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 asked on a forum what that meant. Those of us who work with injured singing voices responded that Vocal Cord Dysfunction wasn’t a diagnosis.

Any vocal fold injury or pathology creates “vocal cord dysfunction.” Right?? That is perfectly logical.

Evidently, in the medical community “Vocal Fold Dysfunction” is another name for “PDFM”–Paradoxical Vocal Fold Movement.

And, evidently, ‘Vocal Cord Dysfunction’ is not categorized the same as ‘Vocal Fold Injury.’ However, both affect movements of the vocal folds and the larynx.

PVFM doesn’t refer to one specific vocal fold injury diagnosis. It’s anything that causes “an episodic unintentional adduction of the vocal folds on inspiration.”  Which means the vocal folds are working backwards—they close when the patient tries to inhale. Normally the vocal folds open upon inhalation.

Can you imagine how awful that would feel? However, 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 other alias’, 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, noted that

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 very confusing….

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

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. It’s really imperative 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.

************************************************************************

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

I. Individual Singing Voice Rehabilitation

For individual singers after diagnosis from your doctor.

II. Cate’s Collegial Consults

For experienced voice teachers and their student together, for those who live in areas without access to the resources they need.

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

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.