We present a case of benign paradoxical vocal cord adduction' presenting to the emergency department as acute stridor. This patient received direct laryngoscopy at initial presentation documenting inspiratory vocal cord adduction. The syndrome is not well known to emergency physicians and, because it often mimics life-threatening airway compromise, prompt recognition of the benign nature of this syndrome may avert more aggressive airway interventions such as beta agonists, steroids, endotracheal intubation and tracheostomy. Successful treatment has included relaxation, sedatives and speech therapy to abort the acute attack and prevent further recurrence. As direct flexible laryngoscopy is more readily available in the emergency department, goals for the future are more rapid diagnosis and appropriate treatment of this benign syndrome.