Post Graduate Resident University of New Mexico Hospital, Department of Surgery, Division of Otolaryngology Albuquerque, New Mexico
Introduction: There is a paucity of literature on infantile paradoxical vocal fold motion (PVFM); published literature is focused on older children and adults. Initially considered psychosomatic, PVFM etiology is now thought to be largely neurologic or inflammatory. Commonly mistaken for asthma, treatment is multimodal (speech therapy, anti-reflux agents, and behavioral modifications). Dynamic examination such as flexible laryngoscopy is required for diagnosis.
Methods: After obtaining institutional IRB approval, all charts of patients ages 0-18 months, who underwent flexible endoscopic evaluation of swallow and/or flexible laryngoscopy from 1/2013-8/2021 were reviewed. Twenty-four infants diagnosed with PVFM were identified.
Results: The most common presenting symptoms included stridor or coughing with feeds. 63% were male and mean age at time of diagnosis was 3.9 months. Comorbid conditions included: GERD (46%), pulmonary diagnoses (25%) and neurologic diagnoses (54%). 16/24 infants had co-existing otolaryngology diagnoses such as laryngomalacia, tracheomalacia, subglottic stenosis or ankyloglossia. 12/24 of infants were treated with conservative management such as H2-blockers or proton pump inhibitors, thickening feeds or change in feeding position. 33 % of patients treated with conservative management had resolution of their symptoms. 10/24 (42%) underwent surgical management of concurrent otolaryngology diagnoses. PVFM infants with neurologic comorbidities were more likely to require alternative feeding access (p < 0.05). All 11 infants who required surgical feeding access had coexisting neurologic diagnoses (cerebral palsy, epilepsy, or brain tumor). 5/10 of infants with neonatal abstinence syndrome (NAS) required alternative feeding means and, 40% were able to tolerate oral feeds after medical management of NAS. Mean length of follow up was 11.4 months, (range 0-52 months).
Conclusion: PVFM appears to be most commonly seen in infants with other medical comorbidities. Healthy infants with PVFM frequently improved with conservative management. While PVFM in infants is understudied, it is imperative to include PVFM in the differential diagnosis of stridor in the infant.