Vocal Cord Dysfunction Symptoms And Treatment

What is Vocal Cord Dysfunction? How does it differ from asthma? How do you get it? Can you only have one condition or the other, or is it possible to have both? How does the treatment for Vocal Cord Dysfunction differ from asthma treatment?

Vocal cord dysfunction (VCD), also known as paradoxical closure of the vocal cords, may occur in a person who also has asthma, but it can occur without asthma as well. The patient, and often the physician, hear wheezing in the chest, and the patient may appear very distressed. Patients have even been seen in emergency rooms with this problem, and admitted to an intensive care unit with the diagnosis of status asthmaticus (life-endangering asthma).

VCD is the closing of the vocal cords paradoxically — they snap closed during inspiration rather than staying open during this phase of breathing. The closure is accompanied by a wheezing sound made at the vocal cord area in the neck by air passing through a smaller than usual passage. The wheeze may be transmitted into the chest and thus create the appearance of asthma.

Often the patient also has asthma and it may be difficult to distinguish worsened asthma from the symptoms of VCD, which are usually self-limiting (and do not usually require medications or hospitalization). The VCD probably is the result of our autonomic nervous system (the one we do not control, that governs functions such as our blinking when something comes toward our eye). It is known that psychosocial problems may be very important in causing VCD, but not always. There is also an interesting twist to VCD. Patients, often elite athletes, will have VCD at the peak moment of their exercise and have to halt what they are doing at the time it occurs. The diagnosis is suspected when the clinical presentation does not follow the pattern of asthma. The diagnosis can also be made when reviewing the inspiratory curve on the pulmonary function studies and confirmed by direct visualization of the vocal cords while the patient takes a deep breath.

Therapy starts by having the patient fully understand what is occurring and helping them differentiate their symptoms from those of asthma. If asthma is present, the care for asthma is optimized. Speech therapy will allow the patient to learn maneuvers that can halt the symptoms, and psychosocial interventions are employed where indicated.

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