Use of botulinum toxin type A to avoid tracheal intubation or tracheostomy in severe paradoxical vocal cord movement

Chest. 2000 Sep;118(3):874-7. doi: 10.1378/chest.118.3.874.


Paradoxical vocal cord movement (PVCM) is characterized by paradoxical adduction of the vocal cords during inspiration and/or expiration. Patients with severe forms of PVCM can present with acute dyspnea. In this article, we describe a patient with severe PVCM who had required tracheal intubation or tracheostomy at multiple occasions and who presented with acute hypercapnic respiratory failure. Using sedation and intralaryngeal injection of botulinum toxin type A, we could avoid more invasive intervention. Our observation shows that botulinum toxin type A should be considered in the acute care setting for severe PVCM.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Botulinum Toxins, Type A / administration & dosage
  • Botulinum Toxins, Type A / therapeutic use*
  • Contraindications
  • Female
  • Humans
  • Intubation, Intratracheal*
  • Laryngeal Diseases / complications
  • Laryngeal Diseases / drug therapy*
  • Laryngeal Diseases / physiopathology
  • Neuromuscular Agents / administration & dosage
  • Neuromuscular Agents / therapeutic use*
  • Respiratory Distress Syndrome / drug therapy*
  • Respiratory Distress Syndrome / etiology
  • Respiratory Distress Syndrome / physiopathology
  • Tracheostomy*
  • Vocal Cords / drug effects
  • Vocal Cords / physiopathology*


  • Neuromuscular Agents
  • Botulinum Toxins, Type A