What Is Vocal Cord Dysfunction?

Vocal cord dysfunction, or VCD, is a respiratory ailment caused by the closing of the vocal cords while breathing. Your vocal cords, also called vocal folds, are parallel bands of muscle located inside the larynx at the top of your windpipe. The vocal cords open (or separate) on in-breaths and close only partway on out-breaths. They close (or come together) when we speak, swallow, sing, cough, or lift objects. Persons with VCD have trouble breathing because their vocal cords close at the wrong time, reducing the flow of air to the lungs.

Vocal cord dysfunction goes by a variety of names, including paradoxical vocal fold movement (PVFM) and laryngeal dysfunction. It has several similarities to asthma, and is generally diagnosed by allergy specialists, but is a distinct medical condition with a different course of treatment. Though not considered life-threatening, VCD episodes can be unpleasant and temporarily debilitating.

Partly because it is so often misdiagnosed as asthma, VCD’s actual rate of occurrence is unknown. It does appear to be more common in women than in men and in young adults between 20 and 40 years old. It might also be more common in athletes, possibly as a learned response to high levels of cardiopulmonary activity. If you or a loved one is having breathing difficulties that suggest either VCD or asthma, seek care. For more information, see your Baptist Health medical provider or a member of our allergy and asthma team.

Signs & Symptoms

Vocal cord dysfunction is marked by a number of symptoms:

• A feeling that something is caught in your windpipe (“a lump in your throat”)
• A raspy noise originating in your throat, the medical term for which is stridor
• Changes in the sound of your voice
• Difficulty breathing, especially on the in-breath (inhalation)
• Regular coughing
• Temporary loss of speaking ability
• Throat tightness or pain.

There are four primary forms of VCD. The first, laryngospasm or the spastic contraction of the vocal cords, is a variation on the general condition. The other three types – exercise-induced, irritant-induced, and stress-induced VCD – describe additional factors that trigger vocal cord closure.

Causes

Medical science remains unclear as to the cause or causes of vocal cord dysfunction. A primary function of the vocal cords is the prevention of swallowed foods and liquids from entering the windpipe and lungs. Unsurprisingly, tissues in the tracheal region are highly sensitive to incoming matter. It is for this reason that VCD may be a learned response, that is, an overreaction of hypersensitive tissues to the threat of foreign-matter ingestion, similar to an allergy.

In keeping with this, researchers have identified a number of environmental or contextual factors that serve to trigger vocal cord dysfunction:

• Dust, fumes, smoke, or chemical irritants
• Emotional or psychological stress
• Exercise, especially for prolonged periods
• Gastroesophageal reflux disease (GERD)
• Respiratory or sinus infections
• Some medications, including certain antipsychotics.

Dietary change does not appear to impact the incidence of vocal cord dysfunction.

Diagnosis

The diagnosis of vocal cord dysfunction is complicated because its symptoms are similar to those of asthma. Confusion of the two is common and is further complicated by the fact that some patients have both conditions. That said, the two are distinguishable by symptoms. VCD primarily affects inhalation or in-breathing; asthma is most noticeable on exhalation – the out-breath.

The diagnosis of VCD typically requires the following steps:

• Information gathering: At your first meeting, your physician will record your symptoms and document your medical history. He or she will be interested in any outside factors that may be playing a role in your condition, as triggers for the onset of symptoms.
• Physical examination: Your physician will conduct a physical exam of your mouth, throat, neck, and chest.

You may be scheduled for one or both of these diagnostic procedures:

• Flow-volume loop: This is a test for measuring the performance of your respiratory system. If you have VCD rather than asthma, a reduction of airflow will be evident on in-breaths but not on out-breaths.
• Laryngoscopy: A laryngoscope is a thin, flexible tube with a tiny, attached camera that your physician can introduce to the windpipe to observe the operation of your vocal cords.

These tests can be conducted when the patient is exercising or at rest. Physical activity may be required to trigger a vocal cord closure for observation.

Treatment

There are two facets to the treatment of vocal cord dysfunction. The first is steps that you can take during an episode, and these vary with its duration and severity. The second is steps that you can take as part of a long-term strategy for managing VCD.

Options for responding to a VCD episode include:

• Breathing exercises: Your first concern during a VCD episode should be reestablishing breath control. A speech-language pathologist can teach you exercises that will help you increase airflow to the lungs.
• Heliox inhalation: More serious cases sometimes require care at an emergency medical facility. You may be given heliox – a gaseous mixture of helium and oxygen – that is often effective at opening air passages to the lungs.
• Surgery: A surgical procedure, called a tracheostomy, is performed in highly critical situations. The surgeon will make an incision in your windpipe below the vocal cords and insert a tube through which air can pass into the lungs.

VCD isn’t curable but can be successfully managed. Long-term treatment options include:

• Trigger avoidance: Once you’ve identified the trigger or triggers for your episodes, you can make efforts to avoid them. For example, if you’re sensitive to smoke or fumes, you’ll need to forgo social settings where people use tobacco or related products.
• Speech therapy: Speech therapy is a proven tool for increasing a person’s control over the vocal apparatus, including the vocal cords.
• Psychotherapy: Learning stress management is an effective means of limiting the impact of one of VCD’s primary triggers.

The prognosis for persons with vocal cord dysfunction is positive when they’ve planned ahead and have a management strategy in place.

Living with Vocal Cord Dysfunction

Because there is no cure for vocal cord dysfunction, persons with this condition must learn to live with it. There are steps that you can take to help you manage VCD.

Strategies for Managing Acute Episodes

VCD is riskiest during an acute attack. Have a response in mind to decrease the impact on your breathing and reduce the anxiety that you’re likely to experience.

Importance of Personalized Action Plans

Developing a personalized action plan for dealing with VCD can lessen the concern you feel during an episode. You’ll have a known means of responding without the guesswork.

Communication with Healthcare Providers and Educators

Medical researchers are making strides all the time in understanding and combating conditions such as VCD. Keep in touch with your allergy and asthma specialist for the latest advances in managing this chronic condition.

Prevention

There is no cure for vocal cord dysfunction but, by identifying the triggers to which you are sensitive, it is possible to reduce the frequency and intensity of VCD episodes. Keep in mind that VCD is not life-threatening – oxygen flow is reduced but never completely cut off when the vocal folds close. Maintaining calm during an episode is a critical aspect of managing this or any chronic condition.

Learn More About Vocal Cord Dysfunction at Baptist Health

Though vocal cord dysfunction is rarely a serious medical threat, it can be, under more severe circumstances, a worrisome and potentially risky condition. Learn the symptoms and seek medical care when necessary. For more information on Baptist Health asthma and allergy services, contact a speech pathologist at Baptist Health today.