Vocal Cord Dysfunction
Vocal Cord Malfunction
Laryngeal Dyskinesia
Inspiratory Adduction
Paroxysmal Laryngospasm
Functional Airway Obstruction
Adductor Laryngeal Breathing Disorder
Fogerty 4/8/03

 Inappropriate adduction of the vocal folds during inhalation
 Two physiological variants:
1. Adduction of true and false folds throughout the breathing cycle
2. Adduction during deep inspiration and slight abduction on expiration

 incidence / prevalence unclear
– may be as high as 40% of patients with asthma
 age of onset: 9+ years
 usually female

May be...
 Coexistent with asthma
 Precipitated by emotional events
 Occurring with or without organic conditions
(Mathieson, 2001)

 Gastroesophageal reflux
 Psychogenic stridor
 Respiratory-type laryngeal dystonia
 Drug-induced laryngeal dystonic reactions
 Asthma-associated laryngeal dysfunction
 Abnormalities that affect the brainstem
(Koufman, 1994)

 sensation of throat being closed
 dramatic episodes of breathing difficulty
 stridor
 pt. struggles to inspire

 shortness of breath
‘wheezing’
 cough

 shouting or coughing
 physical exercise
 acid reflux
 breathing cold air
 irritants (smoke, pollen, etc.)
 psychosocial issues
 neurological issues
(ASHA, 2001)

 Throat tightness
 voice changes during attack
 little/no improvement with asthma Tx
 no night awakening secondary to attack

 ‘clean wheeze’
 ask pt. to pant (may improve symptoms)
 ask pt. to hold breath
 normal lung volume
 relatively normal expiratory flows

 “crucial in making the diagnosis”
(Koufman, 1994)
Classic Pattern
 VF adduction of anterior two-thirds during inspiration
 Posterior glottal chink during closure on inspiration
 50% will have normal VF motion when asymptomatic

 alternatively phonate /i/ and sniff, rapidly
 take deep breaths
 cough, throat clear, chuckle
 count to fifty, rapidly and loudly
 read a written passage in a loud voice
 sing
(Koufman, 1994)

Pattern
Reflux
Dystonia
Paroxysmal
Daytime
Psychogenic Paroxysmal
Brainstem Continual
Duration
Minutes
Hours
Variable
Continual
Hoarseness
Usually
Rarely
Never
Sometimes
Airway Support
Needed
Almost never
Sometimes
Sometimes
Usually
(Koufman, 1994)

 Asthma
 Other causes of laryngeal obstruction
– bilateral vocal fold paralysis
– laryngeal stenosis
Abduction may be inconsistent, incomplete, inappropriate in PVFM, but must occur for a diagnosis
Many patients have inappropriately received intubation or tracheostomy. Sometimes multiple times!

 Understanding anatomy and physiology of the laryngeal system
– learn to control vocal fold movement
 Performing relaxation exercises
– differential relaxation of excess tension in upper body
 Focusing
– focal breathing on face rather than neck
 Reducing precipitators
– daily log to chart precipitators of PVFM episodes


– relieves most severe symptoms


ASHA (2001). Paradoxical vocal fold movement . Retrieved from: http://www.asha.org/speech/ disabilities/vocal_fold.cfm.
Buddiga, P. & O’Connell, M. (2002).
Vocal cord dysfunction . Retrieved from: http://www.emedicine.com/med/topic3563.htm.
Colton, R. & Casper, J. (1990). Understanding Voice Problems: A Physiological Perspective for
Diagnosis and Treatment . Baltimore: Williams & Wilkins.
Koufman, J. (1994). The differential diagnosis of paradoxical vocal cord movement. The Visible
Voice , 3(3). Retrieved 4/3/03 from: http://www.bgsm.edu/voice/ paradoxical.html.
Mathieson. (2001).
Greene & Mathieson’s The Voice & Its Disorders
. (6th Ed.) Philadelphia: Whurr
Publishers.
Roussel, N. (n.d.). Vocal cord dysfunction: Role of the SLP in management . Retrieved 4/3/03 from
University of Louisiana at Lafayette: http://www.usc.loisiana.edu/~ncr3025/roussel/codi504/
VCD.html
Shreve, M. (1997). Vocal cord dysfunction . Retrieved from University of Minnesota: http://www.peds.umn.edu/divisions/pccm/pulm/shreve/VCD.html
Stemple, J., Glaze, L., & Klaben, B. (2000). Clinical Vocal Pathology: Theory and Management . (3 rd ed.). Singular Publishing.
Von Berg, S. (n.d.) Unmasking voices disorders: Paradoxical vocal fold movement . Retrieved 4/3/03 from ASHA Website: http://www.asha.org
Weiss, T. & Quinn, F. (2001). Vocal cord dysfunction: Paradoxical vocal cord motion - a thorough review. Grand Rounds Presentation, UTMB Dep. of Otolaryngology . Retrieved from: http://www.utmb.edu/Grnds/Vocal-Cord-2001-07/VCD-2.hmt#_ednref1