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Paradoxical Vocal Fold Movement (PVFM) PowerPoint PPT Presentation


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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.

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Paradoxical Vocal Fold Movement (PVFM)

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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

  • 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

  • incidence / prevalence unclear

    • may be as high as 40% of patients with asthma

  • age of onset: 9+ years

  • usually female


Etiology

May be...

  • Coexistent with asthma

  • Precipitated by emotional events

  • Occurring with or without organic conditions

    (Mathieson, 2001)


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

  • sensation of throat being closed

  • dramatic episodes of breathing difficulty

  • stridor

  • pt. struggles to inspire

  • shortness of breath

  • ‘wheezing’

  • cough


Triggers

  • shouting or coughing

  • physical exercise

  • acid reflux

  • breathing cold air

  • irritants (smoke, pollen, etc.)

  • psychosocial issues

  • neurological issues

    (ASHA, 2001)


Diagnosis - History

  • Throat tightness

  • voice changes during attack

  • little/no improvement with asthma Tx

  • no night awakening secondary to attack


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

  • “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

  • 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

(Koufman, 1994)


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

  • 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

  • Heliox - 80% helium, 20% oxygen

    • relieves most severe symptoms

  • Psychological intervention


References


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