Breathing disorder that is frequently mistaken for asthma.
Accurate diagnosis is made by a multidisciplinary team, which can include a speech language pathologist, a primary care physician, an asthma/allergy specialist, a pulmonologist, a psychologist, a psychiatrist, a sports medicine specialist, an athletic trainer, and a gastroenterologist.
Diagnosis is established through the case history, laryngeal visualization, and pulmonary function studies.
Behavioral therapy by a speech language pathologist is the standard treatment.
Paradoxical vocal fold motion (PVFM), also called paradoxical vocal cord dysfunction, is a breathing disorder characterized by approximation rather than abduction/opening of the vocal folds during inspiration. This can result in upper-airway obstruction and stridor. Diagnosis is most often based upon exclusion of other differentials.
History and exam
Key diagnostic factors
- history of laryngopharyngeal reflux or GERD
- previous treatment for asthma without response to bronchodilators
- episodic shortness of breath: rapid onset and resolution
- difficulty inhaling
- inspiratory stridor
- increased sensitivity to nonspecific triggers after initial exposure
- palpable laryngeal tension
- loss of consciousness
- laryngopharyngeal reflux (LPR)
- occupational/environmental irritant exposure
- female sex
- competitive athletics
- multisystem atrophy (MSA)
- muscle tension dysphonia
- adductor laryngeal breathing dystonia
1st investigations to order
- flexible fiberoptic nasendoscopy
- PFTs/flow-volume plot
Investigations to consider
- sinus CT
- laryngeal sensory discrimination testing
unstable, undiagnosed patient with stridor
stable patient with stridor suspected to be secondary to PVFM
without acute stridor
Sherri K. Zelazny, MA, RSLP, CCC-SLP
Senior Clinical Speech Language Pathologist
Surrey Voice Clinic
Abilities Neurological Rehabilitation
SKZ has received income from Northern Speech Services for educational webinar production on Paradoxical Vocal Fold Motion and Chronic Cough. SKZ is President of Speech and Hearing BC (2017-2019), and on the Board of Directors of Parkinson Society BC.
Susan L. Thibeault, PhD
Director of Voice and Swallowing Clinic
Division of Otolaryngology - Head and Neck Surgery
University of Wisconsin School of Medicine and Public Health
Health Sciences Learning Center
SLT declares that she has no competing interests.
Ms Sherri K. Zelazny and Dr Susan L. Thibeault would like to gratefully acknowledge Dr Michael Johns, a previous contributor to this topic. MJ declares that he has no competing interests.
Julina Ongkasuwan, MD
Otolaryngology - Head and Neck Surgery
Baylor College of Medicine
Texas Children’s Hospital
JO receives book royalties from Springer and Elsevier.
Janet Wilson, BSc, MD, FRCSEd, FRCSEng
Professor of Otolaryngology - Head and Neck Surgery
Honorary Consultant Otolaryngologist
JW declares that she has no competing interests.
Ryner Jose Dela Cruz Carrillo, MD, MSc, FPSOHNS, FPAHNS
Department of Otorhinolaryngology
Department of Anatomy
University of the Philippines
College of Medicine
RJDCC declares that he has no competing interests.
Tom Murry, PhD
Professor of Speech Pathology
Department of Otolaryngology - Head and Neck Surgery
Clinical Director of the Voice and Swallowing Center
College of Physicians and Surgeons
Columbia University at New York Presbyterian Hospital
TM declares that he has no competing interests.
- Vocal fold paresis/paralysis
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