Inspiratory muscle strength training
Inspiratory muscle training (IMT) has been used to improve the strength of respiratory muscles in a wide range of medical conditions and athletic training. There are case reports of improvement through IMT with athletic adolescents diagnosed with exercise-induced paradoxical vocal fold motion (intermittent laryngeal obstruction) (EILO). In combination with medical and behavioural management, athletes were shown to have eliminated EILO and improved performance in their respective events with the athletes improving their maximum inspiratory pressure.[100]Ruddy BH, Davenport P, Baylor J, et al. Inspiratory muscle strength training with behavioral therapy in a case of a rower with presumed exercise-induced paradoxical vocal-fold dysfunction. Int J Pediatr Otorhinolaryngol. 2004;68:1327-1332.
http://www.ncbi.nlm.nih.gov/pubmed/15364505?tool=bestpractice.com
[101]Mathers-Schmidt BA, Brilla LR. Inspiratory muscle training in exercise-induced paradoxical vocal fold motion. J Voice. 2005;19:635-44.
http://www.ncbi.nlm.nih.gov/pubmed/16112543?tool=bestpractice.com
[102]Hatzelis V, Murry T. Paradoxical vocal fold motion: respiratory retraining to manage long-term symptoms. J Soc Bras Fonoaudiol. 2012;24:80-85.
http://www.ncbi.nlm.nih.gov/pubmed/22460377?tool=bestpractice.com
[103]Sandnes A, Andersen T, Clemm HH, et al. Exercise-induced laryngeal obstruction in athletes treated with inspiratory muscle training. BMJ Open Sport Exerc Med. 2019;5(1):e000436.
https://bmjopensem.bmj.com/content/5/1/e000436
http://www.ncbi.nlm.nih.gov/pubmed/30792880?tool=bestpractice.com
Hypnosis
There is case reporting in which hypnosis was used as a diagnostic tool in a controlled environment. Self-hypnosis was guided to suggest a paradoxical vocal fold motion (intermittent laryngeal obstruction) attack during flexible fibre-optic nasendoscopy. This use may suggest a role as a form of treatment in addition to speech therapy and counselling.[104]Anbar RD, Hehir DA. Hypnosis as a diagnostic modality for vocal cord dysfunction. Pediatrics. 2000;106:E81.
http://pediatrics.aappublications.org/content/106/6/e81.full
http://www.ncbi.nlm.nih.gov/pubmed/11099624?tool=bestpractice.com
Electromyographic biofeedback
There is case reporting of use of surface electromyography (EMG) to treat paradoxical vocal fold motion (intermittent laryngeal obstruction) in which standard breathing recovery exercises were ineffective.[105]Warnes E, Allen KD. Biofeedback treatment of paradoxical vocal fold motion and respiratory distress in an adolescent girl. J Appl Behav Anal. 2005;38:529-532.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1309714
http://www.ncbi.nlm.nih.gov/pubmed/16463532?tool=bestpractice.com
Short-term intensive therapy
One study of 11 adolescent athletes suggests that short-term intensive therapy may be beneficial for athletes with paradoxical vocal fold motion (intermittent laryngeal obstruction).[106]Gallena SK, Johnson AT, Vossoughi J. Short-Term Intensive Therapy and Outcomes for Athletes With Paradoxical Vocal Fold Motion Disorder. Am J Speech Lang Pathol. 2019 Feb 21;28(1):83-95.
https://www.doi.org/10.1044/2018_AJSLP-17-0223
http://www.ncbi.nlm.nih.gov/pubmed/30453332?tool=bestpractice.com
Olin exercise-induced laryngeal obstruction biphasic inspiration (EILOBI) breathing techniques
Olin EILOBI breathing techniques are designed to relieve EILO during high intensity exercise. The teaching process for these techniques consist of benchmarks of expectation setting, planning, splitting where biphasic breathing occurs, and learning forceful inhalation. A total of 66% of individuals with EILO perceived benefit from the use of these exercises.[93]Johnston KL, Bradford H, Hodges H, et al. The Olin EILOBI breathing techniques: description and initial case series of novel respiratory retraining strategies for athletes with exercise-induced laryngeal obstruction. J Voice. 2018 Nov;32(6):698-704.
http://www.ncbi.nlm.nih.gov/pubmed/29050661?tool=bestpractice.com
Buteyko breathing technique
In one study, 12 patients with EILO and hyperventilation who underwent the Buteyko breathing technique showed improvements in dyspnoea severity, resting heart rate, respiratory tidal minute volume, and end tidal CO₂.[107]Katz DH, Sella O, Golan H, et al. Buteyko Breathing Technique for Exertion-Induced Paradoxical Vocal Fold Motion (EI-PVFM). J Voice. 2019 Aug 12;:.
https://www.doi.org/10.1016/j.jvoice.2019.07.017
http://www.ncbi.nlm.nih.gov/pubmed/31416749?tool=bestpractice.com
Athletes may benefit from this technique.
Botulinum toxin
Botulinum toxin has been used in some studies in patients with severe symptoms to maintain an open airway, on as needed basis.[108]Maillard I, Schweizer V, Broccard A, et al. Use of botulinum toxin type A to avoid tracheal intubation or tracheostomy in severe paradoxical vocal cord movement. Chest. 2000;118:874-877.
http://journal.publications.chestnet.org/article.aspx?articleid=1079121
http://www.ncbi.nlm.nih.gov/pubmed/10988221?tool=bestpractice.com
[109]Mahoney J, Hew M, Vertigan A, et al. Treatment effectiveness for vocal cord dysfunction in adults and adolescents: a systematic review. Clin Exp Allergy. 2022 Mar;52(3):387-404.
http://www.ncbi.nlm.nih.gov/pubmed/34699093?tool=bestpractice.com
However, further research is required.