What is Paradoxical Vocal Fold Motion

Paradoxical vocal fold motion is a condition that causes shortness of breath and noisy breathing (stridor). It may also be called vocal cord dysfunction.

Normally, the vocal cords (vocal folds) inside the voice box (larynx) open when you breathe in and out. If you have paradoxical vocal fold motion, your vocal cords close when you try to breathe. This makes breathing difficult.

This condition can be scary, but it is usually not dangerous. It can be confused with asthma because the symptoms are similar.

What are the causes?

Paradoxical vocal fold motion is caused by overreaction (hyperexcitability) of the nerves that provide movement and feeling in the vocal cords. The cause of hyperexcitability is not known, but sometimes triggers can be identified. Common triggers of vocal cord hyperexcitability include:

• Stomach acid flowing up into your throat (gastric reflux).
• Mucus going down the back of your throat (postnasal drip).
• Infection in the nose, mouth, throat, or larynx (upper respiratory tract infection).
• Exercise.
• Strong smells.
• Cigarette smoke or other irritating substances in the air.
• Stress.
• Allergies.

What are the signs or symptoms?

Symptoms of this condition include:

• Shortness of breath. This may happen at rest or during exercise.
• Frequent coughing and clearing the throat.
• A feeling of choking or tightness in the throat.
• Stridor or wheezing.
• Hoarse voice.

Symptoms may come and go. They do not occur during sleep. They may range from mild to severe.

How is this diagnosed?

This condition can be hard to diagnose because it comes and goes and is similar to asthma. Your health care provider may suspect paradoxical vocal fold motion if you do not have symptoms while you sleep or if asthma medicines do not relieve your symptoms. Your health care provider may:

• Have you work with (refer you to) an ears, nose, and throat specialist (otolaryngologist, ENT) or a speech and language specialist (speech-language pathologist) who will examine your vocal cords to see if they close when you breathe. This examination is usually done by inserting a thin, flexible tube with a light and camera on the end of it through your nose to look down into your larynx (laryngoscopy). This is the most reliable way to diagnose the condition.
• Refer you to a breathing specialist (pulmonologist) who will do breathing tests (spirometry or pulmonary function tests, PFTs) to check for a breathing pattern that is typical for this condition.
• Do a physical exam.
• Ask about your symptoms and what seems to cause them (your triggers).
• Listen to your breathing.
• Test your blood for:
  • Oxygen levels.
  • Allergies.
• Do a chest X-ray.

How is this treated?

This condition is treated with speech or voice therapy, which includes breathing and relaxation exercises to help you learn how to relax and control your vocal cords. After you learn those exercises, you can practice them at home and use them to stop an attack. Talk therapy (psychotherapy) with a psychologist can help you learn ways to reduce stress and anxiety and avoid triggers.

In some cases, your health care provider may recommend medicines to treat an underlying condition that can trigger paradoxical vocal fold motion. These may include medicines for:

• Postnasal drip.
• Gastric reflux.
• Upper respiratory tract infection.
• Allergies.
• Stress.

Follow these instructions at home:

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Follow instructions from your speech or voice therapist about practicing your vocal cord relaxation and breathing exercises at home.
• Follow instructions from your psychologist about how to lower your stress and anxiety.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Avoid triggers.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider. Cigarette smoke may trigger this condition.
• Keep all follow-up visits as told by your health care providers, including therapists. This is important.

Contact a health care provider if:

• Your symptoms do not get better with treatment and home care.

Get help right away if:

• You have chest pain.
• You have trouble breathing that is not relieved by doing exercises and following instructions from your health care providers.

Summary

• Paradoxical vocal fold motion is a condition that causes your vocal cords (vocal folds) to close when you try to breathe.
• This condition is often triggered by stress or irritation of your vocal cords.
• Symptoms include sudden shortness of breath and noisy breathing (stridor).
• Doing a vocal cord exam (laryngoscopy) is the most reliable way to diagnose this condition.
• This condition is treated with speech or voice therapy and talk therapy (psychotherapy).