Understanding Upper Airway Disorders
Your throat closes. You can't get air in. It feels like you're suffocating. And your inhaler does nothing.
Inducible Laryngeal Obstruction (ILO), Paradoxical Vocal Fold Motion (PVFM), and Vocal Cord Dysfunction (VCD) are conditions where the vocal folds inappropriately narrow or close during breathing, particularly on the in-breath. This creates sudden episodes of breathing difficulty, throat tightness, noisy breathing (stridor), and a choking sensation. These episodes are frightening. Many patients describe them as the most terrifying moments of their lives.
Upper airway disorders are frequently misdiagnosed as asthma because the symptoms look similar: shortness of breath, wheezing, respiratory distress. But asthma medications target the lower airways. ILO, PVFM, and VCD affect the upper airway at the level of the larynx (the voice box). Inhalers won't fix what's happening at the vocal folds. Many patients spend years on escalating asthma medications that provide little relief, because the diagnosis is wrong.
Sacha Allnatt (NZSTA #12789) has 15 years of hospital-based respiratory and voice experience across Te Whatu Ora Wellington and Austin Health Melbourne. Speech therapy is recognised internationally as the first-line treatment for these conditions. Most patients see real improvement within 2-6 sessions.
Seek Medical Assessment If
Get medical evaluation immediately if you experience:
- Sudden severe breathing difficulty requiring emergency care
- Blue lips or fingertips during breathing episodes
- Breathing difficulty not responding to asthma inhalers
- Loss of consciousness during breathing episodes
Speech Therapy Indicators
Consider upper airway disorder therapy when:
- Inspiratory wheeze (noisy breathing IN)
- Throat tightness or choking sensation
- Triggered by exercise, stress, or strong odours
- Asthma medications provide limited relief
Evidence-Based Treatment
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Know What to Do Mid-Episode
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Finally Get the Right Diagnosis
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Return to Exercise Without Fear
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Your Respiratory Team, Connected
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Manage Triggers Before They Escalate
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Reduce Episodes Over Time
Speech Therapy: The First-Line Treatment
Speech therapy is internationally recognised as the first-line treatment for ILO, PVFM, and VCD. Not a supplementary add-on. Not a last resort. First line.
The reason is straightforward: these conditions involve the vocal folds behaving abnormally during breathing. Medications can't retrain that behaviour. Inhalers target the wrong part of the airway entirely. What works is teaching the laryngeal muscles to respond differently. That's what speech therapists do.
Sacha starts with rescue breathing techniques so you have something to use immediately when an episode hits. From there, she builds a programme around your specific triggers: diaphragmatic breathing for respiratory control, progressive laryngeal tension reduction, exercise protocols if sport is involved, and anxiety management if stress plays a role.
Most patients see real improvement within 2-6 sessions. You'll practise techniques in clinic, then daily at home. The work between sessions matters as much as the sessions themselves.
Breathing Pattern Assessment
We evaluate how you breathe at rest, during speech, and under exertion. We map your triggers, identify laryngeal tension patterns, and listen to your breathing history, including every failed treatment you've tried before.
Respiratory Retraining
You'll learn specific breathing techniques that interrupt the abnormal vocal fold closure. These aren't generic relaxation exercises. They target the larynx directly, retraining the muscles that are closing when they should be open.
Laryngeal Relaxation
Chronic throat tension keeps the vocal folds primed to close. We use specific exercises to release that tension and restore normal vocal fold movement during breathing. Less tension means fewer episodes.
ILO/PVFM/VCD vs Asthma: Understanding the Difference
Why Misdiagnosis Happens
Upper airway disorders and asthma share similar symptoms: shortness of breath, wheezing, and respiratory distress. But they affect different parts of the airway and need different treatments. Many patients cycle through multiple asthma medications with limited success before discovering the breathing difficulty originates from the vocal folds, not the lungs. This delay often spans years.
Features Suggesting ILO/PVFM/VCD
- Inspiratory stridor (noisy breathing in)
- Throat tightness or choking sensation
- Triggered by odours, exercise, or stress
- Voice changes during episodes
- Poor response to asthma inhalers
Typical Asthma Features
- Expiratory wheeze (noisy breathing out)
- Chest tightness rather than throat
- Allergies, pollen, or weather triggers
- Normal voice quality
- Good response to asthma medication
Important Note: Co-existence
Some patients have both an upper airway disorder AND asthma at the same time. This makes diagnosis harder and treatment more confusing. We work directly with your respiratory physicians and ENT specialists to ensure both conditions are managed properly. Treating one while ignoring the other leaves you stuck.
Treatment Techniques
- Rescue breathing techniques for acute episodes
- Diaphragmatic breathing for respiratory control
- Progressive laryngeal tension reduction exercises
- Trigger identification and management strategies
- Anxiety and stress management techniques
- Exercise protocols for athletes and active individuals
- Environmental modification and exposure strategies
- Home exercise programmes for ongoing management
Who We Help
Misdiagnosed for years. You've been told it's asthma. You've tried preventer inhalers, reliever inhalers, nebulisers, oral steroids. Nothing works properly. Your GP keeps escalating medications. You've ended up in A&E during bad episodes and been sent home with "asthma management plans" that don't manage anything. Nobody has questioned whether it's actually asthma. You're starting to wonder if anyone will.
