Maschka D A, Bauman N M, McCray P B, Hoffman H T, Karnell M P, Smith R J
Department of Otolaryngology-Head and Neck Surgery, The University of Iowa College of Medicine, Iowa City, U.S.A.
Laryngoscope. 1997 Nov;107(11 Pt 1):1429-35. doi: 10.1097/00005537-199711000-00002.
Paradoxical vocal cord motion (PVCM) is characterized by the inappropriate adduction of the true vocal cords during inspiration. Multiple causes have been proposed for this group of disorders, which share the common finding of mobile vocal cords that adduct inappropriately during inspiration and cause stridor by approximation. Management of this group of disorders has been complicated by the lack of a classification scheme to include all types of PVCM. We propose that PVCM be classified according to its underlying etiology and recognize the following causes of the disorder: 1. brainstem compression; 2. cortical or upper motor neuron injury; 3. nuclear or lower motor neuron injury; 4. movement disorder; 5. gastroesophageal reflux; 6. factitious or malingering disorder; 7. somatization/conversion disorder. Case reports are presented to illustrate the characteristic features and diagnostic evaluation used in assessing patients with PVCM. Management varies depending on the cause of PVCM and entails speech therapy, pharmacologic therapy, behavioral modification, and/or surgical intervention. Recognition of the multiple causes of PVCM allows otolaryngologists to formulate well-directed diagnostic evaluation and treatment.
矛盾性声带运动（PVCM）的特征是在吸气时真性声带不适当内收。对于这组疾病已提出多种病因，它们的共同特点是声带可活动，但在吸气时不适当内收并因靠拢而导致喘鸣。由于缺乏涵盖所有类型PVCM的分类方案，这组疾病的管理变得复杂。我们建议根据PVCM的潜在病因进行分类，并认识到该疾病的以下病因：1. 脑干受压；2. 皮质或上运动神经元损伤；3. 核或下运动神经元损伤；4. 运动障碍；5. 胃食管反流；6. 做作性或诈病障碍；7. 躯体化/转换障碍。本文通过病例报告来说明评估PVCM患者时所使用的特征性表现和诊断评估方法。治疗方法因PVCM的病因不同而异，包括言语治疗、药物治疗、行为矫正和/或手术干预。认识到PVCM的多种病因可使耳鼻喉科医生制定针对性强的诊断评估和治疗方案。
