Vocal Cord Dysfunction

Vocal cord dysfunction (VCD) is a syndrome that causes asthma-like symptoms as a result of the abnormal closure of the vocal cords. Symptoms may include wheezing, shortness of breath, and chest or neck tightness. VCD can so closely mimic asthma that this syndrome has also been called vocal cord asthma.

However, asthma medications have no effect on VCD. Sometimes, people undiagnosed for VCD will go to the emergency room and be treated as if they have asthma. Find out more about how VCD is diagnosed and effectively treated.

Symptoms

Normally, the vocal cords, which sit over the airway at the voice box (larynx), open to let air move through when you take a deep breath. Then, the vocal cords close and vibrate over the airway to make a sound when you are talking.

Typically, when VCD occurs, a person will notice the sudden onset of severe symptoms like trouble breathing, wheezing, or stridor (a high-pitched noise) when inhaling. The person will probably be unable to speak or will speak only with a ​hoarse voice.

Asthma inhalers do not help in this situation; the person may find that sitting down and taking slow, deep breaths gradually resolves the symptoms over many minutes.

Causes

The cause of VCD is not fully known or understood. Some experts think that the condition is related to stress and anxiety and may even be a symptom of a psychiatric disorder. Recently, VCD has also been attributed to gastroesophageal reflux disease (GERD) and laryngeal spasms.

VCD seems to be triggered in various ways. For some, exercise is the only trigger, and the amount of exercise that triggers the problem can depend on the individual. For others, stress and anxiety—often during social gatherings—is a common trigger. Other people have their VCD triggered by irritants, such as GERD, or the inhalation of various environmental irritants such as strong odors or perfumes.

Diagnosis

Clues to the diagnosis include a person who has been diagnosed as having severe asthma, yet has not responded well to typical asthma medications. The person may have had multiple emergency room visits, hospitalizations, and even endotracheal intubations as a result of symptoms. Even so, asthma continues to be difficult to control.

The best diagnostic test, usually performed by an ear, nose and throat doctor, is for the physician to directly see the movement of the vocal cords using a flexible nasopharyngoscope. This involves a tiny camera at the end of a long, thin plastic tube that's inserted into the nose and down the throat.

For VCD to be diagnosed, the doctor needs to see that the vocal folds come together during inspiration, which is the opposite of what they should do.

Treatment

There are many treatment options for people with VCD, many of which focus on relaxation of the vocal cord muscles. Others aim to prevent triggers that lead to VCD attacks. Options include:

• Speech therapy
• Breathing exercises
• Relaxation techniques
• Biofeedback
• Hypnotherapy
• Botox injections in the vocal cords
• Treatment of GERD

In one study, almost all of the people with VCD who were followed had symptoms for fewer than five years—and many had symptoms for no more than six months. So VCD isn't necessarily a condition you have to live with for life.