A Singer Diagnosed with "Vocal Cord Dysfunction"
Recently, a colleague’s singing student received a diagnosis of “Vocal Cord Dysfunction” from an ENT. The teacher reached out to me to find out what this meant and to see what she could do to help her student.
It would seem that any vocal fold injury or pathology creates “vocal cord dysfunction.” Right??
But in the medical and vocal health community “Vocal Fold Dysfunction” is another name for “PDFM”–Paradoxical Vocal Fold Motion. It can cause “Muscle Tension Dysphonia” or not.
Plot twist!
But ‘Vocal Cord Dysfunction’ is not categorized the same as ‘Vocal Fold Injury.’ However, both do affect movements of the vocal folds and the larynx.
Vocal Fold Dysfunction (or PVFM) doesn’t refer to one specific vocal fold injury diagnosis. It is anything that causes “an episodic unintentional adduction of the vocal folds on inspiration.” Which means the vocal folds are working out of sync or backwards. In a functioning system, they “abduct” (come apart) when you inhale, and “adduct” (come together) when you speak or sing.
It pays to have cool colleagues who know the words and things
Kerrie Obert, a Clinical Voice Specialist at The Ohio State University and Dept. of Otolayrngology and co-author of The Owner’s Manual to the Voice: A Guide for Singer’s and Other Professional Voice Users, says
“While scary, one of the things to know is that oxygen levels remain normal during an attack. People with this disorder feel they are not getting enough air but they actually are. It is one of the things that distinguishes it from asthma or other respiratory disease. It is basically a behavioral problem and generally remedied with just a few sessions with an SLP.“
This voice disorder ALSO has lots of other names, such as laryngeal dyskinesia, inspiratory adduction, periodic occurrence of laryngeal obstruction, Munchausen’s stridor, hysterical croup and irritable larynx syndrome.…just to name a few!
Kristine Pietch, SLP at Johns’ Hopkins’ Dept. of Neck and Head in Baltimore and Bethesda, Maryland ,and a singer added:
“We don’t like the term ‘vocal cord dysfunction’ in our clinic for the reasons you describe (very non specific!) but it is the one that most pulmonologists use and that our patients hear first! I see a number of these patients every week and on my handout have to write “vocal cord dysfunction AKA paradoxical vocal fold motion” and NOW I’m probably going to have to add yet another…ILO aka inducible laryngeal obstruction which has been taking off (especially outside of the US). Too many terms…..very confusing….“
Other stuff to know
Paradoxical Vocal Fold Movement is misdiagnosed frequently as asthma because the symptoms are:
Noisy or wheezy inhale
A feeling of not inhaling enough air when playing sports or singing but recovers quickly, within 5 minutes.
Asthma or allergy medications don’t help with breathing problems
Has a history or symptoms of acid reflux
Patient points to the throat more than the chest to indicate the area of tension
This condition seems to be most common in young females 11-13 who are competitive athletes and quite driven academically. It occurs more in females than in males and can be caused by other things such as constantly being exposed to second hand smoke or irritants in perfumes.
It’s really important that the student get a correct diagnosis (asthma or PVFM) and specialized therapy from a voice care clinic and an experienced Speech-Language-Pathologist.
Sometimes asthma and PVFM occur at the same time too. The speaking and breathing need to be addressed before the singing voice.
Butyeko breathing helps in many cases.