Vocal Cord Dysfunction (VCD) is a condition defined by the miscoordination of the vocal cords, causing sudden breathing difficulty. These episodes occur because the vocal folds close unexpectedly during inhalation, rather than opening to allow air into the lungs. The resulting restricted airflow produces symptoms like stridor, a high-pitched, wheezing-like sound that occurs when breathing in. Though the experience of gasping for air can be frightening, VCD is manageable and highly treatable.
Understanding What Vocal Cord Dysfunction Is
VCD is a functional disorder of the larynx, or voice box, where the vocal cords exhibit paradoxical movement. Normally, the vocal cords open widely to facilitate breathing and come together to produce sound. In VCD, the cords inappropriately close during the inspiratory phase of the breath cycle, leading to upper airway obstruction.
This mechanism is distinct from asthma, which involves inflammation and narrowing of the lower airways. A key difference is that VCD symptoms primarily cause difficulty breathing in, while asthma typically causes difficulty breathing out. VCD symptoms are often unresponsive to conventional asthma medications like inhaled bronchodilators, which is a major clinical clue.
The definitive diagnosis often requires a flexible laryngoscopy, where a doctor uses a camera to directly observe the vocal cords. This procedure, ideally performed during a symptomatic period, confirms the diagnosis by visualizing the paradoxical closure of the vocal folds. Spirometry, a breathing test that measures airflow, can also support the diagnosis by showing a characteristic flattening of the inspiratory flow-volume loop.
Immediate Techniques for Managing Acute Episodes
When an acute VCD episode begins, the first step is to recognize the onset and actively work to break the paradoxical closure of the vocal cords. The immediate goal is to regain control of the airway using specific breathing patterns, often referred to as rescue breathing maneuvers.
One highly effective technique is the “sniff-breath” maneuver, which involves taking two or three quick, deep sniffs through the nose in rapid succession. This reflexive, forced inhalation helps to pull the vocal cords apart, allowing air to pass into the lungs. Following the sniffs, the air should be slowly exhaled through pursed lips, often while making a sibilant sound like “s,” “sh,” or “f” for a count of eight to ten.
Pursed-lip breathing alone is also a valuable tool for acute management, as it creates back-pressure in the airway that helps stabilize the vocal cords. The slow, controlled exhalation helps prolong the breath out and prevent hyperventilation. Adopting a relaxed posture, such as sitting upright with the neck and shoulders relaxed, can also reduce musculoskeletal tension.
The Role of Speech Therapy in Long-Term Correction
The primary and most effective long-term treatment for VCD is specialized speech therapy, delivered by a Speech-Language Pathologist (SLP). This therapy focuses on respiratory retraining and establishing new, functional muscle memory for breathing. The process begins with education, where the SLP explains that the abnormal cord movements are reversible, habitual patterns rather than a structural problem.
A foundational element of respiratory retraining is diaphragmatic breathing, often called belly breathing. Patients are taught to inhale deeply, causing the abdomen to expand outward, without engaging the upper chest or shoulders. This technique promotes relaxed breathing and reduces accessory muscle tension in the neck and throat.
The SLP also introduces vocal function exercises that normalize the function of the vocal cords. Techniques may include using reflexive sounds like a sigh or a yawn to promote a relaxed throat and open airway. Phonation on inhalation is another strategy used to keep the vocal cords open during the inspiratory phase.
For those with exercise-induced VCD, the SLP provides specific breathing strategies to be integrated during physical activity. This intensive training conditions the body to automatically use correct breathing patterns, reducing the frequency and severity of future episodes.
Identifying and Addressing Underlying Triggers
Managing VCD requires a comprehensive approach that includes identifying and controlling the factors that provoke the episodes. Triggers are typically categorized into physiological, environmental, and psychological factors.
Physiological triggers frequently include Gastroesophageal Reflux Disease (GERD) and Laryngopharyngeal Reflux (LPR), where stomach acid irritates the laryngeal area. Treating GERD through dietary modifications, lifestyle changes, and medications is an important step in reducing laryngeal irritation. Post-nasal drip, chronic cough, and upper respiratory infections also act as common irritants that can lower the threshold for a VCD episode.
Environmental triggers, such as smoke, strong perfumes, cleaning chemicals, dust, and cold air, can directly irritate the sensitive laryngeal nerves. Psychological factors, including anxiety, emotional stress, and panic attacks, are well-established triggers for VCD episodes.
Stress management techniques, relaxation exercises, and sometimes collaboration with mental health professionals are incorporated into the treatment plan. By systematically avoiding irritants and medically treating underlying conditions, the overall excitability of the vocal cord mechanism can be significantly reduced.