Paradoxical vocal fold motion (intermittent laryngeal obstruction)

Paradoxical vocal fold motion (intermittent laryngeal obstruction) (PVFM/ILO) is a 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, continuous laryngeal visualization during exercise, and pulmonary function studies.

Behavioral therapy by a speech language pathologist is the standard treatment.

PVFM/ILO, 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.[1]Andrianopoulos MV, Gallivan GJ, Gallivan KH. PVCM, PVCD, EPL, and irritable larynx syndrome: what are we talking about and how do we treat it? J Voice. 2000;14:607-618. http://www.ncbi.nlm.nih.gov/pubmed/11130117?tool=bestpractice.com [2]Maschka DA, Bauman NM, McCray PB Jr, et al. A classification scheme for paradoxical vocal cord motion. Laryngoscope. 1997;107:1429-1435. http://www.ncbi.nlm.nih.gov/pubmed/9369385?tool=bestpractice.com [3]Mathers-Schmidt BA. Paradoxical vocal fold motion: a tutorial on a complex disorder and the speech-language pathologist's role. Am J Speech Lang Pathol. 2001;10:111-25.[4]Al-Alwan A, Kaminsky D. Vocal cord dysfunction in athletes: clinical presentation and review of the literature. Phys Sportsmed. 2012;40:22-27. http://www.ncbi.nlm.nih.gov/pubmed/22759602?tool=bestpractice.com [5]Patel RR, Venediktov R, Schooling T, et al. Evidence-based systematic review: effects of speech-language pathology treatment for individuals with paradoxical vocal fold motion. Am J Speech Lang Pathol. 2015;24:566-584. http://www.ncbi.nlm.nih.gov/pubmed/25836980?tool=bestpractice.com ​​ Diagnosis is most often based upon exclusion of other differentials. ILO is a term increasingly used to describe the disorder. It is an umbrella term that encompasses: (a) irritant-induced ILO and (b) exercise-induced ILO.[6]Christensen PM, Heimdal JH, Christopher KL, et al. ERS/ELS/ACCP 2013 international consensus conference nomenclature on inducible laryngeal obstructions. Eur Respir Rev. 2015 Sep;24(137):445-50. https://publications.ersnet.org/content/errev/24/137/445 http://www.ncbi.nlm.nih.gov/pubmed/26324806?tool=bestpractice.com