A case of diaphragm flutter (Sandage et al., 2021)

Purpose: This case study describes the clinical course for an individual referred to a speech-language pathologist (SLP) for assessment and treatment of paradoxical vocal fold motion/inducible laryngeal obstruction (PVFM/ILO) who was ultimately diagnosed with diaphragm flutter. This case presentation describes the critical importance of a multidisciplinary approach to identify conditions in the differential diagnosis of PVFM/ILO, which may lead to timely diagnosis and treatment of such conditions.

Method: Using a case study format with links to pre- and posttreatment videos, the clinical course of a 20-year-old woman presenting with persistent inspiratory stridor and cough during waking time was delineated. Data used to determine the differential diagnosis included careful clinical observation, extensive medical history, and endoscopic laryngeal assessment.

Results: Using a multidisciplinary approach with professionals from three different treatment centers, the diagnosis of diaphragm flutter was affirmed and successful medical management with an empiric trial of Baclofen was initiated with complete resolution of the dyspnea, cough, and inspiratory stridor over 3 weeks.

Conclusions: This case study describes a rare condition in the differential diagnosis of PVFM/ILO called diaphragm flutter, characterized by persistent inspiratory stridor and cough that interrupted connected speech and swallowing. SLPs who specialize in the assessment and treatment of PVFM/ILO may encounter this condition. Clinician awareness of the clinical profile for diaphragm flutter is critical for rapid referral to the appropriate medical specialists to achieve timely symptom relief.

Supplemental Material S1. Recording of the patient’s presenting symptoms.

Supplemental Material S2. The laryngoscopy conducted.

Supplemental Material S3. Two and a half weeks after initiation of Baclofen, the stridor resolved.

Sandage, M. J., Billingsley, C. P., Hatcher, J. L., Petty, B., & Olin, J. T. (2021). When inspiratory stridor is not paradoxical vocal fold motion/inducible laryngeal obstruction: A case study of diaphragm flutter. Perspectives of the ASHA Special Interest Groups. Advance online publication. https://doi.org/10.1044/2021_PERSP-21-00039