Paradoxical Vocal Fold Dysfunction

Symptoms              Evaluation          Treatment

Paradoxical vocal fold dysfunction is a disorder that occurs with abnormal movement of the vocal folds while breathing. The vocal folds are located in the larynx (voice box), and they are positioned horizontally just behind the Adam's apple.

Normally the vocal folds are in an abducted (open) position in the shape of a "V" during inspiration and exhalation of air, which easily allows for the passage of air into and out of the lungs. The vocal folds adduct (close) during a cough, while swallowing, and when producing voice.

During episodes of paradoxical vocal fold motion, the vocal folds partially or fully close during breathing, restricting the passage of air to the lungs.

Symptoms

• Shortness of breath
• Dyspnea on exertion, particularly while inhaling
• Changes in voice quality (hoarseness)
• Wheezing
• Stridor
• Sensation of tightness in the throat or chest
• Burning sensation in the throat or chest

Paradoxical vocal fold dysfunction is often confused with asthma because both of these disorders can produce similar symptoms; however, paradoxical vocal fold dysfunction is typically unresponsive to asthma medications.

An accurate diagnosis requires the skill of a knowledgeable professional team that typically includes an otolaryngologist, pulmonologist, and speech-language pathologist, although there may be involvement of an allergist and psychologist.

Patients referred for evaluation are typically seen by both an otolaryngologist and speech-language pathologist.

Evaluation

• Patient questionnaire regarding breathing problems and lifestyle
• A detailed case history 
• Clinical Evaluation using a flexible scope passed through the nose to view the vocal folds and airway (laryngoscopy)
• Patient performance of various breathing and voice maneuvers
• If physical activity is a trigger for the symptoms, the clinical evaluation may also include visualizing the throat with the flexible scope following a period of physical exercise

Treatment

Evaluation findings are reviewed and discussed with the patient and the family members that are present.

If paradoxical vocal fold dysfunction is suspected from the history or observed during the clinical examination, a plan of care is presented that normally includes the recommendation for therapy with a speech-language pathologist and may include treatment with medication.

While uncommon, some severe cases of paradoxical vocal fold dysfunction might require further intervention to help maintain open vocal folds while breathing.

Therapy for paradoxical vocal fold dysfunction is called laryngeal rehabilitation or laryngeal control therapy, and is provided by a speech-language pathologist.

The treatment program typically consists of two to four sessions. This begins with education regarding normal breathing patterns, with exercises that increase awareness of the abdomen and relaxation of the throat muscles. This is followed by identification of restrictive breathing patterns; and instruction in techniques and exercises to voluntarily maintain the vocal folds in an open position during episodes of breathing difficulty. Laryngeal control therapy is usually sufficient to correct the disorder.