Paradoxical Vocal Fold Movement or Paradoxical Movement of Vocal Cords


Paradoxical Movement of Vocal Cords (PMVC) or Paradoxical Vocal Fold Movement (PVFM) are older terms previously used for what is now known as Vocal Cord Dysfunction (VCD). All three of these terms will be used interchangeably in this article. VCD happens when the vocal cords close inappropriately on the in-breath, which results in obstruction of the airway. During normal breathing, the vocal cords move apart from each other when we breathe in, allowing air into the airway. The vocal cords move towards each when we breathe out, when we speak and when we cough. The key feature of VCD is that, during breathing, the vocal cords can try to close over rather than stay open and it is this squeezing that reduces the size of the air passages, making it harder to get air into the lungs. In order to diagnose VCD, the doctor will watch the vocal cords moving. Between attacks the vocal cords may appear to move normally, resulting in a false negative test, so it can be necessary to trigger an attack.

The tem “paradoxical” is used in medicine to denote something happening in the opposite direction to what is expected. When a person is breathing, it would be expected that the vocal cords would be open to allow the greatest possible air flow. But in some people, the vocal cords close over when they are breathing, squeezing the air passage. This lessens or restricts the air flow and so this movement of the vocal cords is termed “paradoxical” because they close over when they should be open.

Intermittent paradoxical closure of the vocal cords can bring on a major attack of breathlessness, or air hunger (dyspnea). The paradoxical movement of the vocal cords or decreased movement during attacks can be recorded on video by a doctor or can also be seen by using a mirror placed at the back of the tongue. Paradoxical movement of the vocal cords can also cause noisy breathing, raspiness or wheezing (stridor). PMVC / PVFM / VCD is not the only cause of noisy breathing: it can also be caused by laryngitis, inflammation of the vocal cords and vocal polyps or nodules (little swellings).

VCD is a problem that can appear on breathing IN and is caused by the vocal cords closing over at the wrong time. It is treated by a Speech Therapist, with breathing retraining or vocal physiotherapy, with exercises to strengthen the airways. Often 3 – 4 visits are scheduled, although great relief may be found even after the first appointment. In addition, visual imaging techniques are taught as a method of keeping the vocal cords open during rapid breathing. It may also be necessary to treat any acid reflux, (GERD) asthma, or other airway or medical concerns.


Asthma is a reversible airway disease, which may be chronic or intermittent. It is usually characterized by variable and reversible airway obstruction. It is a problem that appears on breathing OUT and is caused by a narrowing of the airways in the lungs and an increase in airway resistance. It is normally treated with inhalers. A diagnosis of asthma is often given to those with VCD and may occur at the same time in some patients. VCD may be confused with asthma since both can cause wheezing and problems breathing. Those with asthma often have trouble getting air out. People with VCD are more likely to have trouble getting air in. People with VCD do not respond well to asthma treatment. Asthma medications fail to resolve the cough and often make it worse. Patients often notice problems taking a breath in, throat tightness, change in voice quality, a loud noise while breathing in, or pain in their throat.

Some facts on VCD

* PVFM can occur at all ages.
* VCD is often seen in young athletes who develop symptoms during exercise. They may be incorrectly diagnosed with exercise – induced asthma.
* More females suffer from it than males
* Speech Therapy is considered the gold standard for treatment of PVFM.

Monitor and manage your VCD with a breathing diary

VCD can be challenging to diagnose. Individuals who present with symptoms of asthma that do not respond to traditional treatment should be evaluated for PVFM. A breathing diary can help with this.

Keep records of your symptoms, big or small, such as whether it is noisy when you breathe in, when you breathe out, or both? How often do you have a tight feeling throat? Do you struggle with breathing while exercising, during school, or each morning? Do you have a stubborn cough, which gets worse at times? Also keep a note of the circumstances in which these symptoms appear, such as on exercise, on detecting strong smells, any particular foods or stressful situations, etc. This information may be important in working out the best treatment. Make sure you pay attention to any changes in your symptoms.

Keep your breathing diary with you at all times. You can never know when something could happen that you need to write down: don’t just assume you’ll remember it later. Record everything that could be relevant. Remember to be honest with your entries. Your diary is not an exam, or a novel, it could help you reach a correct diagnosis and get the best treatment.

Vocal Cord Dysfunction can be treated very easily. You may not necessarily have asthma. Check it out!