Paradoxical Vocal Cord Dysfunction (PVCD)

With Paradoxical Vocal Cord Dysfunction (PVCD), the vocal cords close together, or constrict, when a person inhales, leaving only a small opening for air to flow into the windpipe.

What is Paradoxical Vocal Cord Dysfunction (PVCD)?

To understand paradoxical vocal cord dysfunction (PVCD), it is helpful to know how the vocal cords function normally. When you breathe in (inhale) the vocal cords open, allowing air to flow into your windpipe (trachea) and reach your lungs. However, with PVCD, the vocal cords close together, or constrict, when the person inhales. This leaves only a small opening for air to flow into the windpipe. PVCD occurs on and off. Patients with Paradoxical Vocal Cord Dysfunction often complain that they have trouble breathing in, feel tightness in the throat, hear noisy breathing from their throat (stridor), and sometimes have a cough or clear their throats with the episodes. Breathing does not typically get better with use of inhalers alone. PVCD is a disorder that typically occurs in children over the age of 8 years old.

What Can Trigger Symptoms of PVCD?

Many things can trigger an episode of PVCD. Possible triggers of PVCD are often similar to asthma triggers.

  • Upper respiratory infections
  • Exercise
  • Emotional upset (anxiety, depression)
  • Fumes/odors
  • Exposure to cigarette smoke
  • Stomach acid and reflux
  • Post nasal drip
  • Allergies/exposure to allergens
  • Asthma

How is PVCD Evaluated?

PVCD is best diagnosed by a test called a laryngoscopy. This test is usually done by an otolaryngologist (also called an ENT doctor) and a speech-language pathologist. Using a flexible tube inserted through the patient’s nose, the vocal cords are viewed as they open and close. Sometimes, a laryngoscopy will be done while a patient is having symptoms because abnormal vocal cord movements do not happen all the time. However, PVCD can be diagnosed based upon symptoms and detailed clinical history if the laryngoscopy is normal at the time it is performed.

What is the Treatment for PVCD?

A special type of speech therapy is a very important part of the treatment for PVCD. Special exercises increase a person’s awareness of abdominal breathing and relax the throat muscles. This enables the person to have more control over their throat and breathing. The child will learn to practice these exercises while they have no symptoms so they can use the exercises during PVCD episodes. These exercises help overcome the abnormal vocal cord movements and improve airflow into their lungs.

Speech therapy is usually the first treatment for PVCD. Often it is enough to correct the disorder. Other professionals such as psychologists may also be involved in the treatment. Speech therapy focuses on decreasing tension in the larynx by helping patients focus on exhaling rather than inhaling.

What Are Concerning Symptoms That I Should Look for in My Child with PVCD?

It can be difficult for a parent or family member to discern the severity of a problem when there is noisy breathing. If you are concerned, we encourage you to seek medical evaluation immediately.

Symptoms that should trigger emergent evaluation include: pauses in the breathing, color change of the skin (particularly if the lips, face, or hands are turning blue), appearing lethargic or tired, or any other sudden change from a child’s normal breathing pattern. If any of these or other concerning signs develop, please seek immediate medical attention.