Paradoxical vocal fold motion disorder in the elite athlete: experience at a large division I university

Laryngoscope. 2014 Jun;124(6):1425-30. doi: 10.1002/lary.24486. Epub 2013 Dec 13.


Objectives/hypothesis: To review our experience at a large division I university with the diagnosis and management of paradoxical vocal fold motion disorder (PVFMD) in elite athletes.

Study design: A single institution retrospective review and cohort analysis.

Methods: All elite athletes (division I collegiate athletes, triathletes, and marathon runners) with a diagnosis of PVFMD were identified. All patients underwent flexible fiberoptic laryngoscopy (FFL) to confirm the diagnosis of PVFMD. The type of PVFMD therapy was identified and efficacy of treatment was graded based on symptom resolution.

Results: Forty-six consecutive athletes with PVFMD were identified. A total of 30/46 (65%) were division 1 collegiate athletes and 16/46 (35%) were triathletes or marathon runners. In comparison to a nonathlete PVFMD cohort, athletes were less likely to present with a history of reflux (P < 0.01), psychiatric diagnosis (P < 0.01), dysphonia (P < 0.01), cough (P = 0.02), or dysphagia (P < 0.01). The use of postexertion FFL provided additional diagnostic information in 11 (24%) patients. Laryngeal control therapy (LCT) was recommended for 45/46. A total of 36/45 attended at least one LCT session and 25 (69%) reported improvement of symptoms. Additionally, biofeedback, practice-observed therapy, and thyroarytenoid muscle botulinum toxin injection were required in three, two, and two patients, respectively.

Conclusion: The addition of postexertion FFL improves the sensitivity to detect PVFMD in athletes. PVFMD in athletes responds well to LCT. However, biofeedback, practice-observed therapy, and botulinum toxin injection may be required for those patients with an inadequate response to therapy.

Level of evidence: 4.

Keywords: Paradoxical vocal fold dysfunction; athlete; dyspnea; laryngeal control therapy.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Airway Obstruction / diagnosis*
  • Airway Obstruction / epidemiology
  • Asthma, Exercise-Induced / diagnosis*
  • Asthma, Exercise-Induced / epidemiology
  • Athletes / statistics & numerical data*
  • Case-Control Studies
  • Comorbidity
  • Diagnosis, Differential
  • Female
  • Humans
  • Incidence
  • Laryngoscopy / methods
  • Male
  • Middle Aged
  • Prognosis
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sports
  • Universities
  • Vocal Cord Dysfunction / diagnosis*
  • Vocal Cord Dysfunction / epidemiology
  • Vocal Cord Dysfunction / therapy*
  • Young Adult