A Singer Diagnosed With “Vocal Cord Dysfunction”

Recently, a singing student of a colleague received a diagnosis of “Vocal Cord Dysfunction” from an ENT. The voice teacher reached out to find out what this meant and see what she could do to help her student.

It would seem that any vocal fold injury or pathology creates “vocal cord dysfunction.” Right??

But in the medical and vocal health community “Vocal Fold Dysfunction” is another name for “PDFM”–Paradoxical Vocal Fold Motion. It can cause “Muscle Tension Dysphonia,”or not.

Plot Twist!

But ‘Vocal Cord Dysfunction’ is not categorized the same as ‘Vocal Fold Injury.’ Both do affect movements of the vocal folds and the larynx.

Vocal Fold Dysfunction (or PVFM) doesn’t refer to one specific vocal fold injury diagnosis. It is anything that causes “an episodic unintentional adduction of the vocal folds on inspiration.”  Which means the vocal folds are working backwards—in a functioning system, they “abduct” (come apart) when you inhale, and “adduct” (come together) when you speak or sing.

It pays to have cool colleagues who know the words and things

Kerrie Obert, a Clinical Voice Specialist at The Ohio State University and Dept. of Otolayrngology and co-author of The Owner’s Manual to the Voice: A Guide for Singer’s and Other Professional Voice Users, says

While scary, one of the things to know is that oxygen levels remain normal during an attack. People with this disorder feel they are not getting enough air but they actually are. It is one of the things that distinguishes it from asthma or other respiratory disease. It is basically a behavioral problem and generally remedied with just a few sessions with an SLP.

This voice disorder ALSO has lots of other names, such as laryngeal dyskinesia, inspiratory adduction, periodic occurrence of laryngeal obstruction, Munchausen’s stridor, hysterical croup and irritable larynx syndrome.…just to name a few!

Kristine Pietch, SLP at Johns’ Hopkins’ Dept. of Neck and Head in Baltimore and Bethesda, Maryland and a fine singer added:

We don’t like the term ‘vocal cord dysfunction’ in our clinic for the reasons you describe (very non specific!) but it is the one that most pulmonologists use and that our patients hear first! I see a number of these patients every week and on my handout have to write “vocal cord dysfunction AKA paradoxical vocal fold motion” and NOW I’m probably going to have to add yet another…ILO aka inducible laryngeal obstruction which has been taking off (especially outside of the US). Too many terms…..very confusing….

Other stuff to know

Paradoxical Vocal Fold Movement is misdiagnosed frequently as asthma because the symptoms are:

  • Noisy or wheezy inhale
  • A feeling of not inhaling enough air when playing sports or singing but recovers quickly, within 5 minutes.
  • Asthma or allergy medications don’t help with breathing problems
  • Has a history or symptoms of acid reflux
  • Patient points to the throat more than the chest to indicate the area of tension

What is VERY interesting is that this condition seems to be most common in young females 11-13 who are competitive athletes and quite driven academically. It occurs more in females than in males and can be caused by other things such as constantly being exposed to second hand smoke or irritants in perfumes.

It’s really important that the student get a correct diagnosis (asthma or PVFM) and specialized therapy from a voice care clinic and an experienced Speech-Language-Pathologist.

Sometimes asthma and PVFM occur at the same time too. The speaking and breathing need to be addressed before the singing voice.

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Please view my services as an Independent Singing Voice Specialist and my qualifications:

I. Individual Singing Voice Rehabilitation

For individual singers after a diagnosis is made from your fellowship trained otolaryngologist. (An ENT with the extra training to work with singers and vocal function.)

II. Cate’s Collegial Consults

Together, an experienced voice teacher and their student book one session with me to make sure they have the information they need and for the teacher to observe ways to work with the student. Questions answered and total respect for the teacher’s work is given and acknowledged.

2 Comments

  1. Really good overview, Cate. I have had paradoxical vocal fold behavior from time to time, usually associated with a reflux event in the night. It is truly frightening when the vocal fold go into a spasm, and you can’t breathe in freely. But a speech pathologist showed me how to bypass the the spasm by sniffing in through the nose, very strongly. The folds are forced to open, you get air in your lungs, and the spasm eventually calms down.

    Like

    1. Joanne here again: I was just told by an SLP that my “version” might be something a bit different than typical PVFB. So my experience may not mirror others’ who deal with this condition, whatever we call it.

      Like

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