Paradoxical vocal fold motion disorder (PVFM), also known as vocal cord dysfunction (VCD), is an acquired disorder that can affect both breathing and voicing. It causes episodes of shortness of breath (SOB) that may be triggered by a variety of stimuli, such as exercise (sometimes only one particular sport), strong smells (perfume, smoke, household cleaners) and/or intense emotions (anxiety/stress). Sometimes people lose their voice or the quality changes during episodes.  

During normal breathing, the vocal folds open during inhalation (breathing in). However, during an episode of PVFM, the vocal folds partially or almost fully close with inhalation, thus temporarily narrowing the airway. This behavior is felt to be due to the vocal folds over-protecting the trachea (airway) during exposure to certain stimuli. Over time, this behavioral response can become automatic. It does not improve with inhalers, as the condition is due to muscle movement in the throat rather than a lung disorder. It is possible to have both PVFM and underlying lung conditions, requiring joint management with pulmonology.

Paradoxical Vocal Fold Motion Disorder Symptoms, Signs, and Diagnosis

Patients with PVFM often report symptoms of increased difficulty with inhalation, feeling as if the throat is tightening or closing off, and a sound (stridor) with inhalation.

Diagnosis is made through the process of elimination by first ruling out other conditions that can cause shortness of breath. Before your referral to the Voice and Swallowing Center, you will typically have seen a pulmonologist (lung doctor) and/or been given inhalers by your PCP and may have had a cardiac (heart) work-up. If these tests are normal, or the shortness of breath is not fully managed by inhalers, you are then sent to us. We review prior test results and identify any behavioral patterns (chronic throat clearing, hydration, speaking patterns, reflux symptoms) that could be contributing factors.  

The gold standard of diagnosing PVFM is by visualizing vocal fold movement during an episode of shortness of breath via a transnasal flexible laryngoscopy or video laryngostroboscopy. If you have specific triggers (e.g. strong odors/perfumes, physical exertion) we may expose you to those triggers or have you briskly walk or run in attempt to trigger complaints. If we see abnormal vocal fold movement, we immediately coach you through breathing exercises to resolve the episode of shortness of breath. The video of the examination is recorded and we review it together.

Treatment for Paradoxical Vocal Fold Motion Disorder 

Patients with PVFM are often referred for behavioral treatment also known as laryngeal control therapy with one of our specialized voice pathologists. In laryngeal control therapy, you will be instructed on a set of breathing (respiratory retraining) exercises designed to keep the vocal folds open and the throat relaxed. The goal of therapy is to reduce the effort it takes to breathe and to retrain the breath cycle in attempt to prevent shortness of breath.