scholarly journals Paradoxical vocal fold motion: respiratory retraining to manage long-term symptoms

2012 ◽  
Vol 24 (1) ◽  
pp. 80-85 ◽  
Author(s):  
Victoria Hatzelis ◽  
Thomas Murry
Keyword(s):  
Vocal Fold ◽  
Laryngopharyngeal Reflux ◽  
Extended Period ◽  
Vocal Folds ◽  
Post Treatment ◽  
Shortness Of Breath ◽  
Patient Reported ◽  
Vocal Fold Motion ◽  
Paradoxical Vocal Fold Motion

Paradoxical vocal fold motion (PVFM) is a laryngeal disorder characterized by abnormal adduction of the vocal folds during respiration. It is caused by a multitude of etiologies and their interactions. In the current study, a 24-year-old female patient with a 12-year complaint of shortness of breath was diagnosed with paradoxical vocal fold motion following nasal endoscopy, spirometry testing and detailed case history analysis. She had no history or indication of laryngopharyngeal reflux or chronic cough. She performed respiratory retraining exercises three to four times daily for a period of four weeks, and continued daily exercises for two additional months as needed. After four weeks of treatment, abnormal vocal fold adduction continued to be seen on endoscopy and the patient was mildly symptomatic. One month post-treatment, there was no abnormal vocal fold adduction and the patient reported rare shortness of breath. At three months post-treatment, there was no abnormal vocal fold adduction and the patient no longer reported shortness of breath. She reported normal breathing with no symptoms one year later. The results suggest that non-pulmonary related shortness of breath treated with respiratory retraining can effectively eliminate dyspnea in patients with long term breathing difficulties caused by paradoxical vocal fold motion. Resolution may require treatment over an extended period of time.

Behavioral Management of Paradoxical Vocal Fold Motion

2014 ◽  
Vol 24 (2) ◽  
pp. 64-70 ◽  
Author(s):  
Jennifer R. Reitz ◽  
Stephen Gorman ◽  
Jennifer Kegyes
Keyword(s):  
Vocal Fold ◽  
Multidisciplinary Approach ◽  
Upper Airway ◽  
Vocal Folds ◽  
Vocal Cord Dysfunction ◽  
Behavioral Management ◽  
Assessment And Treatment ◽  
Laryngeal Control ◽  
Vocal Fold Motion ◽  
Paradoxical Vocal Fold Motion

Paradoxical vocal fold motion (PVFM), or vocal cord dysfunction (VCD), is a non-organic, behavioral, upper airway disorder primarily characterized by adduction of the true vocal folds during respiration. Recognition of this condition is becoming more prevalent amongst physicians, resulting in an increased number of referrals to speech-language pathologists (SLPs) for assessment and treatment. Diagnosis of PVFM requires a multidisciplinary approach. Treatment for PVFM is also multi-factorial, but is primarily designed to train abduction of the vocal folds during the breathing cycle, allowing easy movement of breath to and from the lungs without laryngeal constriction. Behavioral management is the preferred and most common approach to treatment and may include relaxed throat breathing and laryngeal control exercises during trigger-specific training.

scholarly journals Visual biofeedback for paradoxical vocal fold motion (PVFM)

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Rachelle Alyce LeBlanc ◽  
Daniel Aalto ◽  
Caroline C. Jeffery
Keyword(s):  
Vocal Fold ◽  
Medication Use ◽  
Vocal Folds ◽  
Asthma Medication ◽  
Secondary Outcome ◽  
Post Intervention ◽  
Visual Biofeedback ◽  
Vocal Fold Motion ◽  
Paradoxical Vocal Fold Motion

Abstract Objectives Paradoxical vocal fold motion (PVFM) is a common condition where the vocal folds inappropriately adduct during inspiration. This results in dyspnea and occasionally significant distress. The condition is thought to be primarily functional, with behavioural therapy considered mainstay in the non-acute setting. However, practice variations and limited access to speech language pathology (SLP) services can pose management challenges. We aimed to examine the efficacy of surgeon performed visual biofeedback as first-line treatment for PVFM. Study design Prospective, non-randomized, non-comparative clinical study. Methods Adult patients referred for possible PVFM and congruent laryngoscopy findings over a two-year period were included. Patients were excluded if they presented in acute distress, had alternate diagnosis to explain symptomology and/or coexisting untreated lower respiratory pathology. Patients underwent immediate surgeon-performed visual biofeedback on the same visit day. The primary outcome of interest was change in Dyspnea Index (DI) scores pre- and post-intervention 3 months follow-up. The secondary outcome measured was change in asthma medication use from baseline to follow-up. Results Of 34 patients presenting, 25 met inclusion criteria. Of these, 72% were female with an average age of 36.9 ± 14.1. Approximately 48% of patients had a diagnosis of well-controlled asthma at presentation and co-morbid psychiatric diagnoses were common (52%). Pre- and post-intervention analysis showed significant improvement in DI scores (p < 0.001) and reduction in bronchodilator use (p = 0.003). Conclusion This is a prospective study that evaluates the role of visual biofeedback in PVFM patients. Our data suggests that visual biofeedback effectively reduces short-term subjective symptoms and asthma medication use. Level of evidence 3 Graphical abstract

