Laryngeal Dyskinesia as a Cause of Stridor in Infants

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Abstract
Objective: To describe 9 cases of stridor attributed to the failure of the vocal cord to abduct during inspiration. Design: Case series. Setting: Pediatric otolaryngology referral center. Patients: Nine hospitalized infants, aged 1 to 13 months, presented over a 3-year period for exploration of inspiratory stridor that was attributed to a condition that we have termed laryngeal dyskinesia. Results: A consistent clinical presentation was noted in all cases. The laryngeal dyskinesia occurred during calm breathing, crying, or sleep and was associated with gastroesophageal reflux in 8 cases (diagnosed clinically and/or with pH monitoring). In addition, 3 infants suffered from fainting spells associated with vagal hypertonia that was confirmed by 24-hour Holter monitoring. True paralysis of the abductor muscles was ruled out in all infants because of the presence of normal glottic motion during calm breathing or induction of anesthesia. The stridor resolved between the ages of 4 and 13 months in 7 of the patients. Improvement was progressive and had no clear relationship to treatment for gastroesophageal reflux. Conclusion: Laryngeal dyskinesia in infants seems to be a distinct clinical entity, frequently associated with gastroesophageal reflux. (Arch Otolaryngol Head Neck Surg. 1996;122:612-616)