Maillard I Schweizer V Broccard A Duscher A Liaudet L Schaller MD 2000 Paradoxical vocal cord movement (PVCM) is characterized by paradoxical adduction of the vocal cords during inspiration and/or expiration. Patients with severe forms of PVCM can present with acute dyspnea. In this article, we describe a patient with severe PVCM who had required tracheal intubation or tracheostomy at multiple occasions and who presented with acute hypercapnic respiratory failure. Using sedation and intralaryngeal injection of botulinum toxin type A, we could avoid more invasive intervention. Our observation shows that botulinum toxin type A should be considered in the acute care setting for severe PVCM. https://sonar.ch/global/documents/277839 eng info:eu-repo/semantics/altIdentifier/doi/10.1378/chest.118.3.874 info:eu-repo/semantics/altIdentifier/pmid/10988221 Chest. - 2000 Adult Botulinum Toxins, Type A Contraindications Female Humans Intubation, Intratracheal Laryngeal Diseases Neuromuscular Agents Respiratory Distress Syndrome, Adult Tracheostomy Vocal Cords Use of botulinum toxin type A to avoid tracheal intubation or tracheostomy in severe paradoxical vocal cord movement. http://purl.org/coar/resource_type/c_6501