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Related Problems
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Related
Problems Paradoxical
Vocal Fold Motion (PVFM,
laryngospasm) Gastro-Esophageal
Reflux Disorder
(GERD)
Paradoxical Vocal Fold Motion
(PVFM) Other
names PVFM is commonly seen in young athletes who
develop symptoms during athletic exertion. These
athletes may be incorrectly diagnosed with
exercise-induced asthma. The disorder is also common in adults. Symptoms
often cause awakening in the middle of the night,
but they may occur at any time. These symptoms may
be triggered by eating or drinking, especially
something sour. Symptoms Some of the common symptoms of PVFM are: Cause When symptoms occur during the night, the cause
is nearly always related to GERD
(Gastroesophageal Reflux Disorder). In this
case, acid from the stomach refluxes back up the
esophagus and spills over onto the larynx (see
About the Voice),
irritating the vocal folds (also called vocal
cords; see the explanation
of this terminology) and causing them to twinge or
spasm. This feels like a choking sensation. When
the individual attempts to inhale forcefully, the
vocal folds are actually sucked together,
preventing inhalation. This causes more forceful
inhalation and creates a vicious cycle that can be
very frightening to the individual. The vicious
cycle is such that the vocal folds may relax
slightly during exhalation, but come together
during inhalation. Thus, the disorder is called
Paradoxical Vocal Fold Motion because of
this backwards movement of the vocal folds. The
gasping sound on inhalation is known as inhalatory
stridor. The scenario is similar if you are a young
athlete. The individual begins panting and gasping
for air, trying to inhale more forcefully, and the
vocal folds are sucked together. The same
frightening cycle ensues. It may also happen when
the athlete chokes slightly on his or her own
saliva, especially when the throat becomes very dry
from panting. In some cases, an individual with PVFM is able
to gain control of his or her own breathing, and
the episode ends. In other cases, he or she needs
to be seen in an emergency room. In either case,
the experience can be so alarming that if the
conditions present themselves again, the same set
of responses is triggered by the anxiety. Moreover,
it is generally not helpful to suggest to an
individual who cannot breathe that they should
"just relax." Treatment Treatment for reflux is an important component
of treating most cases of PVFM. This usually
involves prescribing anti-reflux medications to
reduce the irritation. Also, you may be counseled
about dietary precautions to alleviate GERD. Relief
may occur in days, or may take a month more. In the Lions Voice Clinic, breathing training is
given so that the individual knows how to reverse
the paradoxical motion of the vocal folds and
breathe easily again. Most often, the breathing
training includes flexible endoscopy. This enables
you to observe the motion of the vocal folds while
doing the various maneuvers learned in training.
Watching yourself control your own breathing is
generally very reassuring, and even if the
laryngospasms continue for a time, the full-blown
paradoxical episodes usually end within a few
weeks. In the case of an athlete, particularly a young
athlete, care is taken to differentiate between a
pulmonological (lung) problem such as asthma, and
PVFM. Evaluation is done jointly with the
Department of Pulmonology or Pediatric Pulmonology.
Often, we use a treadmill to simulate athletic
exertion, and then, an endoscopic exam is done
immediately after to confirm the occurrence of PVFM
during exertion. Breathing training is done as
previously described, and may include work on the
treadmill to train special breathing techniques for
athletic exertion. Because of the anxiety
associated with this disorder, the young person and
his or her parents are counseled carefully and
sensitively.
GERD (Gastro Esophageal
Reflux Disorder) Other
names Symptoms Interestingly, the majority of
the patients in the Lions Voice Clinic
who have laryngeal symptoms of GERD do
not have any stomach discomfort or
sensation of heartburn. Cause Acid from the stomach refluxes back up through
the esophagus and spills over onto the larynx. This
irritates the vocal folds (also called vocal cords;
see the explanation
of this terminology) and creates inflammation,
which causes the vocal folds to vibrate unevenly.
Coughing and throat clearing from the irritation
can make the inflammation worse. The resulting
voice disorder is often related to the poor
vibratory quality of the inflamed vocal folds and
the muscle tension created by effortful attempts at
compensation. Treatment Anti-reflux medication and dietary precautions
are the first line of defense. Functional voice
therapy is useful to teach techniques for reducing
effortful compensation and instruct the individual
in improved vocal hygiene. At the Lions Voice Clinic, we do not hand out a
list of foods and beverages that must be avoided.
Rather, we educate about types of foods and
beverages known to cause reflux and encourage the
individual to systematically investigate which
foods stimulate their own reflux. Also, the
individual is encouraged to manage reflux under the
care of a Gastroenterologist (gastrointestinal
specialist). Interested readers are encouraged to look at the
website of the Center for Voice Disorders at Wake
Forest University for a more in depth discussion of
GERD and the voice (see our Links
page). Lifestyle changes
that may help reduce symptoms of
GERD/LPRD Types of foods known
to trigger increased stomach
acid
Reading this list might make you think you can only
eat bread and oatmeal for the rest of your life.
Fortunately, most individuals are not triggered by
everything on this list. For example, for every
person who is lactose intolerant and has problems
with dairy products, there may be someone else
whose digestive system is calmed by milk. Also, in
our experience, few persons are triggered by
peppermints or chocolate. Therefore, we recommend
that you experiment with your own dietary habits,
changing one food class at a time. Also, if you
have recently started taking anti-reflux
medications, you may want to wait for several
months, to see how the medication works without any
change in your dietary habits.
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Date Last Modified: 8/23/07 |