Symptoms of paradoxical vocal fold motion (PVFM), also known as vocal cord dysfunction, often are mistaken for severe asthma, and the average time to diagnosis ranges from months to years.
Previously, PVFM was thought to be a conversion disorder but now is considered a primary functional disorder. The precise incidence and etiology are unknown, but pediatric PVFM usually is considered a stress-related condition.
Although affecting either gender, it usually presents in preteen and teenage females with a predilection for scholastic and athletic overachievers. Episodes can happen any time, even when asleep, but sentinel events often occur during an extreme sporting event, accounting for PVFM’s frequent misdiagnosis as exercise-induced asthma.
A flattened inspiratory loop on pulmonary function testing is highly suggestive of PVFM. The gold standard of diagnosis, though, is flexible fiberoptic laryngoscopy during an acute episode where paradoxical vocal cord adduction during inspiration is seen.