Objectives: Paradoxical vocal fold motion (PVFM) is a condition that exhibits inappropriate adduction of the vocal cords during inspiration, with females comprising the majority of the patients. As awareness has increased, more patients are being referred for evaluation. No study to date has reported additional laryngeal pathologies found concurrent to PVFM.Methods: A retrospective chart review of patients referred for evaluation of "paradoxical vocal fold motion" between July 2002 and December 2002 was performed. Questionnaires were completed by the patients at the time of the office visit. Data collected from the medical record included age, sex, duration of symptoms prior to evaluation, asthma, gastroesophageal reflux symptoms, and laryngoscopic findings. Exercise stress testing was performed when suitable. The diagnosis of PVFM was made based on history and laryngoscopy.Results: 32 patients were identified. There was a 29:3 (90.6%) female predominance. Mean age of presentation was at 28 years (12-67 years). The median time from the onset of respiratory symptoms to diagnosis was 4.5 years (range, 0.5 to 30 years). 17/32 (53%) had asthma. 12/32 had laryngeal findings suggestive of GERD. 4/32 (12%) had laryngoscopic findings of chronic laryngitis. 10/32 (31%) had additional findings including laryngomalacia, vocal fold motion impairment, sulcus vocalis, nodules, subglottic stenosis, and Reinke's edema.Conclusions: PVFM is still under-recognized, as demonstrated by a median duration of symptoms prior to diagnosis of 4.5 years. Additional laryngeal pathologies may be seen in 1/3 of patients. As in previously published studies, there was a female predominance and relative prevalence of asthma.

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We identified 219 potentially pertinent articles from the MEDLINE searches, and detailed review of those studies yielded 10 studies for further analysis. Three studies directly compared MT alone with arytenoid adduction and medialization thyroplasty (AA ϩ MT): overall, there was no clear benefit in subjective or objective outcomes for AA ϩ MT versus MT alone. The data did not allow the calculation of the minimum number needed to treat to detect a difference. The other seven studies were related but not pertinent to our specific question.Conclusions: Very limited Grade C evidence indicates that there is no clear benefit in subjective or objective outcomes if arytenoid adduction is added to medialization thyroplasty, compared to medialization thyroplasty alone.