Our voice pathologists at Wake Forest Baptist Health offer a specialized service called laryngeal control therapy, a treatment approach which teaches patients how to prevent or quickly resolve episodes of chronic cough/throat clearing associated with irritable larynx syndrome or shortness of breath caused by Paradoxical Vocal Fold Motion Disorder (PVFM), also known as vocal cord dysfunction (VCD)

Cough/Throat Clearing Suppression Therapy 

Man coughing with someone looking on.Cough suppression therapy is a behavioral treatment for chronic cough that integrates a combination of strategies to reduce the severity, duration, and frequency of symptoms. Patients are referred for cough suppression therapy when their providers feel there is a behavioral component and a degree of laryngeal/throat hyperreactivity or hypersensitivity (neurogenic laryngeal hypersensitivity) triggering the cough. 

First, your voice pathologist with help you identify specific triggers and warning signs before the cough/throat clearing occurs. Triggers can include a “tickle” in the throat, the sense of a lump or mucus in the throat, certain smells (perfume, smoke, chemical irritants), or activities (talking, yelling, eating, lying down).   

We introduce cough suppression techniques and breathing exercises to prevent or more quickly resolve an episode of coughing. Therapy also includes extensive education on strategies to improve laryngeal health and hygiene as we work on desensitizing nerve receptors in the throat to reduce cough-reflex sensitivity. Sometimes, cough suppression therapy is recommended in conjunction with medication or other treatments recommended by your otolaryngologist or laryngologist. 

It takes mindfulness of behaviors and being willing to implement changes to reduce or resolve a cough that’s been present for months to years. We have seen this work time and time again, working in partnership with the patient to gradually reduce the urge and pattern of coughing. We typically work with patients for 1-3 sessions.  Together we can reduce the impact the cough has on your quality of life! 

Respiratory Retraining Therapy 

Family jogging together. Respiratory retraining (laryngeal control) therapy is a behavioral treatment for Paradoxical Vocal Fold Motion Disorder (PVFM).This condition is characterized by the vocal folds partially or almost fully coming together during inhalation (breathing in). This temporary airway restriction results in difficulty breathing in, the sensation of the throat tightening or closing off, and may also cause a noise with inhalation (stridor). 

Your voice pathologist will help you identify specific triggers and warning signs of your episodes of shortness of breath. Triggers may include strong odors/perfumes, physical exercise, temperature changes, coughing, or stress/strong emotions. We teach you a set of breathing exercises designed to keep the vocal folds open and the throat relaxed. When possible, we trigger episodes then coach you through resolution of the breathing problem while in-office for real world applicability. The goal of respiratory retraining therapy is to reduce the effort it takes to breathe and to retrain the breath cycle to prevent this type of shortness of breath. 

Perhaps the most important aspect of respiratory retraining therapy is reassuring the person that there is no physical or structural problem (no organic/physical obstruction of the airway). Studies have shown that while people may feel short of breath, oxygen levels typically remain high and within normal limits. Consequently, teaching patients to learn how to control their breathing through relaxed and intentional inhalation/exhalation will prevent and minimize the severity of possible PVFM “attacks.” 

How long would I need to attend laryngeal control therapy? 

Initially, our voice pathologists may see patients on a frequent and regular basis (one to two times a week), depending on the severity and frequency of symptoms. On average, patients are seen for a total of two to five sessions until therapy goals are achieved and the patient is able to suppress or resolve PVFM independently.