Is it asthma or a vocal cord dysfunction?

Young Black man bending over with hands on knees, breathing deeply after outdoor training

Many athletes with breathing difficulties are treated for asthma. But when treatments don’t work, the search for an answer often ends with a little-known diagnosis, and one that comes with a dose of relief.

In layman’s terms, it’s usually referred to as vocal cord dysfunction, but the term generally used by medical professionals is “paradoxical vocal fold motion disorder,” or PVFMD.

It means that your vocal cords tighten up when they should be open. It’s not life-threatening, and it doesn’t damage your lungs.

At The Ohio State University Wexner Medical Center, lung and vocal cord experts work together in a joint clinic to identify PVFMD. Patients are tested to determine if they have asthma or another breathing issue, then evaluated for the condition. If a vocal cord issue is suspected, they’re referred directly to an ear, nose and throat expert.

While athletes make up a large number of patients, the condition can affect anyone. Someone with a mild lung disease, for example, may also have a cough caused by PVFMD, or a person who works with cleaning supplies or other chemicals could have episodes triggered by the condition.

In our clinic, we’re sometimes able to tell patients that they don’t have asthma, a diagnosis they’ve lived with for years, and they can stop taking asthma medication altogether. Sometimes we find a patient has both asthma and PVFMD but can rely on asthma medication less frequently.

Read on for more information about PVFMD.

What is paradoxical vocal fold motion disorder?

PVFMD, often called vocal cord dysfunction, is a condition involving the voice box.

Normally, when we talk, our vocal cords close, and when we breathe, they open. With PVFMD, the vocal cords don’t always open when they should. So, it’s as if a door is closing on the windpipe when you’re trying to let air through. A person experiencing this feels short of breath, but the lungs are fine.

PVFMD isn’t life-threatening, but it can feel that way. It leads to emergency department visits and a lot of medical care and can really impact quality of life.

What are symptoms of vocal cord dysfunction?

PVFMD symptoms are similar to symptoms of asthma, so testing should be done to rule out any lung issues.

  • Shortness of breath
  • Tight feeling in the throat (as opposed to in the chest with asthma)
  • Noisy breathing (usually when inhaling, versus more common wheezing on exhale with asthma)
  • No response to rescue inhalers
  • Short duration, with episodes that may resolve within minutes

Some patients with vocal cord dysfunction have a persistent cough and have been unsuccessfully treated for allergies, asthma or reflux.

Vocal cord dysfunction does not cause sleep disruption. Because it’s a condition of the voice box, it also does not cause issues with swallowing, eating or drinking.

Gender-affirming vocal care helps patients find their voice

What triggers vocal cord dysfunction?

PVFMD episodes are triggered by things that irritate the throat, such as:

  • Exercise and other physical stress
  • Strong odors
  • Changes in temperature
  • Acid reflux
  • Post-nasal drainage
  • Upper respiratory tract infections (like cold and flu)
  • Uncontrolled allergies
  • Poor hydration
  • Dryness
  • Stress or anxiety

Some patients’ episodes are triggered by stress or anxiety, but often the stress and anxiety associated with PVFMD come after an episode.

How is vocal cord dysfunction treated?

PVFMD is highly treatable with therapy, and most patients respond well. The therapy is referred to in different ways, but you might hear it called laryngeal control therapy or respiratory retraining therapy. It’s much like sending the voice box to obedience school.

It works by retraining or coaxing the muscle memory in the vocal cords. This helps them rest in a more open position and counteract the tendency to tighten. Patients also identify triggers and learn techniques they can use when they feel the vocal cords start to tighten.

When should I see a doctor about vocal cord dysfunction?

Typically, a patient is referred to a doctor specializing in PVFMD after already visiting an expert in lung health to rule out more serious conditions, which is a critical step.

If you’re concerned about symptoms, it’s a good idea to get lung function tested. Cardiac testing is sometimes necessary as well.

Is vocal cord dysfunction different from vocal cord paralysis?

Yes. With vocal cord paralysis, the vocal cords are physically incapable of moving because the nerve supply to the vocal cords has been lost.

People with PVFMD have full mobility and no nerve weakness or muscle weakness. Their vocal cords just get irritated easily, and when that happens, they tend to tighten.

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