Vocal Cord Dysfunction

What is Vocal Cord Dysfunction?

Vocal cord dysfunction (VCD) is a condition in which individuals experience difficulty breathing due to a problem in the throat or larynx (also known as the voice box). When an individual tries to breathe in, the two tiny white bands in the larynx called the vocal cords (or vocal folds) close, preventing air from entering the windpipe or the trachea. Vocal cord dysfunction is also known as paradoxical vocal fold dysfunction, involuntary vocal fold closure and laryngospasm.

Vocal cord dysfunction is more prevalent in females than males, regardless of age. In children, vocal cord dysfunction is often seen in competitive athletes. Usually the episodes are temporary, but due to a delayed or inaccurate diagnosis, individuals may go without specific treatment for a long time. This problem often coexists with other conditions such as asthma, gastroesophageal reflux disease (GERD) and allergies.

What are the Signs and Symptoms of Vocal Cord Dysfunction?

There are several symptoms of vocal cord dysfunction, many of them serious. A person with VCD may find it difficult to be involved in sports or other physical activity due to their symptoms, including:

  • Shortness of breath (especially recurrent episodes)
  • Noisy breathing or stridor (a harsh vibrating sound heard during respiration)
  • Fatigue
  • Throat and chest tightness
  • More difficulty getting air "in" than "out"
  • Near or total loss of consciousness in severe conditions
  • Sensation of choking or suffocation
  • Lightheadedness and dizziness
  • Difficulty swallowing
  • Intermittent voice loss or change of voice
  • Chronic throat clearing or cough

What Causes Vocal Cord Dysfunction?

The exact cause of vocal cord dysfunction has not been established. Upper airway sensitivities, reflux, central nervous system (CNS) disorders and psychosomatic issues have been suspected to result in adapting improper upper airway patterns during the breathing process.

How is Vocal Cord Dysfunction Evaluated?

Diagnosis and treatment of vocal cord dysfunction often involves a team of specialists including (but not limited to) speech-language pathologists, pulmonologists, allergists, otolaryngologists, gastroenterologists, neurologists, psychiatrists, psychologists, athletic trainers and coaches. Often clients will receive an extensive medical evaluation and interview prior to the assessment of vocal cord dysfunction by a speech-language pathologist.

A speech-language pathologist and otolaryngologist will typically perform an endoscopic examination of the voice box and run a variety of breathing tasks to determine:

  • Laryngeal valving performance
  • Respiratory driving pressure for speech
  • Musculoskeletal tension in the laryngeal area

They will also complete a structural/functional examination of speech structures and provide biofeedback of breathing exercises. In addition, sometimes a pulmonary specialist will perform pulmonary function tests including spirometry, pulse oximetry and methacholine challenge tests.

What is the Treatment for Vocal Cord Dysfunction?

Treatment for vocal cord dysfunction varies. It requires a multidisciplinary approach and is determined by coexisting conditions. However, the speech-language pathologist is the primary treatment facilitator for vocal cord dysfunction.