paradoxical vocal fold movement pvfm
Download
Skip this Video
Download Presentation
Paradoxical Vocal Fold Movement (PVFM)

Loading in 2 Seconds...

play fullscreen
1 / 16

Paradoxical Vocal Fold Movement PVFM - PowerPoint PPT Presentation


  • 1576 Views
  • Uploaded on

Paradoxical Vocal Fold Movement (PVFM). Also know as... Vocal Cord Dysfunction Vocal Cord Malfunction Laryngeal Dyskinesia Inspiratory Adduction Paroxysmal Laryngospasm Functional Airway Obstruction Adductor Laryngeal Breathing Disorder Fogerty 4/8/03.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Paradoxical Vocal Fold Movement PVFM' - duff


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
paradoxical vocal fold movement pvfm

Paradoxical Vocal Fold Movement(PVFM)

Also know as...

Vocal Cord Dysfunction

Vocal Cord Malfunction

Laryngeal Dyskinesia

Inspiratory Adduction

Paroxysmal Laryngospasm

Functional Airway Obstruction

Adductor Laryngeal Breathing Disorder

Fogerty 4/8/03

definition of pvfm
Definition Of PVFM
  • Inappropriate adduction of the vocal folds during inhalation
  • Two physiological variants:

1. Adduction of true and false folds throughout the breathing cycle

2. Adduction during deep inspiration and slight abduction on expiration

epidemiology
Epidemiology
  • incidence / prevalence unclear
    • may be as high as 40% of patients with asthma
  • age of onset: 9+ years
  • usually female
etiology
Etiology

May be...

  • Coexistent with asthma
  • Precipitated by emotional events
  • Occurring with or without organic conditions

(Mathieson, 2001)

types in order of prevalence
Types (in order of prevalence)
  • Gastroesophageal reflux
  • Psychogenic stridor
  • Respiratory-type laryngeal dystonia
  • Drug-induced laryngeal dystonic reactions
  • Asthma-associated laryngeal dysfunction
  • Abnormalities that affect the brainstem

(Koufman, 1994)

signs symptoms
Signs & Symptoms
  • sensation of throat being closed
  • dramatic episodes of breathing difficulty
  • stridor
  • pt. struggles to inspire
  • shortness of breath
  • ‘wheezing’
  • cough
triggers
Triggers
  • shouting or coughing
  • physical exercise
  • acid reflux
  • breathing cold air
  • irritants (smoke, pollen, etc.)
  • psychosocial issues
  • neurological issues

(ASHA, 2001)

diagnosis history
Diagnosis - History
  • Throat tightness
  • voice changes during attack
  • little/no improvement with asthma Tx
  • no night awakening secondary to attack
physical exam
Physical Exam
  • ‘clean wheeze’
  • ask pt. to pant (may improve symptoms)
  • ask pt. to hold breath

Pulmonary

  • normal lung volume
  • relatively normal expiratory flows
laryngoscopy
Laryngoscopy
  • “crucial in making the diagnosis” (Koufman, 1994)

Classic Pattern

  • VF adduction of anterior two-thirds during inspiration
  • Posterior glottal chink during closure on inspiration
  • 50% will have normal VF motion when asymptomatic
laryngoscopic examination
Laryngoscopic Examination
  • alternatively phonate /i/ and sniff, rapidly
  • take deep breaths
  • cough, throat clear, chuckle
  • count to fifty, rapidly and loudly
  • read a written passage in a loud voice
  • sing

(Koufman, 1994)

differential features
Differential Features

(Koufman, 1994)

confused diagnoses
Confused Diagnoses
  • Asthma
  • Other causes of laryngeal obstruction
    • bilateral vocal fold paralysis
    • laryngeal stenosis

Abduction may be inconsistent, incomplete, inappropriate in PVFM, but must occur for a diagnosis

Many patients have inappropriately received intubation or tracheostomy. Sometimes multiple times!

behavioral treatment
Behavioral Treatment
  • Understanding anatomy and physiology of the laryngeal system
    • learn to control vocal fold movement
  • Performing relaxation exercises
    • differential relaxation of excess tension in upper body
  • Focusing
    • focal breathing on face rather than neck
  • Reducing precipitators
    • daily log to chart precipitators of PVFM episodes
additional treatment
Additional Treatment
  • Heliox - 80% helium, 20% oxygen
    • relieves most severe symptoms
  • Psychological intervention
ad