Exercise-Induced PVFM Often Challenging to Diagnose

Patients are taught to breathe from the diaphragm with a relaxed upper body and shoulder area, alleviating tension in dysrhythmic breathing in the upper thoracic area, added Dr. Klaben. Breathing in through the nose will open the vocal folds to maximal abduction, she said. With athletes, we’ll have them start this type of breathing in a supine position, gradually move them to upright, and then work them on a treadmill or observe them while sprinting, she said.

The therapist may also use biofeedback that allows the patient to view the vocal folds while adducting during inspiration, said Dr. Mirza. With visualization, patients actually become aware of what happens to their vocal folds when they breathe in and out and learn to develop better control of their vocal fold movement, she said.

If the individual is being treated for laryngopharyngeal reflux, diet and behavioral changes, such as not eating prior to sprinting, may also be effective in the control of the condition, said Dr. Klaben.

To address anxiety resulting in excessive laryngeal tension, the speech-language pathologist can help patients combat negative self-talk with cognitive behavioral strategies, said Dr. Mathers-Schmidt. However, some circumstances require a referral to a psychologist, she noted.

Botox injections into the hyperadducting folds may help patients who do not respond to other forms of therapy, added Dr. Mirza. The effect of an injection may last for several months, she noted.

Overall, a multidisciplinary approach to PVFM treatment that includes otolaryngologists, speech pathologists, psychologists, and immunologists, who can address any asthma that might be present, is needed, concluded Dr. Mathers-Schmidt.

References

1. Cukier-Blaj S, Bewley A, Aviv JE, Murry T. Paradoxical vocal fold motion: a sensory-motor laryngeal disorder. Laryngoscope 2008;118(2):367-70.

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2. Murry T, Tabaee A, Owczarzak V, Aviv JE. Respiratory retraining therapy and management of laryngopharyngeal reflux in the treatment of patients with cough and paradoxical vocal fold movement disorder. Ann Otol Rhinol Laryngol 2006;115(10):754-8.

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