O'Connell Ferster Ashley P, Shokri Tom, Carr Michele
Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States.
Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States.
Int J Pediatr Otorhinolaryngol. 2018 Apr;107:6-9. doi: 10.1016/j.ijporl.2018.01.027. Epub 2018 Feb 20.
Paradoxical vocal fold motion (PVFM) is a disorder often misdiagnosed in children presenting with shortness of breath and stridor. In infants, little is known about the clinical course and best approach for treatment of PVFM. This retrospective study assesses the approach to treatment and outcomes for infants with PVFM.
To investigate the clinical course of paradoxical vocal fold motion (PVFM) in infants.
Retrospective review.
Tertiary academic medical center.
Patients less than 2 years of age diagnosed with PVFM were identified and included in the study.
History, physical exam findings, and clinical course of treatment for patients less than 2 years old with PVFM were reviewed. Findings including those on flexible fiberoptic laryngoscopy (FFL) and subjective assessment by parents and clinicians were compiled for review.
Seven infants were diagnosed with PVFM. All patients were full term at birth, and average age at diagnosis was 7 months. All patients initially presented with inspiratory stridor, and two patients had stertor. Two of seven patients also had a history of reactive airway disease and one with laryngomalacia. Five had a history of reflux. Two of seven patients had weight percentiles at diagnosis lower than the 25th percentile, while the remainder were between 37th and 75th percentiles. Initial voice evaluation revealed stridor in all patients, as well as finding of PVFM on FFL. All patients were started on anti-reflux medication. Average time to resolution of PVFM was 5.9 months after treatment.
PVFM can be challenging to diagnose in the infant population. PVFM resolves uneventfully with reflux treatment, however, it is unknown whether reflux treatment is essential or if PVFM would spontaneously resolve. The rarity of infantile PVFM mandates formal evaluation and monitoring by a pediatric otolaryngologist.
矛盾性声带运动障碍（PVFM）是一种在出现呼吸急促和喘鸣的儿童中常被误诊的疾病。对于婴儿期PVFM的临床病程和最佳治疗方法知之甚少。这项回顾性研究评估了婴儿期PVFM的治疗方法和结局。
调查婴儿期矛盾性声带运动障碍（PVFM）的临床病程。
回顾性研究。
三级学术医疗中心。
识别出年龄小于2岁且被诊断为PVFM的患者并纳入研究。
回顾了年龄小于2岁的PVFM患者的病史、体格检查结果和临床治疗过程。汇总了包括软性纤维喉镜检查（FFL）结果以及家长和临床医生的主观评估结果以供审查。
7名婴儿被诊断为PVFM。所有患者出生时均为足月儿，诊断时的平均年龄为7个月。所有患者最初均表现为吸气性喘鸣，2例患者有鼾症。7例患者中有2例有反应性气道疾病史，1例有喉软化症。5例有反流病史。7例患者中有2例诊断时的体重百分位数低于第25百分位数，其余患者在第37至75百分位数之间。初始嗓音评估显示所有患者均有喘鸣，且FFL检查发现PVFM。所有患者均开始使用抗反流药物治疗。治疗后PVFM平均缓解时间为5.9个月。
PVFM在婴儿群体中可能难以诊断。PVFM通过反流治疗可顺利缓解，然而，尚不清楚反流治疗是否必不可少，或者PVFM是否会自行缓解。婴儿期PVFM罕见，需要儿科耳鼻喉科医生进行正式评估和监测。
