PVCM, PVCD, EPL, and irritable larynx syndrome: What are we talking about and how do we treat it?

Paroxysmal vocal cord movement/motion (PVCM), paroxysmal vocal cord dysfunc tion (PVCD), episodic paroxysmal laryngospasm (EPL), and irritable larynx s yndrome (ILS) are terms used to describe laryngeal dysfunction masquerading as asthma, upper airway obstruction, or functional and organic voice disor ders. The differential diagnosis of PVCM, PVCD, EPL, and ILS is critical to successful medical and behavioral management of the patient. During the pa st 10 years, 27 subjects, ages 15-79 years, were identified to have paroxys ms of inspiratory strider, acute respiratory distress, associated aphonia a nd dysphonia, resulting in misdiagnosis and unnecessary emergency treatment s, including endotracheal intubation, cardiopulmonary resuscitation, massiv e pharmacotherapy, or tracheostomy. A multifactorial management program is proposed utilizing principles of motor learning, neurolinguistic programmin g model, respiratory and phonatory synchronization, relaxation techniques, concurrent monitoring of behavioral adjustments, and formal psychological c ounseling.