Episodes during sport. You're an athlete. Or you were, before the breathing episodes started. Running, swimming, cycling, team sport. Exertion triggers something terrifying. Your throat slams shut. You can't get air in. You've pulled out of races, stopped training, dropped off teams. You've seen sports medicine doctors, respiratory physicians, allergists. The inhalers they prescribe don't touch it. You want to train again. You need someone who understands what's actually happening.
Stress shuts your throat. It happens in meetings. Presentations. Difficult conversations. Conflict. Your throat tightens, your breathing becomes noisy, and you feel like you're choking in front of colleagues. You've been told it's anxiety, and maybe anxiety plays a role, but this is a physical event, not a panic attack. The distinction matters, because the treatment is different.
Asthma AND upper airway disorder. This is the most confusing scenario. You have confirmed asthma. Real, diagnosed, medication-responsive asthma. But some of your episodes don't respond to treatment. Some feel different. Your respiratory physician suspects you might have an upper airway component on top of the asthma. You need someone who can address the laryngeal piece while your medical team manages the asthma piece. We coordinate both sides.
Working With Your Medical Team
Upper airway disorders benefit from coordinated care across multiple specialties.
Hospital-Trained Collaboration
Sacha's 15 years across Te Whatu Ora Wellington and Austin Health Melbourne means she speaks the same clinical language as your specialists. She works directly with ENT surgeons for laryngoscopy diagnosis, respiratory physicians for differential diagnosis, and psychologists when anxiety management is part of the picture.
We provide detailed clinical reports to your medical team and attend multidisciplinary meetings when appropriate. Every specialist involved in your care stays informed.
Diagnosis and Confirmation
Laryngoscopy by an ENT specialist is the gold standard for confirming ILO, PVFM, and VCD. The specialist visualises paradoxical vocal fold movement during provocation testing. You can actually see the vocal folds closing when they should be opening. Pulmonary function tests may also show characteristic inspiratory flow limitation.
We coordinate with your specialists to interpret findings and build a treatment plan that combines speech therapy (the first-line treatment) with medical management where needed.
We Collaborate With
- ENT Specialists (Laryngology)
- Respiratory/Pulmonary Physicians
- Allergists and Immunologists
- General Practitioners
- Psychologists (Anxiety/Stress)
- Sports Medicine Physicians
Your Recovery Journey
Evidence-based therapy supporting ongoing recovery
Book Your Assessment
Schedule online. 75-minute initial appointment. Wellington in-person or telehealth from anywhere in New Zealand. Same-week availability is common.
Breathing Pattern Evaluation
Sacha assesses your breathing at rest and under load, maps your triggers, reviews your medication history, and identifies whether upper airway involvement is driving your symptoms.
Your Treatment Plan
Clear goals, specific techniques, realistic timeline. You'll leave with rescue breathing strategies you can use immediately, before the next session.
Practise and Refine
Weekly sessions to build technique. Daily home exercises between appointments. We adjust the programme as your breathing improves and you face real-world triggers.
Ongoing Management
Follow-up sessions to address new triggers, refine sport-specific protocols, and coordinate with your medical team. Most patients graduate within 2-6 sessions.
Transparent, Fair Pricing
Choose the option that works best for you
Wellington Clinic
In-person appointments at our Newtown clinic
Telehealth
Secure video sessions from your home
Package discounts available: Save with our 6-session therapy packages. Contact us for details
Payment accepted via credit/debit card, EFTPOS, or direct bank transfer. Invoices provided for insurance claims.
Frequently Asked Questions
Laryngoscopy by an ENT specialist during symptom provocation is the gold standard. The specialist watches the vocal folds in real time and can see them closing when they should be opening. Pulmonary function tests may show inspiratory flow limitation as a secondary indicator. We work closely with ENT and respiratory physicians to get you an accurate diagnosis, not another round of asthma medications.
Most patients see real improvement within 2-6 sessions over 4-8 weeks. You'll learn rescue breathing techniques in the first session, something you can use immediately. Athletes and exercise-triggered cases may need additional sessions for sport-specific protocols. Some patients achieve complete resolution. Others develop strong management skills that make episodes rare and short-lived.
Yes. If you have confirmed asthma alongside your upper airway disorder, keep taking your prescribed asthma medications. Speech therapy addresses the laryngeal component, the part your inhalers can't reach. We coordinate with your respiratory physician so both conditions are managed together, not separately.
Yes. We can observe your breathing patterns, demonstrate techniques, and give real-time feedback via video. Many athletes and professionals prefer telehealth because it fits around training and work schedules without travel time. The techniques translate directly. You're practising in the environment where episodes actually happen.
Anxiety can trigger upper airway episodes, and episodes can trigger anxiety. They feed each other. But the laryngeal closure is a physical event. Your vocal folds are literally closing during breathing. Telling someone to 'just relax' doesn't address the mechanism. We teach specific techniques that interrupt the closure pattern. If anxiety management is also needed, we coordinate with psychologists.
Initial assessment (75 min): $207 in-person, $167 telehealth. Follow-up sessions (45 min): $157 in-person, $127 telehealth. Most patients need 2-6 sessions. We provide invoices for insurance claims.
Your story matters.
Communication is complex and deeply personal. Specialist speech therapy helps you achieve your goals.