The forgotten cause of stridor in the emergency department

Figures & data

Figure 1 Typical adducted vocal cords with posterior glottic chink seen on laryngoscopy during stridor.

Table 1 Pittsburgh Vocal Cord Dysfunction Index

Symptoms	Score
Dysphonia	2
Absence of wheezing	2
Throat tightness	4
Odors identified as a trigger	3
Maximum score=ll

Notes: Data from Traister et al.⁴

Table 2 Clinical features that should raise the possibility of paradoxical vocal fold movement disorder

Asthma-like symptoms that do not respond to bronchodilators or corticosteroids

Asthma-like symptoms that are precipitated by stress, emotional factors, or anxiety

Exercise-induced asthma

Athletes with choking sensation during exercise

Irritant-induced asthma-like symptoms

Note: Reproduced from Postgrad Med J, Paradoxical vocal cord motion disorder: past, present and future, Ibrahim WH, Gheriani HA, Almohamed AA, Raza T, 2007;83(977):164–172. © 2007 The Fellowship of Postgraduate Medicine with permission from BMJ Publishing Group Ltd.⁶