Understanding Paradoxical Vocal Fold Motion - Symptoms, Diagnosis, and Treatment Options

Introduction

Vocal chords stay open during regular breathing, allowing air to flow easily through the windpipe. The vocal folds shut during breathing in paradoxical vocal fold movement (PVFM), commonly known as vocal cord dysfunction or laryngospasms. Due to its resemblance to asthma, paradoxical vocal fold motion (PVFM) is an underdiagnosed respiratory condition. By examining the symptoms, current treatments, and diagnostic techniques, this article seeks to shed light on PVFM.

What Is Paradoxical Vocal Fold Motion?

When the movement of the vocal cords is abnormal, an episodic disorder known as paradoxical vocal fold motion (PVFM) or vocal cord dysfunction occurs. When a person breathes, the vocal cords are open; when they talk, sing, swallow, or lift heavy objects, they are closed. It is known as vocal cord dysfunction when the voice cords close when one wants them to open to breathe—an unnatural constriction of the voice box results from this improper action of the vocal cords. There may be a restriction in the amount of space available for air to pass through the vocal cords due to the narrowing of the voice box, which can cause difficulties breathing in and out of the lungs. Individuals who experience PVFM episodes frequently have highly reactive or sensitive airways. Typical catalysts consist of:

• Acid reflux.

• Work out.

• Airborne particle allergy.

• Postnasal drip.

• Intense feeling.

• Overuse of voice.

• Cough.

• Smoke.

Asthma and vocal cord dysfunction can have similar symptoms and causes, leading to the misdiagnosis of vocal cord dysfunction as asthma. The distinction between PVFM and asthma is that the former is treatable with bronchodilators, such as Albuterol, which opens the breathing tubes. The bronchodilator will only be effective if it has PVFM.

What Are the Symptoms of Paradoxical Vocal Fold Motion?

Accurate diagnosis of PVFM requires recognition of its symptoms. Typical signs and symptoms include:

• Inspiratory Stridor: Breathing noises made when inhaling are known as inspiratory striders.

• Expiratory Stridor: Breathing difficulties or wheezing are signs of an expiratory strider.

• Breathlessness: The sensation of being out of breath.

• Coughing with Tightness in the Throat: Prolonged coughing and tightness in the throat.

• Exercise-Supported Symptoms: Engaging in physical exercise may make symptoms worse.

What Are the Causes of Paradoxical Vocal Fold Motion?

There is no recognized cause of PVFM. It often begins with brief bouts and might be brought on by specific meals, scents, or physical activity. On the other hand, some people never encounter any triggers for PVFM. PVFM may also be caused by other variables such as stress, anxiety, and acid reflux. It is important to consider physiological and psychological aspects when evaluating people with PVFM.

What Is the Diagnosis of Paradoxical Vocal Fold Motion?

Clinical assessment, diagnostic testing, and ruling out other respiratory disorders are used to diagnose PVFM. The following are the crucial steps in PVFM diagnosis:

Clinical Assessment:

1. A thorough medical history is obtained to comprehend the patient's symptoms, triggers, and general health.

2. The medical professional will ask whether the patient has expiratory or inspiratory symptoms, such as tightness in the throat, coughing, shortness of breath, or stridor.

Laryngoscopy:

1. Direct visualization through a rigid or flexible laryngoscope of the vocal folds.

2. A laryngoscopy allows a medical expert to see how the vocal folds move during inspiration and expiration.

Tests For Pulmonary Function (PFTs):

1. PFTs assist in evaluating lung function and separating asthma from PVFM.

2. The volume and velocity of air that can be breathed and expelled are measured by spirometry.

Provocation Test:

1. Symptoms are induced by exercise difficulties or exposure to stimuli.

2. During exercise, continuous laryngoscopy can record aberrant movements of the vocal folds.

Collaboration With Experts:

Cooperation with pulmonologists, speech-language pathologists, and other experts is essential for a thorough assessment.

