Paradoxical Vocal Fold Motion: A Tutorial on a Complex Disorder and the Speech-Language Pathologist’s Role

Mathers-Schmidt, Barbara

doi:10.1044/1058-0360(2001/012)

Cited by 64 publications

(63 citation statements)

References 67 publications

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“…As demonstrated by the terms initially used to describe the condition, such as hysterical stridor, factitious asthma, and Munchausen stridor, many investigators have postulated that PVFM might be caused by psychological stress, anxiety, trauma, hysteria, or other psychiatric conditions. A number of studies have reported a high prevalence of these types of conditions in their sample [22-28] but other investigators have not, and some authors have argued that the higher rates of anxiety and depression that have been described may be the effect rather than the cause of PVFM [13, 29, 30]. There are clearly some individuals in whom counseling alone or in conjunction with speech therapy can produce a resolution of symptoms [19].…”

Section: Discussionmentioning

confidence: 99%

“…Key components of PVFM treatment include patient education, supportive counseling, tension reduction/relaxation, and training in appropriate breathing techniques, tailored to the needs of the individual patient [13]. During evaluation, “rescue” breathing strategies are trialed using endoscopic biofeedback to determine which will be most effective in re-establishing the glottic airway in the event of an acute PVFM attack [14].…”

Section: Methodsmentioning

confidence: 99%

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Functional Outcomes after Behavioral Treatment of Paradoxical Vocal Fold Motion in Adults

Drake

Palmer

Schindler

et al. 2017

Folia Phoniatr Logop

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Objective: Paradoxical vocal fold motion (PVFM) is responsive to behavioral therapy, often resulting in a remission of symptoms, but little is known about whether treatment is beneficial with regard to PVFM-associated psychological symptoms or functional limitations. The goal of the study was to identify patient perceptions of the impact of treatment for PVFM and characteristics associated with treatment outcomes. Methods: A survey was conducted of all adults who had received at least 1 session of treatment for PVFM in our outpatient clinic over a 2-year period. Results: The 39 participants ranged in age from 18 to 82 and had received a median of 3 treatment sessions. At a median follow-up of 10 months following treatment, respondents reported improvements in a wide range of areas, including sports and leisure, daily activities, and social participation. The majority reported improvements in feelings of anxiety, helplessness, and control. Poorer outcomes were associated with more severe voice symptoms, fewer treatment sessions, and needing oral steroids for asthma control. Conclusion: There was a reduction in a wide range of activity limitations after treatment. Feelings of control were strongly associated with positive outcomes. The therapy appeared to be equally effective for adults with exercise-induced and environmental variants of PVFM.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Functional Outcomes after Behavioral Treatment of Paradoxical Vocal Fold Motion in Adults

Drake

Palmer

Schindler

et al. 2017

Folia Phoniatr Logop

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“…Extrathoracic airway hyperresponsiveness is thought to be the primary underlying pathophysiology of PVFM [4] . PVFM has been associated with aetiological factors such as psychological conditions, laryngeal dystonia and airway irritation due to GER or sinusitis [5] .…”

Section: Introductionmentioning

confidence: 99%

Acoustic and Electroglottographic Voice Characteristics in Chronic Cough and Paradoxical Vocal Fold Movement

Vertigan

Theodoros

Winkworth

et al. 2008

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Objective: Chronic cough (CC) and paradoxical vocal fold movement (PVFM) may be associated with voice problems. Objective acoustic and electroglottographic (EGG) measures have the capacity to delineate these vocal characteristics. This study investigated acoustic and EGG voice features of CC and PVFM. Patients and Methods: Acoustic and EGG findings were compared among 5 groups of participants. The first 3 groups, CC (n = 56), PVFM (n = 8) and combined CC-PVFM (n = 55), included individuals with cough and respiratory symptoms that persisted despite medical treatment. Groups 4 and 5 included individuals with muscle tension dysphonia (n = 25) and healthy controls (n = 27). Results: Participants with CC/PVFM recorded reduced phonation times (p < 0.001), greater jitter (p < 0.001), reduced harmonic to noise ratio (p = 0.001), reduced phonation range (p = 0.007) and shorter closed phase of vocal fold vibration (p = 0.006) in comparison to healthy controls. Females with CC had reduced fundamental frequency in connected speech (p = 0.009). There was consistent overlap between the participants with CC and those with PVFM. Duration of closed phase and fundamental frequency were lower in the participants with CC and PVFM than in those with muscle tension dysphonia. Conclusion: These results confirm abnormalities in acoustic and EGG voice features in CC and PVFM.

