A 57-yr-old female developed inspiratory stridor and suprasternal retractions in the postanesthesia care unit (PACU) after general endotracheal anesthesia. Paradoxical vocal fold motion disorder was diagnosed by transnasal flexible laryngoscopy. Image A shows the vocal cords when dysfunctional, B after treatment with an anxiolytic, and C when respiratory control therapy was provided by straw breathing, which resolved her symptoms.

Paradoxical vocal fold motion disorder is a cause of postoperative respiratory distress marked by desynchronized or paradoxical adduction of the vocal folds during inspiration or expiration. Patients typically present with inspiratory stridor and a sensation of airway restriction. Common symptoms also include choking, aphonia, or dysphonia and chronic cough. Paradoxical vocal fold motion disorder is commonly seen in patients with upper or lower motor neuron injury, movement disorder, conversion disorder, and gastroesophageal reflux. It may be triggered by...

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