Psychogenic stridor: Diagnosis and management

Abstract

Psychogenic stridor is a rare cause of apparent acute upper airway obstruction, usually occurring in young female adults. The alarming presence of inspiratory stridor leads to suspicion of organic disease, with urgent management directed towards treatment of suspected pathology. Careful history taking may suggest the correct diagnosis and early examination of the larynx, preferably by fibreoptic nasendoscopic examination, may identify the underlying abnormality of paradoxical adduction of the vocal cords on inspiration, accounting for the stridor. This characteristic feature allows a positive diagnosis to be made and may avoid potentially harmful and inappropriate interventions. Three cases are presented, illustrating an evolution of management.