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Transcript of PVFM
Paradoxical Vocal Fold Movement (PVFM)
What is it?
Treatment & Therapy
Also known as
A nonorganic voice disorder of the upper airway
Both true and false vocal folds display paradoxical function during respiration
For inspiration, expiration, or both
Laryngeal structures and appearance are all within normal limits
There is nothing abnormal or deviant about them structurally or how they look
When respiring, the tissues of the glottis (including the false VFs) constrict, leaving only a small glottal chink through which air can pass
In comparison to a normally-functioning larynx, the airway is considerably narrower
Symptoms are those shared with respiratory distress
PVFM symptoms don't respond to asthma medications or treatments
Voice symptoms from PFVM can include an intermittent stridor, strained vocal quality, and non-productive cough
There are three theories of possible etiology
Such as a form of conversion disorder, where
there is a sudden stress on one's life that triggers
unusual neurological response without an organic cause
Related to laryngopharyngeal reflux (LR)
or an upper airway sensitivity
As in a form of laryngeal dystonia
PVFM can be mistaken for asthma in
As high as 5% prevalence in Olympic-level athletes
Patients are usually asymptomatic during evaluation/assessment
Necessary to take a good case history
Suggested that PVFM can be induced and seen through the use of bronchoconstrictors (Guss & Mirza, 2006)
Through the use of methacholine testing (MCT)
Many therapies involve voice therapy and use of video-endoscopic biofeedback
Botulinum toxin (Botox) along with video feedback as another treatment option
There is no evidence of this treatment being more effective than other
The goal of treatment is to increase laryngeal control by 'retraining' normal
Educating the patient on what it feels like to have normal VF positioning during respiration and phonation
Making patients aware of deviant positioning that was problematic
Reestablishing a normal tidal respiration and airflow for phonation
Suggested techniques to use for laryngeal relaxation, airflow, and coordinated breath support:
Rapid adduction (ee-ee-ee)
Using /s/, /h/, /f/ words, phrases and sentences for airflow practice
For carryover, the patient is encouraged to practice breathing techniques during activity to carry over this breathing pattern while increasing respiration
During walking or exercising, for example
Bhargava, H.D., (2012, 02, 28). Lung functions for asthma.
Retrieved from http://www.webmd.com/asthma/lung-function-tests-asthma/
Boone, D.R., McFarlane, S.C., Von Berg, S.L., & Zraick, R.I.
(2010). The voice and voice therapy. (8th ed.). Boston: Mass: Allyn & Bacon.
Schwartz, S.K. (2004). The source for voice
disorders: Adolescent & adult. East Moline: IL: Linguisystems, Inc.