Vocal Cord Dysfunction (VCD), also known as paradoxical vocal fold motion, is a disorder where the vocal cords move in an uncoordinated manner. The vocal cords close during inhalation when they should open, creating a temporary restriction of the airway and causing difficulty breathing in. Because symptoms include wheezing and shortness of breath, VCD is frequently mistaken for asthma, which affects the lower airways and typically causes difficulty breathing out. This article focuses on the diagnosis and effective management of VCD.
Confirming the Diagnosis
Achieving a definitive diagnosis is the first step toward successfully managing VCD, as asthma treatment is ineffective for this upper airway disorder. Consultation with an Otolaryngologist (ear, nose, and throat specialist) or a Pulmonologist is often required to distinguish VCD from other respiratory conditions. The standard diagnostic procedure involves flexible fiberoptic laryngoscopy, where a flexible tube with a camera is passed through the nose to view the vocal cords directly.
The procedure is most informative when performed during a symptomatic episode, allowing the physician to confirm the inappropriate closing of the vocal cords upon inhalation. Physicians often use a specific challenge, such as exercise or an inhaled trigger, to provoke an episode if the patient is not currently symptomatic. This visualization is essential for excluding other causes of airway obstruction, such as vocal cord paralysis or laryngeal tumors. Specialized breathing tests, like a flow-volume loop, can also suggest an obstruction in the upper airway, further supporting the VCD diagnosis.
Immediate Techniques for Episode Relief
When a VCD episode occurs, the sudden sensation of throat tightening can cause panic, which often worsens the paradoxical closure of the vocal cords. Learning specific behavioral techniques provides the patient with control to interrupt the episode and restore normal breathing. The goal of these rescue maneuvers is to consciously shift the focus of breathing away from the constricted upper throat.
One effective technique is pursed-lip breathing, which involves slow inhalation through the nose followed by a long, controlled exhalation through tightly pursed lips. This prolonged exhale helps relax the muscles around the larynx and generates back-pressure that encourages the vocal cords to open. Another technique is the “sniff and blow,” where the patient takes quick, sharp sniffs through the nose, followed by a forceful blow of air out through the mouth.
Specific postural adjustments can also aid relief by reducing muscle tension in the head and neck. Relaxing the shoulders by pulling them back and down, or gently stretching the neck, helps create a more open laryngeal posture. A quick maneuver like panting can momentarily override the laryngeal spasm by forcing rapid, shallow breaths. These techniques consciously engage muscle groups that promote vocal cord abduction, helping the patient regain control during an acute attack.
Speech Therapy and Laryngeal Retraining
The most impactful long-term solution for VCD is laryngeal retraining, delivered through a specialized Speech-Language Pathologist (SLP). The SLP teaches the patient volitional control over the larynx, replacing the involuntary closing motion with a healthy breathing pattern. This behavioral intervention, often called Respiratory Retraining Therapy (RRT), focuses on establishing proper diaphragmatic breathing.
The therapy emphasizes exercises involving a quiet, slow inhalation through the nose and a controlled, relaxed exhalation. Patients practice lower-abdominal breathing, ensuring the stomach rises on the inhale and falls on the exhale, rather than relying on chest and neck muscles. The SLP also introduces laryngeal relaxation exercises, such as the yawn-sigh technique, to reduce the excessive muscle tension contributing to the dysfunction.
These controlled breathing patterns are practiced daily to build new muscle memory and are integrated into activities that previously triggered symptoms. For example, athletes learn specific breathing strategies to maintain an open airway during physical exertion. The goal is to fundamentally shift the patient’s breathing habits, making the correct vocal cord movement the default, automatic response.
Managing Contributing Health Factors
A comprehensive approach to VCD must address the underlying medical and environmental conditions that frequently trigger episodes. Chronic irritation from conditions like Gastroesophageal Reflux Disease (GERD) or Laryngopharyngeal Reflux (LPR) can make the vocal cords hypersensitive and prone to spasm. Treatment involves dietary modifications, lifestyle changes (such as elevating the head of the bed), and medications like proton pump inhibitors to reduce acid exposure.
Allergies and chronic post-nasal drip also contribute to laryngeal irritation; managing these with nasal steroids or antihistamines can reduce episode frequency. Avoiding environmental irritants, such as strong perfumes, cleaning chemicals, or smoke, is also necessary, as these inhaled substances can directly provoke a laryngeal spasm. Since VCD is a functional disorder, psychological factors like high stress, anxiety, or panic attacks can also precipitate episodes.
Managing psychological triggers often requires behavioral therapy, counseling, or relaxation techniques like mindfulness. By treating co-existing medical conditions and managing emotional distress, the overall hypersensitivity of the vocal cords can be lowered. This multi-pronged strategy, combining behavioral retraining with medical trigger management, reduces the frequency and severity of VCD events.