What Is the Treatment for Paradoxical Vocal Fold Motion?

Treatment for PVFM frequently takes a multidisciplinary approach, treating the disorder's underlying psychological and physical components. These are typical courses of treatment options:

Speech Pathology:

1. Speech-language pathologists employ various methods to enhance coordination and retrain the vocal folds.

2. Exercises to improve relaxation, breath support, and appropriate vocal fold movement may be part of therapy.

Breathing Exercises:

1. Patients pick up skills to regulate and enhance their breathing patterns.

2. Pursed-lip breathing and diaphragmatic breathing are helpful symptom management techniques.

Stress Management and Counseling:

1. It is crucial to address psychological elements like stress and anxiety.

2. Reducing causes for paradoxical vocal fold motion might be accomplished with counseling and stress-reduction strategies.

Drugs:

1. Medication may be recommended in some circumstances to treat symptoms.

2. Depending on each person's demands, bronchodilators or anti-anxiety drugs may be taken into consideration.

Patient Education:

1. Long-term effectiveness depends on educating patients about their illnesses, triggers, and symptom management.

2. Provide knowledge on how to reduce exacerbations and lifestyle adjustments.

Monitoring and Follow-Up:

1. Follow-up sessions are crucial to evaluate the patient's progress and make any required modifications to the treatment plan.

2. Keep an eye out for any modifications to the symptoms or the emergence of fresh triggers.

Changes in Lifestyle: Reducing exposure to environmental triggers, such as allergens or irritants, can help with symptom management.

Emergency Procedure: Creating an emergency action plan with medical professionals guarantees a prompt reaction for patients with severe symptoms in acute exacerbations.

What Is the Differential Diagnosis of Paradoxical Vocal Fold Motion?

The following are some conditions that clinicians may consider in the differential diagnosis of PVFM:

• Asthma: Asthma, a prevalent respiratory condition characterized by airway inflammation and bronchoconstriction, shares symptoms such as wheezing, coughing, and shortness of breath with PVFM.

• Chronic Obstructive Pulmonary Disease (COPD): COPD, encompassing chronic bronchitis and emphysema, leads to airflow obstruction and symptoms akin to PVFM, including wheezing and difficulty breathing.

• Gastroesophageal Reflux Disease (GERD): GERD, causing acid reflux that may irritate the vocal folds, can manifest symptoms resembling PVFM, such as throat tightness and persistent coughing.

• Upper Airway Cough Syndrome (UACS): UACS, or postnasal drip syndrome, can contribute to chronic cough and throat irritation, mirroring PVFM symptoms and necessitating a thorough evaluation.

• Allergic Rhinitis: Allergies affecting the upper respiratory tract can result in nasal congestion, throat irritation, and coughing, overlapping with PVFM symptoms.

• Anxiety and Panic Disorders: Psychological factors, including anxiety and panic disorders, may present with respiratory symptoms akin to PVFM, emphasizing the importance of assessing emotional factors.

• Vocal Cord Lesions or Polyps: Structural abnormalities like nodules or polyps on the vocal cords can cause changes in voice and respiratory difficulties, requiring differentiation from the functional disorder of PVFM.

• Neuromuscular Disorders: Conditions impacting nerves or muscles involved in breathing may lead to respiratory challenges, necessitating consideration, particularly if there is a limited response to speech therapy.

• Infections: Respiratory infections, viral or bacterial, can exhibit symptoms resembling PVFM, underscoring the importance of ruling out infections through appropriate diagnostic tests.

• Laryngeal Obstruction Due to Tumors or Masses: Benign or malignant growths in the larynx causing airway obstruction can present with stridor or breathing difficulties, requiring distinction from PVFM.

Conclusion

Paradoxical vocal fold motion poses distinct difficulties for diagnosis and treatment, frequently necessitating cooperation between medical professionals with expertise in respiratory, speech, and psychiatric fields. People with PVFM may actively manage and enhance their respiratory health by knowing the symptoms, causes, and available treatments.