Exercise-induced paradoxical vocal fold motion disorder: diagnosis and management.

OBJECTIVES/HYPOTHESIS To review our experience with the diagnosis and treatment of exercise-induced paradoxical vocal fold motion disorder (EPVFMD). STUDY DESIGN Single-institution retrospective review and cohort analysis. METHODS A single-institution retrospective review was performed identifying patients with paradoxical vocal fold motion disorder (PVFMD). Patients with isolated exercise-induced dyspnea were selected for further review. Flexible fiberoptic laryngoscopy (FFL) performed on these patients were reviewed with regard to presence of laryngeal pathology as well as the presence of PVFMD at rest and/or with exertion. The type of therapy was reviewed. Symptom outcomes were graded as complete resolution, improvement, or unchanged following therapy. RESULTS There were 758 patients who were identified with PVFMD. A total of 104 patients demonstrated symptoms of PVFMD that were only exercise related (EPVFMD). There were 93/104 (89%) patients who underwent a pre- and post-trigger FFL. Of these, 48/93 (52%) patients had no evidence of PVFMD on initial FFL. After subjecting these patients to exertion, 83/93 (89%) had evidence of PVFMD on postexertion FFL, and 39/93 (42%) patients had evidence of PVFMD on both pre-exertion and postexertion FFL. There were 87/104 (84%) patients who had evidence of laryngeal edema, and 23/104 (23%) had one or more laryngeal lesion on examination. A total of 67 patients were enrolled in laryngeal control therapy and attended at least one session, with 48/67 (72%) demonstrating improvement or complete resolution of their symptoms. CONCLUSIONS The diagnosis of EPVFMD is augmented with the addition of provocation testing. Findings of PVFMD can be identified at rest when asymptomatic. Laryngeal control therapy is an effective treatment for EPVFMD.