Abstract
Inducible laryngeal obstruction (also known as vocal cord dysfunction and paradoxical vocal fold motion) is a heterogeneous disease process that manifests as the sensation of airway restriction at the level of the upper airway but can also occur in conjunction with voice disorders and laryngeal irritative symptoms such as throat clearing and cough. The demographic affected by this disease includes all ages from adolescence to adulthood and affects all genders. In general, there are non-exercise-induced and exercise-induced variants. The classic diagnostic finding is inappropriate vocal fold adduction during inspiration observed during laryngoscopy when symptomatic. However, patients can be observed with symptoms in the absence of overt glottic narrowing or limitation of airflow. The diagnosis is generally made by history and supported by response to behavioral therapy typically in the form of respiratory retraining. There are many confounding or contributing diagnoses which support the use of a multidisciplinary approach to diagnosis and treatment. Due to the lack of widely used objective diagnostic and outcome metrics, behavioral, medical, and surgical treatments are largely unproven. As a result, the disease presents significant opportunity for future developments in its understanding and management.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Olin JT, Clary MS, Connors D, Abbott J, Brugman S, Deng Y, et al. Glottic configuration in patients with exercise-induced stridor: a new paradigm. Laryngoscope. 2014;124(11):2568–73.
Christensen PM, Heimdal JH, Christopher KL, Bucca C, Cantarella G, Friedrich G, et al.; ERS/ELSL/ACCP Task Force on Inducible Laryngeal Obstructions. ERS/ELS/ACCP 2013 international consensus conference nomenclature on inducible laryngeal obstructions. Eur Respir Rev. 2015;24(137):445–50.
Jain S, Bandi V, Officer T, Wolley M, Guntapalli KK. Role of vocal cord function and dysfunction in patients presenting with symptoms of acute asthma exacerbation. J Asthma. 2006;43(3):207–12.
Powell DM, Karanfilov BI, Beechler KB, Treole K, Trudeau MD, Forrest LA. Paradoxical vocal cord dysfunction in juveniles. Arch Otolaryngol Head Neck Surg. 2000;126(1):29–34.
Johansson H, Norlander K, Berglund L, Janson C, Malinovschi A, Nordvall L, et al. Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population. Thorax. 2015;70(1):57–63.
Liao KS, Kwak PE, Hewitt H, Hollas S, Ongkasuwan J. Measuring quality of life in pediatric paradoxical vocal fold motion using the SF-36v2. J Voice. 2017;31(4):518.e1–5.
Maturo S, Hill C, Bunting G, Baliff C, Ramakrishna J, Scirica C, et al. Pediatric paradoxical vocal-fold motion: presentation and natural history. Pediatrics. 2011;128:e1443–9.
Maat RC, Roksund OD, Olofsson J, Halvorsen T, Skadberg BT, Heimdal JH. Surgical treatment of exercise-induced laryngeal dysfunction. Eur Arch Otorhinolaryngol. 2007;264(4):401–7.
Mehlum CS, Walsted ES, Godballe C, Backer V. Supraglottoplasty as treatment of exercise induced laryngeal obstruction (EILO). Eur Arch Otorhinolaryngol. 2016;273(4):945–51.
Røksund OD, Heimdal JH, Clemm H, Vollsæter M, Halvorsen T. Exercise inducible laryngeal obstruction: diagnostics and management. Paediatr Respir Rev. 2017;21:86–94.
O’Connell MA, Sklarew PR, Goodman DL. Spectrum of presentation of paradoxical vocal cord motion in ambulatory patients. Ann Allergy Asthma Immunol. 1995;74(4):341–4.
Morris MJ, Allan PF, Perkins PJ. Vocal cord dysfunction: etiologies and treatment. Clin Pulm Med. 2006;13(2):73–86.
Morris MJ, Deal LE, Bean DR, Grbach VX, Morgan JA. Vocal cord dysfunction in patients with exertional dyspnea. Chest. 1999;116(6):1676–82.
Hanks CD, Parsons J, Benninger C, Kaeding C, Best TM, Phillips G, Mastronarde JG. Etiology of dyspnea in elite and recreational athletes. Phys Sportsmed. 2012;40(2):28–33.
Newman KB, Dubester SN. Vocal cord dysfunction. Masquerader of asthma. Semin Respir Crit Care Med. 1994;15(2):161–7.
