Paradoxical Vocal Fold Motion/Vocal Cord Dysfunction Assessment

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Irritable larynx syndrome (ILS) provides a vital theoretical framework from which to consider assessment and treatment of those conditions believed to fall on its continuum: chronic throat clearing, chronic cough, paradoxical vocal fold motion, and laryngospasm. Upper airway disorders will be delineated with the distinction between obstructive conditions and behavioral conditions emphasized.

Meet your instructor

Mary J. Sandage

Mary J. Sandage, Ph.D., CCC-SLP is an Assistant Professor in the Department of Communication Disorders at Auburn University. She earned her M.S. degree in speech language pathology from the University of Iowa and her Ph.D. in Exercise Science at Auburn University. She has been a clinician for over 24 years, specializing in…

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Chapters & learning objectives

1. Irritable Larynx Overview

This chapter will explain the theoretical construct of the irritable larynx from the basic literature with a particular emphasis on the Nobel Prize winning research completed by Eric Kandel, Ph.D. This construct will be presented in a clinician-friendly manner to serve as a rational to share with patients as they are counseled about the nature of their upper airway disorder. Many patients have been told that nothing is really wrong with them and that they should just be able to stop the behavior. This theoretical construct provides a compassionate approach to therapy that, while letting the client off the hook for the development of the disorder, provides a behavioral roadmap to overcome the behavior.

2. Upper Airway Disorders Defined

This chapter will differentiate extrathoracic obstruction conditions from the upper airway disorders that are amenable to speech language pathology assessment and treatment. There are many obstructive conditions of the upper airway that may impact breathing or cause cough without affecting voice, such as large vocal process granuloma, bilateral vocal fold paralysis, recurrent respiratory papillomatosis, and subglottic or tracheal stenosis. The importance of ruling out physically obstructing conditions that are not amenable to behavioral intervention is vital. Medical versus behavioral interventions for these conditions will be described.

3. Assessment for Paradoxical Vocal Fold Motion

This chapter will define PVFM and describe demographics for this client population. The requisite medical work up for specific differential diagnostic conditions that should occur prior to the SLP referral will be outlined: pulmonary work-up, allergy work-up, otolaryngology work-up, etc. Typical referral sources will be outlined. The case history for PVFM will be covered in detail with specific guidance provided for common pitfalls and barriers that may occur during the client interview. The complex nature of the breathing disorder requires excellent interviewing skills to discern the nature of the problem, the likely triggers for the disorder, and relevant medical and behavioral history.

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