Paradoxical vocal fold motion (PFVM), also known as vocal fold dysfunction (VCD), is a condition characterized by abnormal motion of the vocal folds. For example, during inhalation, the vocal folds open widely to accommodate airflow into the lungs. When we talk, or cough, the vocal folds come together to make sound. If the vocal folds are closed when breathing in, this is opposite from what we expect or “paradoxical”. This can be scary as this is accompanied by noisy breathing and a feeling of reduced airflow. Thankfully, this is temporary but often leaves patients frightened about when the next episode will occur.
Throughout the medical literature, paradoxical vocal fold motion is known to impact more women than men. We do not fully understand why this occurs in general, and do not understand why women are much more likely to be impacted. Historically, this condition has been thought to be psychiatric in origin and we feel strongly this is not the case. We have observed this phenomenon can happen in response to irritants like acid reflux or exercise. It can also happen when speaking or coughing. We treat this by decreasing things that can cause laryngeal irritation in additional to learning specific breathing techniques from a speech and language pathologist. As asthma is often present in the same patient, we work closely with the pulmonary team to optimize a treatment plan. We also offer cardiopulmonary exercise testing (CPET) with laryngoscopy to understand symptoms that occur with exercise.
In addition to paradoxical vocal fold motion, other conditions in the larynx such as idiopathic subglottic stenosis and phonotraumatic lesions (benign vocal fold lesions associated with voice use) are also more common in women.
Clinicians like Jayme Dowdall, MD and Chandler Thompson, DMA, CCC-SLP are committed to treating women with upper airway breathing disorders and voice disorders. We are in the early stages of developing a research program to better understand how breathing difficulty can manifest in the larynx.