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UR Medicine / Otolaryngology (ENT) / Speech Pathology / Our Services / Paradoxical Vocal Fold Motion


Paradoxical Vocal Fold Motion (PVFM) and Vocal Cord Dysfunction (VFD)

Paradoxical vocal fold motion (PVFM), also called vocal cord dysfunction (VCD), is partial closure of the vocal folds when they are supposed to be open, restricting the airway and causing feelings of shortness of breath

  • Primary Symptoms – Difficulty with inhalation (feelings like you can’t get air in), throat / neck tightness, noisy breathing (stridor)
  • Secondary Symptoms – Cough, hoarseness

What are the triggers for PVFM and VCD? 

Triggers can be environmental (perfumes, fuel fumes, dust), internal (laryngopharyngeal reflux disease, post-nasal drip, allergies), associated with exertion (physical exercise), psycho-social (related to stress or emotional situations) or associated with lower airway disease (asthma, obstructive sleep apnea, COPD, chronic bronchitis, pulmonary fibrosis, pulmonary hypertension, tracheobronchomalasia).

Speech-Language Pathology Evaluation & Therapy

Our Speech-Language Pathologists (SLP), have specialty training and expertise breathing disorders.  The SLP complete a personalized assessment of your breathing.  Assessment will include:

  • A detailed history collection
  • Laryngeal Function Studies consisting of computerized voice analysis and airway measures
  • Behavioral voice and communication analysis (as needed)
  • Education and trials of rescue breathing strategies

Our SLPs can help with PVFM by teaching an individual how to increase control of their dyspnea (shortness of breath) and PVFM symptoms, develop strategies to control these symptoms, provide education about PVFM and provide vocal hygiene training.

  • The main goals of therapy are:
  1. Education on rescue breathing strategies to alleviate immediate symptoms
  2. Retrain and strengthen respiratory muscles
  3. Reduce laryngeal irritation and maximize laryngeal hygiene
  4. Tolerance/Desensitization therapy as needed

Techniques to Control PVFM / Breathing Attacks

  • First, identify what triggers the PVFM episodes / shortness of breath
  • Identify the feeling in the throat or chest that occurs before these attacks start
  • Implement rescue breathing techniques, such as sniff in through your nose and blow out through pursed lips

Laryngeal Hygiene

  • Maximize systemic hydration (at least 48-60 oz of water per day).  Keep water with you at all times.
  • Implement surface hydration (steam inhalation, humidification)
  • Avoid smoking and passive exposure to smoke
  • Minimize consumption of substances with a drying effect on the larynx, including: alcohol, caffeine, medicated cough lozenges
  • Implement diet and lifestyle modifications to reduce laryngopharyngeal reflux and gastroesophageal reflux
  • Attend voice therapy, if prescribed, to learn good vocal technique to reduce irritation of the larynx from poor speaking techniques. 
  • Use of nose rather than mouth breathing to increase ambient humidity when possible