Vocal Cord Dysfunction (VCD), also known as Paradoxical Vocal Fold Movement (PVFM), is a respiratory condition characterized by the inappropriate closure of the vocal cords during breathing. Normally, the vocal cords open widely to allow air into the lungs, but in VCD, they close partially or fully, typically during inhalation. This upper airway obstruction creates a sudden sensation of being unable to get a breath. Because VCD symptoms mimic those of an asthma attack, it is often misdiagnosed, leading to ineffective treatment.
Defining Vocal Cord Dysfunction
VCD is defined by the paradoxical motion of the vocal folds, two bands of muscle tissue located within the larynx. Instead of opening (abducting) upon inhalation, these muscles close (adduct), creating a bottleneck for airflow at the voice box. This functional disorder is an issue of coordination between the breathing and laryngeal muscles, not a problem originating in the lungs.
Primary symptoms include a sudden onset of shortness of breath, a feeling of throat tightness, and often stridor—a high-pitched, noisy sound upon inhalation. Unlike asthma, which typically causes difficulty during exhalation and responds to bronchodilator inhalers, VCD episodes involve greater difficulty inhaling and are not relieved by standard asthma medication. Episodes are often brief, resolving within minutes, but the sensation of suffocation can be intense and cause significant anxiety.
The Diagnostic Process
Diagnosis of VCD requires a multidisciplinary approach involving an Ear, Nose, and Throat (ENT) specialist, a pulmonologist, and a speech-language pathologist. The pulmonologist typically rules out or identifies co-existing lower airway conditions like asthma.
Pulmonary function tests (PFTs), specifically spirometry, help differentiate VCD from asthma by examining airflow patterns. A characteristic pattern on the flow-volume loop, such as a flattening of the inspiratory limb, can suggest an upper airway obstruction. The definitive test for VCD is flexible fiberoptic laryngoscopy, where a small camera is passed through the nose to visualize the vocal cords. This procedure allows the specialist to observe the abnormal closure of the vocal folds during a breathing challenge or a spontaneous episode.
Speech Therapy and Behavioral Techniques
The core of VCD management lies in specialized Speech-Language Pathology (SLP), often called Laryngeal Control Therapy or respiratory retraining. This behavioral therapy focuses on teaching the patient conscious control over their laryngeal muscles and breathing patterns. The goal is to retrain the vocal folds to remain open for unimpeded airflow.
A central component of this therapy is learning diaphragmatic, or belly, breathing, which promotes a lower, more relaxed breathing style. Patients are taught to inhale deeply, allowing the abdomen to expand without raising the chest and shoulders, minimizing the muscle tension that can trigger a VCD episode. Practice often involves placing one hand on the chest and one on the belly to ensure the proper movement is felt.
For managing an acute episode, specialized quick recovery techniques are taught to interrupt the dysfunctional spasm. One common technique involves a rapid series of three short, sharp sniffs through the nose, which forces the vocal folds open, followed by a slow, controlled exhalation through pursed lips. This controlled exhale, often paired with a sound like “s” or “sh,” provides back pressure that helps keep the laryngeal airway open while calming the nervous system.
Another technique is relaxed throat breathing, where the patient focuses on keeping the throat muscles loose and open during inhalation. The SLP may also integrate techniques like the “sniff-puff” or breathing through a straw to encourage a more efficient breathing pattern. Consistent daily practice of these exercises, even when asymptomatic, is necessary to make the correct breathing pattern automatic, reducing the frequency and severity of future episodes.
Addressing Underlying Medical Triggers
While behavioral techniques provide the primary fix for the breathing pattern, VCD is often provoked by other medical conditions that require separate management for complete resolution. Laryngopharyngeal Reflux (LPR) or Gastroesophageal Reflux Disease (GERD) are frequent triggers, as the backflow of stomach acid can irritate laryngeal tissues, leading to hypersensitivity and spasm.
Management of reflux involves a combination of lifestyle changes and medication. Dietary modifications include avoiding or limiting common culprits:
- Caffeine.
- Chocolate.
- Alcohol.
- Spicy or fatty foods.
Behavioral changes, such as not eating within three hours of bedtime and elevating the head of the bed, are also recommended to prevent nocturnal reflux. Medications like proton pump inhibitors (PPIs) or H2-blockers may be prescribed to reduce stomach acid production and allow the laryngeal irritation to heal.
Other medical factors, such as chronic upper airway irritation from post-nasal drip or environmental irritants, must also be addressed. Treating underlying allergies or sinus issues can reduce the local inflammation that sensitizes the vocal cords. Strong emotions, anxiety, and stress are established triggers for VCD, necessitating psychological support or behavioral therapy to learn stress management techniques. Avoiding non-medical environmental triggers like strong odors, smoke, and chemical fumes is a proactive step to reduce the likelihood of an episode.