Paradoxical Vocal Fold Motion in Children and Adolescents

2004 ◽  
Vol 35 (4) ◽  
pp. 353-362 ◽  
Author(s):  
Mary J. Sandage ◽  
Sherri K. Zelazny
Keyword(s):  
Behavioral Interventions ◽  
Vocal Fold ◽  
Behavioral Treatment ◽  
Vocal Folds ◽  
School Nurses ◽  
Management Evaluation ◽  
Adolescent Population ◽  
Speech Language Pathologist ◽  
Vocal Fold Motion ◽  
Paradoxical Vocal Fold Motion

Paradoxical vocal fold motion (PVFM) is a complex adductory disorder of the vocal folds that frequently is mistaken for asthma. PVFM typically requires behavioral intervention by a trained speech-language pathologist for complete resolution of the symptoms. Once thought to be limited to adults, PVFM has been increasingly documented and successfully treated in the child and adolescent population. Understanding PVFM requires thorough knowledge of the differential diagnoses, the clinical features of PVFM, the differentiation of PVFM from asthma, the medical professionals involved in the diagnosis and treatment, and the behavioral interventions that are commonly prescribed. Teachers, school nurses, and coaches may be the first professionals to see the symptoms in children and assume that they have asthma. Successful referral, diagnosis, and behavioral treatment requires a team of individuals in the child’s community, including the school speech-language pathologist, who can work together to ensure identification and resolution of the symptoms. This article discusses etiologies, differential diagnosis, referral, medical management, evaluation, and behavioral treatment of the child or adolescent with PVFM.

Laryngeal Framework Surgery in the Management of Spasmodic Dysphonia

1989 ◽  
Vol 98 (1) ◽  
pp. 52-54 ◽  
Author(s):  
Harvey M. Tucker
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Long Term Results ◽  
Spasmodic Dysphonia ◽  
Management Problem ◽  
Cure Rate ◽  
Adductor Spasmodic Dysphonia ◽  
Laryngeal Framework Surgery ◽  
Selective Lysis

Spasmodic dysphonia continues to be a management problem for otolaryngologists. Selective lysis of the recurrent laryngeal nerve has been useful in the management of this disease. Reported long-term results, however, reveal that spasm recurs in approximately 40% to 50% of initially successful patients in spite of persistence of the unilateral vocal fold paralysis. Although some of these failures can be recaptured with subsequent laser surgery, the overall “cure” rate does not exceed 70%, even in the best hands. The contributions of Isshiki, LeJeune, and Tucker have demonstrated that tension in the vocal folds can be adjusted by laryngeal framework surgery. Experience with 16 patients suffering from adductor spasmodic dysphonia suggests that laryngeal framework surgery is useful in the management of this disorder.

scholarly journals The Effect of Exercise on Respiratory Resistance in Athletes With and Without Paradoxical Vocal Fold Motion Disorder

2015 ◽  
Vol 24 (3) ◽  
pp. 470-479 ◽  
Author(s):  
Sally J. K. Gallena ◽  
Nancy Pearl Solomon ◽  
Arthur T. Johnson ◽  
Jafar Vossoughi ◽  
Wei Tian
Keyword(s):  
Repeated Measures ◽  
Vocal Fold ◽  
Female Athletes ◽  
Exercise Duration ◽  
Treadmill Running ◽  
Respiratory Resistance ◽  
The Difference ◽  
Airflow Perturbation Device ◽  
Vocal Fold Motion ◽  
Paradoxical Vocal Fold Motion

