Department of Otolaryngology

Paradoxical Vocal Fold Motion Disorder

Understanding the Disorder

Paradoxical Vocal Fold Motion Disorder (PVFMD)

PVFMD is a breathing disorder that is caused by the abnormal movement of the vocal folds during breathing. The vocal folds are located on top of the airway and typically open wide for breathing to allow air to pass through, and the vocal folds close together for talking in order to allow the vocal folds to vibrate to make sound. When the vocal folds close during breathing, instead of open, this blocks the flow of air and causes the patient to feel a severe sensation of trouble breathing.

Acid Reflux

Acid reflux is sometimes a contributing factor for PVFMD. When acid reflux is severe enough to reach the throat, it can cause irritation to the vocal folds, causing them to close as a protective mechanism. This protective closing response from the vocal folds can trigger a PVFMD episode.

Stress and Anxiety

PVFMD can be associated with stress and anxiety. Recent research has shown that under periods of stress, the muscles that control the voice box become tense. Periods of prolonged muscle tension in the voice box can lead to an incoordination of the vocal control system.

Causes and Triggers

The cause of PVFMD is unknown, and it can vary drastically in severity. It typically occurs in episodes with periods of normal breathing in between. Common triggers include exposure to strong odors, changes in temperature/weather, stress, lying flat, and exercise.


Ear nose and throat doctors refer to this disorder as “paradoxical vocal fold motion disorder” or PVFMD. Lung doctors (pulmonologists) often refer to this disorder as “vocal cord dysfunction” or VCD. These terms are interchangeable and refer to the same disorder.

Lung Conditions

Breathing difficulty can also be associated with various types of lung disease and should always be evaluated as part of a comprehensive work up.


What are the symptoms of paradoxical vocal fold motion disorder?

Difficulty breathing is the main symptom of PVFMD, ranging from mild to severe. Patients often identify a constricted feeling in the throat area.

Common Symptoms Associated with PVFMD

  • Difficulty breathing in
  • Throat tightness
  • Sensation of breathing through a straw
  • Lightheadedness
  • Noisy breathing
  • Stridor (voicing sound on inhalation)
  • Rescue inhalers are ineffective Symptoms typically occur in episodes and often patients notice an improvement after doing relaxing activities.


How is the diagnosis of a PVFMD made?

1. Patient History:  A history of symptoms and onset of the disorder is the main determinant of a diagnosis of PVFMD.

2. Pulmonary function testing

  • Patients with PVFMD typically have normal pulmonary function tests.
  • Breathing issues can be due to PVFMD or PVFD in conjunction with another pulmonary disease. It is very important to identify any accompanying lung disease in order to recommend appropriate treatment.

3. Laryngoscopy:  Sometimes abnormal closing of the vocal folds can be seen on vocal fold examination; however, this may not occur because PVFMD occurs in episodes which may not be happening at the time of the evaluation. b. Some clinicians choose to trigger a PVFMD episode by having a patient smell strong odors and observe the response of the vocal folds.

4. Investigation of irritants and associated

  • The diagnostic process should also focus on looking for important associated factors, such as:
    • Reflux
    • Allergies
    • Stress


Respiratory Retraining

Respiratory retraining is a series of breathing exercises meant to restore proper opening of the vocal folds during PVFMD episodes. The breathing exercises are geared to the specific needs of the patient and tailored to the specific triggers for each individual.

Reflux Medication

Irritants such as acid reflux need to be reduced for the vocal folds to stop reacting in a protective closing manner. Reflux is treated with medication, and may require an examination by a gastrointestinal doctor if symptoms persist.