American Speech-Language-Hearing Association
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Paradoxical Vocal Fold Movement (PVFM)

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What is PVFM?

Paradoxical vocal fold movement (PVFM) is a voice disorder. The vocal folds (cords) behave in a normal fashion almost all of the time, but, when an episode occurs, the vocal cords close when they should open, such as when breathing.

What are signs and symptoms of PVFM?

PVFM can be mistaken for asthma as it leads to wheezing and difficulty breathing, sometimes to the point of requiring hospitalization.

How is PVFM diagnosed?

PVFM is often diagnosed by a team of professionals, including:

  • speech-language pathologist
  • neurologist
  • pulmonologist
  • otolaryngologist (Ear, Nose, and Throat doctor)
  • psychologist

Diagnosis is difficult because symptoms vary greatly between people. Episodes are not predictable. The team will review the person's medical history, including medications and smoking history. A laryngeal evaluation using endoscopy (passing a scope into the throat to view the vocal cords) is typically done. A voice evaluation by an SLP also aids in diagnosing this disorder.

What treatments are available for PVFM?

PVFM is treated both medically and behaviorally. Medical intervention addresses any physical and/or psychological factors. Behavioral intervention with an SLP includes vocal exercises, relaxation techniques, and proper breath support for speech. The goal of intervention is to make the individual aware of what triggers PVFM so they can avoid those situations. The person is also taught how to handle an episode when it occurs.

What causes PVFM?

PVFM episodes may be triggered by:

  • shouting or coughing
  • physical exercise
  • acid reflux
  • breathing cold air
  • irritants such as smoke or pollen
  • psychosocial issues
  • neurological issues

How common is PVFM?

ASHA has prepared a report, Incidence and Prevalence of Speech, Voice, and Language Disorders in Adults in the United States that includes information about how many people experience voice disorders.

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How effective are treatments for voice disorders?

ASHA has written a treatment efficacy summary on voice disorders [PDF] that describes evidence about how well treatment works. This summary is useful not only to individuals with voice disorders and their caregivers but also to insurance companies considering payment for much needed services for voice disorders.

What do SLPs do when working with individuals with PVFM?

The Preferred Practice Patterns for the Profession of Speech-Language Pathology outline the common practices followed by SLPs when engaging in various aspects of the profession. The Preferred Practice Patterns for voice assessment and intervention are outlined in sections 34 and 35.

Additional information about the role of the SLP is available in the article " Paradoxical Vocal Fold Motion: A Tutorial on a Complex Disorder and the Speech-Language Pathologist's Role" [PDF].

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