Purpose An investigational, portable instrument was used to assess inspiratory (R i ) and expiratory (R e ) resistances during resting tidal breathing (RTB), postexercise breathing (PEB), and recovery breathing (RB) in athletes with and without paradoxical vocal fold motion disorder (PVFMD). Method Prospective, controlled, repeated measures within-subject and between-groups design. Twenty-four teenage female athletes, 12 with and 12 without PVFMD, breathed into the Airflow Perturbation Device for baseline measures of respiratory resistance and for two successive 1-min trials after treadmill running for up to 12 min. Exercise duration and dyspnea ratings were collected and compared across groups. Results Athletes with PVFMD had lower than control R i and R e values during RTB that significantly increased at PEB and decreased during RB. Control athletes' R e decreased significantly from RTB to PEB but not from PEB to RB, whereas R i did not change from RTB to PEB but decreased from PEB to RB. Athletes without PVFMD ran longer, providing lower dyspnea ratings. Conclusion Immediately following exercise, athletes with PVFMD experienced increased respiratory resistance that affected their exercise performance. The difference in resting respiratory resistances between groups is intriguing and could point to anatomical differences or neural adaptation in teenagers with PVFMD. The Airflow Perturbation Device appears to be a clinically feasible tool that can provide insight into PVFMD and objective data for tracking treatment progress.

Vocal fold botulinum toxin injection for refractory paradoxical vocal fold motion disorder

2018 ◽  
Vol 129 (4) ◽  
pp. 808-811 ◽  
Author(s):  
Brad deSilva ◽  
Drew Crenshaw ◽  
Laura Matrka ◽  
L. Arick Forrest
Keyword(s):  
Botulinum Toxin ◽  
Vocal Fold ◽  
Botulinum Toxin Injection ◽  
Vocal Fold Motion ◽  
Paradoxical Vocal Fold Motion

scholarly journals Laryngeal and respiratory patterns in patients with paradoxical vocal fold motion

2011 ◽  
Vol 105 (12) ◽  
pp. 1891-1895 ◽  
Author(s):  
Thomas Murry ◽  
Sabrina Cukier-Blaj ◽  
Alison Kelleher ◽  
Khalid H. Malki
Keyword(s):  
Vocal Fold ◽  
Vocal Fold Motion ◽  
Paradoxical Vocal Fold Motion

Paradoxical Vocal Fold Motion: A Tutorial on a Complex Disorder and the Speech-Language Pathologist’s Role

2001 ◽  
Vol 10 (2) ◽  
pp. 111-125 ◽  
Author(s):  
Barbara A. Mathers-Schmidt
Keyword(s):  
Vocal Fold ◽  
Psychological Intervention ◽  
Specific Treatment ◽  
Future Research ◽  
Research Attention ◽  
Assessment Protocol ◽  
Complex Disorder ◽  
Speech Language Pathologist ◽  
Vocal Fold Motion ◽  
Paradoxical Vocal Fold Motion

Paradoxical vocal fold motion (PVFM) is presented as a complex, poorly understood disorder that merits our clinical and research attention. This tutorial examines PVFM characteristics, etiologies, differential diagnosis, and medical/psychological intervention. The role of the speech-language pathologist in diagnostic evaluation and intervention is delineated. An assessment protocol and specific treatment suggestions are provided. The need for future research is discussed.

Electroglottography and Vocal Fold Physiology

1990 ◽  
Vol 33 (2) ◽  
pp. 245-254 ◽  
Author(s):  
D. G. Childers ◽  
D. M. Hicks ◽  
G. P. Moore ◽  
L. Eskenazi ◽  
A. L. Lalwani
Keyword(s):  
Vocal Fold ◽  
High Speed ◽  
Human Subjects ◽  
Vocal Folds ◽  
Supporting Evidence ◽  
Direct Measurements ◽  
Analysis And Synthesis ◽  
Vocal Fold Motion ◽  
Maximum Opening ◽  
Major Hypothesis

The electroglottogram (EGG) is known to be related to vocal fold motion. A major hypothesis undergoing examination in several research centers is that the EGG is related to the area of contact of the vocal folds. This hypothesis is difficult to substantiate with direct measurements using human subjects. However, other supporting evidence can be offered. For this study we made measurements from synchronized ultra high-speed laryngeal films and from EGG waveforms collected from subjects with normal larynges and patients with vocal disorders. We compare certain features of the EGG waveform to (a) the instant of the opening of the glottis, (b) the instant of the closing of the glottis, and (c) the instant of the maximum opening of the glottis. In addition, we compare both the open quotient and the relative average perturbation measured from the glottal area to that estimated from the EGG. All of these comparisons indicate that vocal fold vibratory characteristics are reflected by features of the EGG waveform. This makes the EGG useful for speech analysis and synthesis as well as for modeling laryngeal behavior. The limitations of the EGG are discussed.

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