What Is Paradoxical Vocal Cord Motion Disorder?
Paradoxical vocal cord motion disorder (PVCM) is a disorder causing abnormal movement of the vocal folds during breathing. It is also called vocal cord dysfunction or paradoxical vocal cord motion dysfunction. The vocal folds are located within the larynx (voice box) at the top of the trachea. In normal conditions, it opens wide and allows air to pass through to help to breathe, and while talking, the vocal folds close together to allow the vocal folds to vibrate to produce sound. When there are changes in this action, like the vocal folds closing during breathing instead of opening, the flow of air is blocked, which causes the individual to feel severe suffocation and trouble breathing. Paradoxical motion primarily affects breathing. However, it also impacts an individual's speech and swallowing.
Paradoxical vocal cord motion disorder poses great challenges in both diagnosis and management. The disorder is often misdiagnosed as asthma, where the airway tightens and causes difficulty in breathing, so differential diagnosis plays a key role as it could lead to high medical utilization, unnecessary use of drugs, and occasionally tracheal intubation or tracheostomy (a surgical procedure that creates a hole in the trachea as an alternative airway for breathing). Laryngoscopy (a procedure to examine the larynx) is a standard for diagnosing PVCM, which helps differentiate between asthma and PVCM.
What Are the Causes of Paradoxical Vocal Cord Motion Disorder?
The exact cause of PVFM is unclear and is often considered multifactorial.
Several factors can contribute to paradoxical vocal cord motion disorder:
1. Psychological Factors - PVFMD can be associated with stress, anxiety, or psychological trauma. Recent research has shown that individuals experiencing high levels of stress or anxiety may unconsciously tense the neck and throat muscles, leading to vocal cord constriction during inhalation. Prolonged muscle tension in the voice box can contribute to incoordination of the vocal control system.
2. Gastroesophageal Reflux Disease (GERD) - GERD produces acid reflux, which may contribute to PVFM. When acid reflux is severe and reaches the throat, it can irritate the vocal folds, and the vocal folds close as a protective mechanism, which can contribute to a PVFM episode.
3. Respiratory Conditions - Respiratory infections, irritants, or allergies can cause inflammation of the vocal folds. The inflammation can cause hyperresponsiveness and paradoxical motion, leading to the closure of vocal folds.
4. Asthma - The association between asthma and PVCM is still unclear. Research has shown that this condition may present alone or in association with asthma.
5. Neurological Factors - Dysfunction in the central nervous system or peripheral nerves that control the vocal cords may contribute to PVFM. However, the neurological mechanisms involved in PVFM dysfunction are not fully understood.
What Are the Symptoms of Paradoxical Vocal Cord Motion Disorder?
The main symptom of PVFM is difficulty breathing. The problem may range from mild to severe, and depending on the severity, hospitalization may be required. Patients often have a feeling of tightness in the throat area. Symptoms typically occur in episodes, and an improvement in the symptoms can be noted after doing relaxing activities. The symptoms may feel similar to asthma. However, rescue inhalers and other medications for asthma will not be effective.
Other common symptoms reported in patients with paradoxical vocal cord motion disorder include:
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Throat tightness.
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Noisy breathing.
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Stridor (a harsh or grating sound on inhalation).
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A sensation of breathing through a straw
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Lightheadedness.
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Coughing.
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A feeling of choking or suffocation.
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Hoarseness of the voice or voice change.
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Sudden loss of voice.
How is Paradoxical vocal cord motion disorder diagnosed?
Diagnosing PVFM can be challenging as the symptoms overlap with those of asthma and other respiratory conditions.
Therefore, a proper evaluation is required, including the following:
1. Patient's History: The physician will check the patient's medical history and inquire about the symptoms, onset of the disorder, triggers, and possible stressors.
2. Pulmonary Function Tests (PFTs): These tests help to assess lung function and identify respiratory issues. This test shows how air flows into the lungs and if there is any blockage. Individuals with PVFM usually have normal pulmonary function tests. Difficulty breathing may be due to PVFM or in a situation where PVFD is in conjunction with another pulmonary disease. Identifying and treating any accompanying lung disease is necessary to achieve effective treatment.
3. Laryngoscopy: In this procedure, the vocal folds are checked using a thin, flexible instrument attached to a light and an endoscope camera. The instrument is inserted through the nose or mouth. During the procedure, the patient will be awake and asked to talk. Then the physician will check for the movement of the vocal fold during the trigger.
4. Investigation of Irritants: The diagnostic process should also check for important associated factors that act as triggers, such as acid reflux, allergies, stress, etc.
5. Provocation Tests: These tests involve inducing PVFM episodes under controlled conditions to confirm the diagnosis.
What Is the Treatment for Paradoxical Vocal Cord Motion Disorder?
The treatment of paradoxical vocal cord motion disorder will depend on the severity of the disorder. The treatment involves a multidisciplinary approach, addressing psychological and physical factors.
The treatment option includes:
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Respiratory Retraining - A series of breathing exercises, called respiratory retraining, help restore the proper opening of the vocal folds during episodes of PVCM. The breathing exercises can be curated to the specific triggers and needs of the patient, thereby maintaining proper vocal cord function during breathing.
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Psychotherapy - Cognitive-behavioral therapy (CBT) will be helpful in individuals in managing anxiety, stress, and emotional triggers that may lead to PVFM episodes.
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Medication - If PVCM is caused by acid reflux, medications may be prescribed to manage conditions, such as GERD or allergies, that will trigger PVFM.
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Speech Therapy - Speech-language pathologist will guide in retraining the vocal fold muscles to function correctly during inhalation and exhalation.
Conclusion:
Paradoxical vocal fold motion disorder is a condition affecting vocal fold closure during inhalation. This disease is misunderstood with other respiratory conditions, as both have similar symptoms. Early and accurate diagnosis is important for providing appropriate treatment and improving the quality of life. Treatment is often multifactorial, involving speech therapists and mental health specialists who can help individuals regain control over their breathing and voice.
