Paradoxical Vocal Cord Dysfunction (PVCD) :: Nationwide Children's Hospital

Paradoxical Vocal Cord Dysfunction (PVCD)

What is Paradoxical Vocal Cord Dysfunction?

When you breathe in (inhale) the vocal cords open, allowing air to flow into your windpipe (trachea) and reach your lungs. However, 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. PVCD typically occurs in children over the age of 8. PVCD can start and stop at any moment. Children with PVCD often complain that they have trouble breathing in, feel tightness in the throat, hear noisy breathing from the throat (stridor) and sometimes have a cough or clear their throats with the episodes. Breathing does not typically get better with the use of inhalers alone.

What can trigger symptoms of PVCD?

Many things can trigger an episode of PVCD and triggers tend to be similar to asthma triggers. Some potential triggers include:

  • 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 Paradoxical Vocal Cord Dysfunction evaluated?

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

What is the treatment for PVCD?

Speech therapy is a very important part of the treatment for PVCD. Speech therapy focuses on decreasing tension in the larynx by helping your child focus on exhaling rather than inhaling. Special exercises increase a child’s awareness of abdominal breathing and relax the throat muscles, enabling your child to have more control over his/her throat and breathing. Your child will learn to practice these exercises when he/she is not experiencing symptoms so that exercises can be used during PVCD episodes. These exercises help overcome the abnormal vocal cord movements and improve airflow into your child’s lungs.

Speech therapy is typically the first treatment for PVCD and is usually enough to correct the disorder. Other professionals such as psychologists may also be involved in the treatment.

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 detect 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 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 your child’s normal breathing pattern. If any of these or other concerning signs develop, please seek immediate medical attention.

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