Paradoxical Vocal Fold Motion (Dysfunction)

Question 1

What is PVFM

Answer 1

Paradoxical Vocal Fold Motion Abnormal adduction of the vocal folds (+/- arytenoid movement) during the respiratory cycle that produces airflow obstruction at the level of the larynx

Question 2

Abnormal adduction pattern

Answer 2

Question 3

Typical Pediatric Profile for PVFM

Answer 3

3:1 female to male ratio high achievers competitive sports anxiety, ADHD, depression

Question 4

Typical Adult Profile PVFM

Answer 4

4:1 female to male 40-50 years of age 12 years of education healthcare field high rates of medical utilization anxiety, depression

Question 5

Clinical History/Presentation

Answer 5

Episodic Tightness localized to the laryngeal area Classically an inspiratory problem Tightness in chest Dyspnea and/or stridor Fast onset and fast resolution Poor response to beta-antagonists and corticosteroids Not usually associated with nocturnal awakening due to breathless May have co-existing asthma, GERD, allergies/PND, psychiatric issues

Question 6

Hormones, Exercise, and Anxiety Hypotheses

Answer 6

Hypothesis: Some women may be a pre-disposed to laryngeal changes as a result of estrogen Hypothesis: Brain might interpret pushing breathing to the limit as danger ad reflexes kick in to ‘protect the airway’ Hypothesis: key CNS areas that control short-term protective reflexes get stuck ‘on’ Stimulus–> Thought/belief–> Emotion–>Behavior

Question 7

Behavioral Intervention

Answer 7

Patient Education Tension Identification and Control Diaphragmatic breathing Open, relaxed breathing Supportive Counseling

Question 8

PVFM Overall Summary

Answer 8

Often under-recognized Careful, trans-disciplinary assessment May be associated with underlying conditions Individualized ‘laryngeal rehabilitation’ by an experienced therapist