(Kiosk 6) Atypical Speech and Respiratory Symptoms in a Pediatric Patient

Case Diagnosis: 13 year old male with paradoxical vocal fold motion disorder (PVFMD)

Case Description or Program Description: A 13-year-old male with a history of multiple upper respiratory infections over the last 6 months presented with complaints of dysphonia, intermittent shortness of breath, and throat tightening sensation brought on by exertion, speaking, and eating. This was preceded by months of cough followed by loss of voice production over the previous 6 weeks. Patient completed a course of amoxicillin and steroid taper with minimal improvement. Patient was evaluated by a pulmonologist who found no evidence of asthma on pulmonary function tests and subsequently by ENT who performed laryngoscopy showing bilateral true vocal fold motion with strong voice production. He was referred to a physiatry clinic for evaluation.

Setting: Out-patient clinical setting

Assessment/Results: Upon examination, the patient did not have any obvious abnormal physical findings. He was reluctant to speak and only did so after encouragement because of a recent episode of throat tightness exacerbated by speech. He was then referred to speech-language pathology (SLP). Considering inconclusive work-up prior to referral to our clinic and the evaluation by SLP, the patient was diagnosed with paradoxical vocal fold motion disorder. Patient was prescribed breathing exercises during speech therapy with improvement in voice production and decreased episodes of throat tightening.

Discussion (relevance): For patients with no obvious etiology (e.g. asthma, true vocal cord dysfunction, malignancy) of throat tightening sensation associated with exertion, speech, oral intake, or other triggers, PVFMD should be on the differential. The dysphonia exhibited by the patient is believed to be a consequence of his anxiety in triggering his shortness of breath and not a sequelae of the vocal fold motion disorder directly. Patients with this disorder can learn appropriate compensatory and mitigation techniques with speech therapy which may improve prognosis and intensity of symptoms. In addition, acquisition of the diagnosis and feelings of control may ameliorate patient and family anxiety.

Conclusions: Patients with PVFMD may present with dysphonia, although it may be an atypical presentation. This case suggests that symptoms of PVFMD and associated dysphonia can be managed and/or improved with speech therapy, possibly through compensatory techniques and mitigation of anxiety.