold motion (PVFM) in infants.

DESIGN

Retrospective review.

SETTING

Tertiary academic medical center.

PARTICIPANTS

Patients less than 2 years of age diagnosed with PVFM were identified and included in the study.

MAIN OUTCOMES AND MEASURES

History, physical exam findings, and clinical course of treatment for patients less than 2 years old with PVFM were reviewed. Findings including those on flexible fiberoptic laryngoscopy (FFL) and subjective assessment by parents and clinicians were compiled for review.

RESULTS

Seven infants were diagnosed with PVFM. All patients were full term at birth, and average age at diagnosis was 7 months. All patients initially presented with inspiratory stridor, and two patients had stertor. Two of seven patients also had a history of reactive airway disease and one with laryngomalacia. Five had a history of reflux. Two of seven patients had weight percentiles at diagnosis lower than the 25th percentile, while the remainder were between 37th and 75th percentiles. Initial voice evaluation revealed stridor in all patients, as well as finding of PVFM on FFL. All patients were started on anti-reflux medication. Average time to resolution of PVFM was 5.9 months after treatment.

CONCLUSIONS

PVFM can be challenging to diagnose in the infant population. PVFM resolves uneventfully with reflux treatment, however, it is unknown whether reflux treatment is essential or if PVFM would spontaneously resolve. The rarity of infantile PVFM mandates formal evaluation and monitoring by a pediatric otolaryngologist.

Authors+Show Affiliations

Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States. Electronic address: aoconnell2@pennstatehealth.psu.edu.Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States.Department of Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29501313

Citation

O'Connell Ferster, Ashley P., et al. "Diagnosis and Treatment of Paradoxical Vocal Fold Motion in Infants." International Journal of Pediatric Otorhinolaryngology, vol. 107, 2018, pp. 6-9.
O'Connell Ferster AP, Shokri T, Carr M. Diagnosis and treatment of paradoxical vocal fold motion in infants. Int J Pediatr Otorhinolaryngol. 2018;107:6-9.
O'Connell Ferster, A. P., Shokri, T., & Carr, M. (2018). Diagnosis and treatment of paradoxical vocal fold motion in infants. International Journal of Pediatric Otorhinolaryngology, 107, 6-9. https://doi.org/10.1016/j.ijporl.2018.01.027
O'Connell Ferster AP, Shokri T, Carr M. Diagnosis and Treatment of Paradoxical Vocal Fold Motion in Infants. Int J Pediatr Otorhinolaryngol. 2018;107:6-9. PubMed PMID: 29501313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis and treatment of paradoxical vocal fold motion in infants. AU - O'Connell Ferster,Ashley P, AU - Shokri,Tom, AU - Carr,Michele, Y1 - 2018/02/20/ PY - 2017/11/08/received PY - 2018/01/16/revised PY - 2018/01/18/accepted PY - 2018/3/5/entrez PY - 2018/3/5/pubmed PY - 2018/4/20/medline KW - Paradoxical vocal fold motion KW - Pediatric laryngology KW - Vocal fold dysfunction KW - Voice disorder SP - 6 EP - 9 JF - International journal of pediatric otorhinolaryngology JO - Int. J. Pediatr. Otorhinolaryngol. VL - 107 N2 - IMPORTANCE: Paradoxical vocal fold motion (PVFM) is a disorder often misdiagnosed in children presenting with shortness of breath and stridor. In infants, little is known about the clinical course and best approach for treatment of PVFM. This retrospective study assesses the approach to treatment and outcomes for infants with PVFM. OBJECTIVE: To investigate the clinical course of paradoxical vocal fold motion (PVFM) in infants. DESIGN: Retrospective review. SETTING: Tertiary academic medical center. PARTICIPANTS: Patients less than 2 years of age diagnosed with PVFM were identified and included in the study. MAIN OUTCOMES AND MEASURES: History, physical exam findings, and clinical course of treatment for patients less than 2 years old with PVFM were reviewed. Findings including those on flexible fiberoptic laryngoscopy (FFL) and subjective assessment by parents and clinicians were compiled for review. RESULTS: Seven infants were diagnosed with PVFM. All patients were full term at birth, and average age at diagnosis was 7 months. All patients initially presented with inspiratory stridor, and two patients had stertor. Two of seven patients also had a history of reactive airway disease and one with laryngomalacia. Five had a history of reflux. Two of seven patients had weight percentiles at diagnosis lower than the 25th percentile, while the remainder were between 37th and 75th percentiles. Initial voice evaluation revealed stridor in all patients, as well as finding of PVFM on FFL. All patients were started on anti-reflux medication. Average time to resolution of PVFM was 5.9 months after treatment. CONCLUSIONS: PVFM can be challenging to diagnose in the infant population. PVFM resolves uneventfully with reflux treatment, however, it is unknown whether reflux treatment is essential or if PVFM would spontaneously resolve. The rarity of infantile PVFM mandates formal evaluation and monitoring by a pediatric otolaryngologist. SN - 1872-8464 UR - https://www.unboundmedicine.com/medline/citation/29501313/Diagnosis_and_treatment_of_paradoxical_vocal_fold_motion_in_infants_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-5876(18)30043-0 DB - PRIME DP - Unbound Medicine ER -