Balkissoon R, Kenn K. Asthma: vocal cord dysfunction (VCD) and other dysfunctional breathing disorders. Semin Respir Crit Care Med. 2012;33(6):595–605.
Ludlow CL, Van Pelt F, Koda J. Characteristics of late responses to superior laryngeal nerve stimulation in humans. Ann Otol Rhinol Laryngol. 1992;101(2 Pt 1):127–34.
Aviv JE, Martin JH, Kim T, Sacco RL, Thomson JE, Diamond B, et al. Laryngopharyngeal sensory discrimination testing and the laryngeal adductor reflex. Ann Otol Rhinol Laryngol. 1999;108(8):725–30.
Perkner JJ, Fennelly KP, Balkissoon R, Bartelson BB, Ruttenber AJ, Wood RP 2nd, Newman LS. Irritant-associated vocal cord dysfunction. J Occup Environ Med. 1998;40(2):136–43.
Murry T, Branski RC, Yu K, Cukier-Blaj S, Duflo S, Aviv JE. Laryngeal sensory deficits in patients with chronic cough and paradoxical vocal fold movement disorder. Laryngoscope. 2010;120(8):1576–81.
Leo RJ, Konakanchi R. Psychogenic respiratory distress: a case of paradoxical vocal cord dysfunction and literature review. Prim Care Companion J Clin Psychiatry. 1999;1(2):39–46.
Gavin LA, Wamboldt M, Brugman S, Roesler TA, Wamboldt F. Psychological and family characteristics of adolescents with vocal cord dysfunction. J Asthma. 1998;35(5):409–17.
Husein OF, Husein TN, Gardner R, Chiang T, Larson DG, Obert K, et al. Formal psychological testing in patients with paradoxical vocal fold dysfunction. Laryngoscope. 2008;118(4):740–7.
Marcinow AM, Thompson J, Forrest LA, deSilva BW. Irritant-induced paradoxical vocal fold motion disorder: diagnosis and management. Otolaryngol Head Neck Surg. 2015;153(6):996–1000.
Traister RS, Fajt ML, Landsittel D, Petrov AA. A novel scoring system to distinguish vocal cord dysfunction from asthma. J Allergy Clin Immunol Pract. 2014;2(1):65–9.
Cummings KJ, Fink JN, Vasudev M, Piacitelli C, Kreiss K. Vocal cord dysfunction related to water-damaged buildings. J Allergy Clin Immunol Pract. 2013;1(1):46–50.
Tonini S, Dellabianca A, Costa C, Lanfranco A, Scafa F, Candura SM. Irritant vocal cord dysfunction and occupational bronchial asthma: differential diagnosis in a health care worker. Int J Occup Med Environ Health. 2009;22(4):401–6.
Strohl KP, Butler JP, Malhotra A. Mechanical properties of the upper airway. Compr Physiol. 2012;2(3):1853–72.
Morris M, Kent C. Diagnostic criteria for the classification of vocal cord dysfunction. Chest. 2010;138(5):1213–23.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. (DSM-5). Arlington: American Psychiatric Association; 2013.
Geneid A, Aaltonen L, Porra L, Peltonen J, Palmu K, Sovijarvi A, et al. Association of breathing sound spectra with glottal dimensions in exercise-induced vocal cord dysfunction. Eur Arch Otorhinolaryngol. 2017;274(11):3933–40.
Nielsen EW, Hull JH, Backer V. High prevalence of exercise-induced laryngeal obstruction in athletes. Med Sci Sports Exerc. 2013;45(11):2030–5.
Higenbottam T. Narrowing of glottis opening in humans associated with experimentally induced bronchoconstriction. J Appl Physiol Respir Environ Exerc Physiol. 1980;49(3):403–7.
Christensen P, Thomsen SF, Rasmussen N, Backer V. Exercise-induced laryngeal obstructions objectively assessed using EILOMEA. Eur Arch Otorhinolaryngol. 2010;267(3):401–7.
Olin JT, Clary MS, Fan EM, Johnston KL, State CM, Strand M, Christopher KL. Continuous laryngoscopy quantitates laryngeal behaviour in exercise and recovery. Eur Respir J. 2016;48(4):1192–200.
Butani L, O'Connell EJ. Functional respiratory disorders. Ann Allergy Asthma Immunol. 1997;79(2):91–9; quiz 99–101.
Murry T, Tabaee A, Aviv JE. Respiratory retraining of refractory cough and laryngopharyngeal reflux in patients with paradoxical vocal fold movement disorder. Laryngoscope. 2004;114(8):1341–5.
