Paradoxical Vocal Cord Motion: Evaluation and Treatment

Paradoxical Vocal Cord Motion: Evaluation and Treatment
Presentation by:Starr M. Cookman, M.A., CCC-SLP
Speech Pathologist
Division of Otolaryngology, UCONN

Pseudonyms
* Episodic Laryngeal Dyskinesia
* Vocal Cord Dysfunction (VCD)
* Munchausen’s Stridor
* Emotional Laryngeal Wheezing
* Pseudo-asthma
* Fictitious Asthma

Definition of PVCM
Essential Features
Symptoms
* Stridor
* Difficulty with inspiratory phase
* Chest and/or throat tightening
* Dysphonia during/following an attack
* Abrupt onset and resolution
* Recalcitrant to medical treatment
* Seems to be related to stress and/or exercise.

Various Etiologies
* Laryngopharyngeal reflux
Vocal Fold Edema
Lx Erythema
Interarytenoid Edema
* Allergic rhinitis
* Conversion disorder
* Respiratory-type laryngeal dystonia
* Drug-induced laryngeal dystonic reactions
* Asthma-associated laryngeal dysfunction
* Brainstem abnormalities
* Chronic laryngeal instability & tension

Patient Profile
Differential Diagnosis
* Mass Obstruction
* Bilateral vocal fold paralysis
* Anaphylactic laryngeal edema
* Extrinsic airway compression
* Foreign body aspiration
* Infectious croup
* Laryngomalacia
* Exercise Induced Asthma/ Asthma

Typical Spirometry Findings for PVCM
* Asymptomatic
* Symptomatic
PVCM Vs. Exercise Induced Asthma
Assessment Protocol
Evaluation Questions
Laryngeal Examination
* Instrumentation
* Observations
Corniculate Collapse
* Apex of arytenoid
* Laryngomalacia
* Perception of airway obstruction
* Treatment: arytenoid reduction surgery and/or behavioral therapy

Normal Larynx
Laryngeal Supraglottic Hyperfunction
PVCM Visualized
Treatment
Speech Therapy
Speech Therapy: Relaxation
Visual Concept of Disorder
Speech Therapy: Phonatory Retraining
Therapeutic goals and methods
Therapeutic goals and methods
Acute Management
Acute Management of Attacks
Referral Candidacy
Conclusion
Videotaped Examples
Case Study
Observations
Laryngeal Observations
Initial Recommendations
Second Evaluation
Laryngeal Findings
Trial Therapy
Results

Paradoxical Vocal Cord Motion:Evaluation and Treatment.ppt