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

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Vocal Cord Visualization

Vocal Cord Visualization
Presentation Team:Erik Joseph Birkeneder, Kevin Ryan Kinney, Eric Jordan Miller, Christopher Carlin Valley
Vocal Cord Visualization

Overview
* Procedure
* Problem Statement
* Background
* Current Prototype
* New Design Alternatives
* The Matrix
* Final Design and Future Work

Claude Shannon’s Alias Frequency Principle
Prototype – LED Stroboscope
Advantages
Limitations
New Design Alternatives
Design 1 – Foot pedal frequency control
Design 2 – Microprocessor
Design 3 – Microprocessor with LCD Vocal Cord Display
Design Matrix
Manufacturing Simplicity
Doctor Ergonomics
Patient Ergonomics
Frequency Accuracy
Procedure Weight
Portability Weight
m-Processor LCD screen
m-Processor LCD screen absent
Foot Pedal
Current Device
Design
Design Matrix
Future Work
* Microprocessor
* Camera Research
* LCD for Vocal Cord Visualization
* Device Housing

Vocal Cord Visualization.ppt

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Exercise Induced Paradoxical Vocal Cord Dysfunction

Exercise Induced Paradoxical Vocal Cord Dysfunction
(EI-PVCD)
Presentation lecture by:Dale R. Gregore, M.S., CCC-SLP
Speech Language Pathologist, Clinical Rehabilitation Specialist - Voice


NORMAL Respiration 101
* On inhalation, the vocal cords (folds) ABduct allowing air to flow into the trachea, bronchial tubes, lungs
* On exhalation, the vocal folds may close slightly, however should and do remain ABducted

Normal Larynx
Vocal fold ABDUCTION occurs during respiration
Vocal fold ADDUCTION Occurs during swallowing, coughing, etc…
Strobe exam
Paradoxical Vocal Fold Movement (PVFM)
* The cord function is reversed in that the vocal folds ADDuct on inspiration versus ABduct
* Leads to tightness or spasm in the larynx
* Inspiratory wheeze evident

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

Patient description of VCD episodes
PVFM Visualized
* Anterior portion of the vocal folds are ADDucted
* Only a small area of opening at the
* Posterior aspect of the vocal folds
* Diamond shaped ‘CHINK’
* May be evident on both inhalation and exhalation

Essential Features
* Vocal fold adduct (close) during respiration instead of abducting (opening)
* Laryngeal instability while patient is asymptomatic
* Episodic respiratory distress

Symptoms

* Stridor
* Difficulty with inspiratory phase
* Throat tightening > bronchial/ chest
* Dysphonia during/following an attack
* Abrupt onset and resolution
* Little or NO response to medical treatment (inhalers, bronchodilators)

Various Etiologies
* Laryngo-Pharyngeal Reflux (LPR)

LPR and Athletes
* Well documented occurrence in weight lifting
* Can be aggravated by bending, pushing/ resisting (tackling, etc…), tight clothing, even drinking water during a game/ meet/ match
* Timing of meals before exercise is important
* Type of foods/ liquids should be monitored

Laryngopharyngeal Reflux: Clinical Signs
Vocal Fold Edema
Lx Erythema
Interarytenoid Edema
Other potential causes of Paradoxical Vocal Cord Dysfunction
* Asthma-associated laryngeal dysfunction
* Brainstem dysfunction
* Chronic laryngeal instability, sensitivity & tension

Athlete Profile for EI-VCD
EI-VCD versus Asthma
Differential Diagnosis of EI-VCD
Differential Diagnosis of VCD
* Team Must Rule Out:
o Mass Obstruction
o Bilateral vocal fold paralysis
o Anaphylactic laryngeal edema
o Extrinsic airway compression
o Foreign body aspiration
o Infectious croup
o Laryngomalacia
o Exercise Induced Asthma/ Asthma

Diagnosis of EI-VCD
EI-VCD and Asthma
EI-PVCD versus
Exercise Induced Asthma
Typical Spirometry Findings for PVCD
* Asymptomatic
* Symptomatic:

Case History Questions
Videostroboscopic Examination
Laryngeal Supraglottic Hyperfunction
VCD appearance on direct examination
Laryngeal Supraglottic Hyperfunction
PVCM Visualized
Diagnostic Features
Acute Management of EI-VCD
Acute Management of EI-VCD
Acute Management of Attacks
Acute Management in the Game
Quick Sniff Technique
Treatment: Speech Therapy
Therapeutic goals and methods
Speech Therapy
Back Pressure Breathing
Relaxation Training
ST Duration: The CCHS Approach
CASE DISCUSSION
Therapy Focus and Outcome
Case Discussion #2
Therapy Focus and Outcome
Outcome
REFERENCES

Exercise Induced Paradoxical Vocal Cord Dysfunction.ppt

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