Dr. Timothy Brown (Dalhousie U) talked about vocal cord dysfunction. When puffers don't help: A review of Vocal Cord Dysfunction by ENT (Dr. Tim Brown). Dr Tim Brown is the last speaker for this session who will speak on a much under-diagnosed topic: Vocal Cord Dysfunction, aka Paradoxical Vocal Fold Motion Disorder (PVFMD).
Least important function of the larynx is speech as per Dr. T. Brown. Larynx as a voice box is the least important function; it did not evolve to do that, but for proper respiratory function. In humans, the vocal cords are like a reed instrument with the rest of our speech determined by changes in the tongue, mouth, etc. It is the resonance of the folds above the vocal cords that produces our unique voice. With only the vocal cords - our voice would sound like a goose call.
The vocal cords must allow air to the lungs but block things intended for the GI tract. This makes them vulnerable. They have a high degree of sensory innervation.
Pts with PVFMD are misdiagnosed as asthma, get large doses of prednisone and almost 1/3 have been intubated. It often takes 5 years for them to get a diagnosis.
Paradoxical Vocal Fold Motion Disorder (PVFMD) - Paradoxical vocal fold movement: the great masquerader.
Exercise-induced stridor-often seen in teens, athletic, female predominance. Exercise-induced stridor can mimic exercise-induced asthma and presents with stridor. It does have a female preponderance and more likely to be noted in those who play a wind instrument…
Acute treatment of PVCM: https://twitter.com/DrLoriConnors/status/1040948373346562049
Flexible NP scope is the gold standard for diagnosis for Paradoxical Vocal Fold Motion Disorder (PVFMD). Acute management: Reassure, reassure, reassure, panting, sniffing, pursed lip exhalation, if not working: Heliox? anxiolytics? in rare recalcitrant cases, botox?
Treatment of Paradoxical Vocal Fold movement: Reassurance, multidisciplinary approach - ENT, SLP, psychology etc, nose breathing, acutely if not working Heliox, recurrent - consider Botox.
To help PVFMD symptoms, nasal breathing can make the vocal cord area adduct naturally. Other breathing/biofeedback tricks can be taught by SLP's (Speech Language Pathologists)
Dr. Mariam Hanna, MD @PedsAllergyDoc
Mary McHenry MD @maryjmchenry
David Fischer, MD @IgECPD
Lori Connors @DrLoriConnors
Dr. A for Allergy MD @Health_Ontario_