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“…The label PVFM or PVFMD has largely replaced the more clinically common term vocal cord dysfunction in the literature and is used to describe narrowing of the laryngeal airway particularly during the inspiratory phase of breathing. Various mechanisms have been implicated for this disorder, the most common and most literal of which is inappropriate adduction of the vocal folds (Andrianopoulos, Gallivan, & Gallivan, 2000;Mathers-Schmidt, 2001;Sandage & Zelazny, 2004). Another documented mechanism is prolapse of laryngeal structures into the airway, also known as exercise-induced laryngomalacia (Christopher & Morris, 2010;Heinle, Linton, & Chidekel, 2003;Hicks, Brugman, & Katial, 2008).…”

mentioning

confidence: 99%

“…The most common demographic group for exercise-induced PVFMD comprises teenage girls who participate in competitive sports (Hicks et al, 2008;Landwehr, Wood, Blager, & Milgrom, 1996;Mathers-Schmidt, 2001). Previously, we demonstrated that 1-min trials with the APD are feasible and reliable before and after exercise (Gallena et al, 2014).…”

mentioning

confidence: 99%

The Effect of Exercise on Respiratory Resistance in Athletes With and Without Paradoxical Vocal Fold Motion Disorder

Gallena

Solomon

Johnson

et al. 2015

Am J Speech Lang Pathol

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a,e Purpose: An investigational, portable instrument was used to assess inspiratory (R i ) and expiratory (R e ) resistances during resting tidal breathing (RTB), postexercise breathing (PEB), and recovery breathing (RB) in athletes with and without paradoxical vocal fold motion disorder (PVFMD). Method: Prospective, controlled, repeated measures withinsubject and between-groups design. Twenty-four teenage female athletes, 12 with and 12 without PVFMD, breathed into the Airflow Perturbation Device for baseline measures of respiratory resistance and for two successive 1-min trials after treadmill running for up to 12 min. Exercise duration and dyspnea ratings were collected and compared across groups. Results: Athletes with PVFMD had lower than control R i and R e values during RTB that significantly increased at PEB and decreased during RB. Control athletes' R e decreased significantly from RTB to PEB but not from PEB to RB, whereas R i did not change from RTB to PEB but decreased from PEB to RB. Athletes without PVFMD ran longer, providing lower dyspnea ratings. Conclusion: Immediately following exercise, athletes with PVFMD experienced increased respiratory resistance that affected their exercise performance. The difference in resting respiratory resistances between groups is intriguing and could point to anatomical differences or neural adaptation in teenagers with PVFMD. The Airflow Perturbation Device appears to be a clinically feasible tool that can provide insight into PVFMD and objective data for tracking treatment progress.

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Paradoxical Vocal Fold Motion: A Tutorial on a Complex Disorder and the Speech-Language Pathologist’s Role

Cited by 64 publications

References 67 publications

Functional Outcomes after Behavioral Treatment of Paradoxical Vocal Fold Motion in Adults

Functional Outcomes after Behavioral Treatment of Paradoxical Vocal Fold Motion in Adults

Acoustic and Electroglottographic Voice Characteristics in Chronic Cough and Paradoxical Vocal Fold Movement

The Effect of Exercise on Respiratory Resistance in Athletes With and Without Paradoxical Vocal Fold Motion Disorder

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