Paradoxical Vocal Fold Motion in a High-Level Athlete
Paradoxical vocal fold motion (PVFM), also known as vocal cord dysfunction or paradoxical vocal cord motion is a nonorganic episodic breathing condition often mistaken for asthma. It involves abnormal adduction of the true vocal folds during inspiration and/or exhalation resulting in narrowing of the upper airway with perceived shortness of breath and/or stridor. It is commonly seen in young, competitive athletes but can occur in adults or in young nonathletes.
DR was in his early 20s and a very high-level runner, regularly competing in distance events at national and international meets. At presentation, he reported a 7-month history of breathing problems that began after a bad flu. He was initially diagnosed with asthma and was taking Advair as well as two puffs of Albuterol prior to exercise. This treatment protocol provided some relief of his dyspnea, but he still felt like his throat “constricted” when running. When symptomatic, he reported increased difficulty inspiring relative to expiring and he was occasionally stridorous on inhalation. His symptoms affected his ability to train as intensely as required and affected his running performance. He denied any limitations related to his voice, but reported increased difficulty with voicing when symptomatic.