Vocal Cord Dysfunction

Vocal cord dysfunction (VCD) is a condition in which the vocal cord (voice box) does not open correctly. This syndrome is also referred to as paradoxical vocal fold movement.

Normally, the vocal cords, which lie over the airway at the voice box, or larynx, open to allow air to move through when one takes a deep inhalation. Then, the vocal cords unite and vibrate over the airway to produce sound when one is talking. In people with VCD, the vocal cords close over the airway unwillingly with breathing, making it enormously tough to breathe. Although this appears hazardous, there is usually a small area at the back of the airway specifically not influenced, so that the person is in fact receiving adequate oxygen during an attack.

VCD is sometimes mistaken with asthma as some of the symptoms are similar. In asthma, the airways (bronchial tubes) squeeze, making breathing obstinate. With VCD, the vocal cord muscles squeeze, this also makes breathing obstinate. But unlike asthma, VCD is not an allergic response of the immune system. Some people suffering from asthma may have VCD, even though both the conditions have similar causes and symptoms, but the treatment approach for VCD is very different from that in case of asthma. This reveals the necessity of accurate diagnosis of VCD by a specialized allergist / immunologist.

Causes

There are various possible causes of VCD such as:

  • Upper respiratory infection (cold)
  • Smoking tobacco
  • Strong odors or fumes
  • Post-nasal drip
  • Acid-reflux (GERD)
  • Long-term emotional stress
  • Exercise

Symptoms

Common signs and symptoms of VCD are:

  • Coughing
  • Wheezing
  • Tight throat
  • Hoarse voice
  • Voice changes
  • Breathing difficulty

Like asthma, breathing of lung irritants, a cold, long exercises, or conditions such as Gastroesophageal Reflux Disease (GERD) and viral infections may spark off symptoms of VCD. Unlike asthma, VCD bring about more difficulty with inhalation than exhalation, while the reverse is true for symptoms of asthma.

Diagnosis
Diagnosis of VCD by an allergist / immunologist includes reviewing the history of inhalation problems and assessing voice quality of the patient. In addition, certain tests such as spirometry and laryngoscopy may be recommended.

Spirometry is a breathing test for measuring airflow whereas laryngoscopy involves the examination of the vocal cords through a camera connected to a narrow flexible tube called an endoscope. Normally vocal cords are open while taking a breath, whereas people suffering from VCD have closed vocal cords instead of open during inhalation.

Treatment

The treatment of VCD is different from various respiratory disorders, as medicines are not employed to control or prevent symptoms of VCD. A broad range of treatment options are available for VCD that includes:

  • Speech therapy
  • Breathing exercises
  • Relaxation techniques
  • Biofeedback
  • Hypnotherapy or psychotherapy

If the patient is suffering from asthma also, it should be treated parallel. If the VCD is triggered by post-nasal drip or acid reflux (GERD), such conditions should be treated with medications.