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