Laryngeal dyskinesia: An under‐recognized condition

Objective:  To perform a review of the epidemiology, pathogenesis, clinical presentation, diagnosis and management of laryngeal dyskinesia. Methods:  A search of the Medline database from 1966 to 2003 was performed. A manual search was performed of the references of each article. Results:  Laryngeal dyskinesia is a respiratory condition characterized by abnormal vocal cord adduction and airflow limitation at the level of the larynx in the absence of evidence of local organic disease. It typically presents to the ED as wheeze, stridor or apparent upper airway obstruction. It occurs across a wide age range, is more common in females, and is typically associated with a range of underlying psychopathologies. Diagnosis is often delayed and unnecessary emergency treatment such as intubation and tracheostomy is not uncommon. Patients are commonly on high‐dose steroids and are frequent users of the health‐care system, often over prolonged periods. There are multiple diagnostic features on history and examination, and flexible nasendoscopy of the vocal cords in the ED can be used to confirm the diagnosis. Treatment options in the ED include sedation and use of continuous positive airway pressure. Long‐term treatment involves a multidisciplinary approach involving respiratory physicians/ear, nose and throat surgeons, speech therapy and psychiatry. Conclusion:  Laryngeal dyskinesia remains an under‐appreciated cause of respiratory presentations to the ED. Emergency physicians are ideally placed to make the diagnosis and initiate appropriate referral for specific therapies that have a high level of success.