Vocal cord dysfunction
Description
Vocal cord dysfunction is a medical condition in which variable upper airway blockage takes place due to intermittent closure of the vocal cords during respiration.
The prevalence has been reported to range from 2.5% of patients presenting to an asthma clinic to up to 22% of patients with recurrent emergency department (ED) visits for dyspnea, while the incidence is not precisely defined.
This condition can be mistaken for or co-exist with asthma and is more common in women.
Symptoms
The patient may suffer from different symptoms :
- Dyspnea
- Choking sensation
- Cough
- Stridor
- Wheezes
- Throat or chest tightness
- Hoarseness
Visit your Chest and Respiratory doctor if you have symptoms of vocal cord dysfunction to be diagnosed properly
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View MoreCauses
There’s no clear cause for the condition, but there are several precipitating factors and triggers :
- Exercise
- Psychological disorders- such as depression and anxiety
- Irritants-such as dust, smoke, and chemicals
- Rhinosinusitis
- Gastroesophageal reflux
- Medication use
Diagnostics
The most valuable tools for diagnosis are :
Pulmonary function testing with flow-loop : It’s a test in which a chart with respiration patterns is produced from a device after the patient respiration. It’s the most common test for diagnosis and it differentiates vocal cord dysfunction from asthma through differences in the produced chart.
Flexible laryngoscopy : It’s the standard tool for diagnosis. In this test vocal cords' movements are directly observed during respiration by a device with camera to confirm the diagnosis.
Other tests such as measuring blood gases may be used to rule out other conditions.
Treatment
Treatment differs in acute episodes and long-term treatment.
Acute episode :
- Reassure patient.
- Following instructions for breathing behaviors, including panting, diaphragmatic breathing, breathing through the nose or a straw.
- Helium and oxygen (heliox) in patients with persistent or severe vocal cord dysfunction.
Long-term treatment :
- Avoiding known triggers, such as smoke, airborne irritants, or certain medications.
- Treating underlying conditions, including anxiety, depression, gastroesophageal reflux disease, and rhinosinusitis.
- Trying inhaled Ipratropium in patients with exercise-induced symptoms.
- Referral for speech therapy is indicated in patients with unresolved symptoms. It’s a mainstay therapy and includes techniques such as relaxed-throat breathing.
- Tracheostomy in severe, resistant cases.
- Vocal cord dysfunction and other respiratory illnesses in two water-damaged buildings. CDC. Available at: https://www.cdc.gov/niosh/nioshtic-2/20044585.html. Last accessed at: 14/9/2022.
- Denipah N, Dominguez CM, Kraai EP, Kraai TL, Leos P, Braude D. Acute Management of Paradoxical Vocal Fold Motion (Vocal Cord Dysfunction). Ann Emerg Med. 2017;69(1):18-23.
- Weir M. Vocal cord dysfunction mimics asthma and may respond to heliox. Clin Pediatr (Phila). 2002;41(1):37-41.
- Husein OF, Husein TN, Gardner R, Chiang T, Larson DG, Obert K, Thompson J, Trudeau MD, Dell DM, Forrest LA. Formal psychological testing in patients with paradoxical vocal fold dysfunction. Laryngoscope. 2008;118(4):740-7.
- Deckert J, Deckert L. Vocal cord dysfunction. Am Fam Physician. 2010;81(2):156-9.