McFadden ER Jr, Zawadski DK. Vocal cord dysfunction masquerading as exercise-induced asthma: a physiologic cause for ‘choking’ during athletic activities. J Resp Crit Care Med. 1996;153(3):942–7.
Christopher KL, Wood RP II, Eckert RC, Blager FB, Raney RA, Souhrada JF. Vocal-cord dysfunction presenting as asthma. N Engl J Med. 1983;308(26):1566–70.
Sterner JB, Morris MJ, Sill JM, Hayes JA. Inspiratory flow volume curve evaluation for detecting upper airway disease. Respir Care. 2009;54(4):461–6.
Perkins MP, Morris LM. Vocal cord dysfunction induced by methacholine challenge testing. Chest. 2002;122(6):1988–93.
Walsted ES, Hull JH, Sverrild A, Porsbjerg C, Backer V. Bronchial provocation testing does not detect exercise-induced laryngeal obstruction. J Asthma. 2017;54(1):77–83.
Bucca C, Rolla G, Brussino L, De Rose V, Bugiani M. Are asthma-like symptoms due to bronchial or extrathoracic airway dysfunction? Lancet. 1995;346(8978):791–5.
Boulding R, Stacey R, Niven R, Fowler SJ. Dysfunctional breathing: a review of the literature and proposal for classification. Eur Respir Rev. 2016;25(141):287–94.
Van Doorn P, Folgering H, Colla P. Control of the end-tidal PCO2 in the hyperventilation syndrome: effects of biofeedback and breathing instructions compared. Bull Eur Physiopathol Respir. 1982;18(6):829–36.
Mathers-Schmidt BA. Paradoxical vocal fold motion: a tutorial on a complex disorder and the speech-language pathologist’s role. Am J Speech Lang Pathol. 2001;10:111–25.
Vertigan AE, Theodoros DG, Gibson PG, Winkworth AL. Voice and upper airway symptoms in people with chronic cough and paradoxical vocal fold movement. J Voice. 2007;21(3):361–83.
Blager FB, Gay ML, Wood RP. Voice therapy techniques adapted to treatment of habit cough: pilot study. J Commun Dis. 1988;21(5):393–400.
Johnston KL, Bradford H, Hodges H, Moore CM, Nauman E, Olin JT. The Olin EILOBI breathing techniques: Description and initial case series of novel respiratory retraining strategies for athletes with exercise-induced laryngeal obstruction. J Voice. 2018; 32(6):698–704.
Patel RR, Venediktov R, Schooling T, Wang B. Evidence-based systematic review: effects of speech-language pathology treatment for individuals with paradoxical vocal fold motion. Am J Speech Lang Pathol. 2015;24(3):566–84.
Varney V, Parnell H, Evans J, Cooke N, Lloyd J, Bolton J. The successful treatment of vocal cord dysfunction with low-dose amitriptyline – including literature review. J Asthma Allergy. 2009;2:105–10.
Kim IK, Cocoran T. Recent developments in heliox therapy for asthma and bronchiolitis. Clin Pediatr Emerg Med. 2009;10(2):68–74.
Altman KW, Mirza N, Ruiz C, Sataloff RT. Paradoxical vocal fold motion: presentation and treatment options. J Voice. 2000;14(1):99–103.
Litts JK, Fink DS, Clary MS. The effect of vocal fold augmentation on cough symptoms in the presence of glottic insufficiency. Laryngoscope. 2018;128(6):1316–9.
Crawley BK, Murry T, Sulica L. Injection augmentation for chronic cough. J Voice. 2015;29(6):763–7.
Simpson CB, Tibbetts KM, Loochtan MJ, Dominguez LM. Treatment of chronic neurogenic cough with in-office superior laryngeal nerve block. Laryngoscope. 2018;128(8):1898–903.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Ambrose, E.C., Litts, J.K., Clary, M.S. (2020). Inducible Laryngeal Obstruction/Paradoxical Vocal Fold Motion. In: Weissbrod, P., Francis, D. (eds) Neurologic and Neurodegenerative Diseases of the Larynx. Springer, Cham. https://doi.org/10.1007/978-3-030-28852-5_22
Download citation
DOI: https://doi.org/10.1007/978-3-030-28852-5_22
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-28851-8
Online ISBN: 978-3-030-28852-5
eBook Packages: MedicineMedicine (R0)