Paradoxical Vocal Fold Movement (PVFM)

Paradoxical vocal fold movement, or PVFM, makes it hard to breathe or talk. It does not happen all of the time but can cause serious problems when it does happen. Children and adults can have PVFM. Speech-language pathologists, or SLPs, can help. Visit ProFind to locate a professional in your area.

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About PVFM

PVFM happens when your vocal folds close when they should open. When you take a breath, your vocal folds should open to let air through to your lungs. With PVFM, your vocal folds close part way or all the way. This can make it hard to breathe. PVFM does not happen all the time. You may not have any other problems with your vocal folds except when PVFM happens.

Signs and Symptoms of PVFM

PVFM can cause breathing problems. Some people will need to go to the hospital if they are having a lot of difficulty breathing. People with PVFM may be told that they have asthma. But PVFM is not asthma. It is a problem with how and when the vocal folds move. Here are some symptoms you might have when PVFM happens:

  • coughing
  • rough-sounding voice
  • difficulty breathing air in
  • noisy breathing
  • tightness in the throat
  • lightheadedness 
  • sudden loss of voice 

Causes of PVFM

The exact cause of PVFM is not known, but it may be triggered by

  • acid reflux,
  • exercise,
  • breathing in cold air,
  • smoke or pollen, and/or
  • emotional stress.

Seeing a Professional

Testing for PVFM

You will probably see a team of professionals to find out if you have PVFM. The SLP is an important member of the team. Other members may include the following:

  • allergist
  • pulmonologist
  • otolaryngologist (ear, nose, and throat doctor)
  • gastroenterologist
  • neurologist
  • psychologist

People with PVFM may have different symptoms. This makes it hard to know if you have PVFM or some other problem. The team will go over your medical history. They will ask about the medicines you take and if you smoke.

The SLP or doctor can look at your vocal folds through a tube, called an endoscope, that goes in through your mouth or nose. A flashing light, called a stroboscope, lets them watch your vocal folds move when you breathe or talk.

Treatments for PVFM

The goal of treatment for PVFM is to make sure your vocal folds open normally and stay open while you are breathing. You also will become aware of what triggers PVFM so you can avoid those triggers.

You may need medical treatment for PVFM if you have a medical condition—like allergies or reflux—that trigger PVFM. You may need to see a psychologist if emotional stress is causing your PVFM.

Treatment by an SLP is very important. The SLP can teach you exercises that help keep your vocal folds open when you breathe and when PVFM happens.  

See information for professionals on ASHA’s Practice Portal pages on Voice Disorders and Aerodigestive Disorders.

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