Vocal Cord Dysfunction (VCD), also known as paradoxical vocal fold movement (PVFM), is a condition where the vocal cords behave abnormally during breathing. Normally, these two bands of muscle tissue open wide during inhalation to allow air into the lungs. With VCD, the vocal cords paradoxically close or adduct, creating an obstruction that leads to symptoms like shortness of breath and throat tightness. This episodic closure often mimics an asthma attack, but it is not a lower airway disease. Treatment is highly effective and typically involves retraining the muscles and managing underlying triggers.
Behavioral and Voice Therapy
The most effective treatment for VCD involves behavioral intervention, respiratory retraining therapy delivered by a Speech-Language Pathologist (SLP). An SLP helps the patient gain conscious control over the laryngeal muscles and breathing pattern to override the involuntary closure of the vocal cords. The goal of therapy is to retrain the coordination between breathing and vocal fold movement, ensuring the cords remain open during inhalation.
A core technique taught is diaphragmatic breathing, which focuses on utilizing the abdominal muscles rather than the upper chest and shoulders. This relaxed breathing pattern helps reduce muscle tension in the throat and neck, which often exacerbates throat tightness. Patients learn to slowly inhale through the nose while allowing the abdomen to expand outward. They then exhale through pursed lips, making a hissing or “s” sound. This controlled, resisted exhalation creates back-pressure that helps keep the vocal cords apart.
Laryngeal relaxation exercises are also integral to the therapy process. Techniques such as resonant voice therapy or semi-occluded vocal tract exercises, which involve humming or blowing through a narrow straw, help the patient find a relaxed, open position for the vocal folds. Consistent practice of these techniques helps establish healthier muscle memory for breathing. The SLP customizes these strategies, providing an exercise program designed to reduce the frequency and duration of VCD episodes.
Medical Management of Contributing Factors
VCD is frequently associated with an over-reactive larynx, often caused by underlying medical conditions that act as triggers. Therefore, a complete treatment plan involves the medical management of these co-existing factors, typically overseen by an otolaryngologist or pulmonologist. One of the most common triggers is reflux, specifically Gastroesophageal Reflux Disease (GERD) and Laryngopharyngeal Reflux (LPR), where stomach contents irritate the throat and vocal cords.
Treatment for reflux often includes pharmacological agents such as proton pump inhibitors (PPIs) or H2 blockers to reduce stomach acid production. Lifestyle and dietary modifications are also implemented to minimize reflux episodes. Chronic post-nasal drip from allergies or sinusitis is another irritant that can sensitize the larynx, requiring treatment with nasal sprays or antihistamines. While VCD and asthma are distinct conditions, they often co-exist, and proper management of asthma is necessary to reduce chronic airway inflammation that can contribute to VCD. Treating these associated conditions reduces the overall sensitivity of the laryngeal area, lowering the likelihood of a VCD episode.
Immediate Techniques for Acute Episodes
When an acute VCD episode occurs, the sudden feeling of air hunger can cause panic, which further tightens throat muscles and worsens the obstruction. The primary goal during an attack is to quickly override the paradoxical closure and regain control of the breath using specific maneuvers. The Quick Sniff Technique is one immediate action that can force the vocal folds to momentarily open.
This technique involves taking two or three rapid, deep sniffs through the nose, followed immediately by a long, controlled exhalation. The sharp, quick inhalation helps pull the cords open. The subsequent exhalation should be performed through pursed lips, making a loud “s” or “sh” sound. This forced, noisy exhalation maintains the opening of the vocal cords and slows the breathing cycle down.
Specific postural changes can also assist in opening the airway during an acute attack. Assuming a position that allows the neck and chest muscles to relax, such as sitting upright and slightly extending the neck by lifting the chin, can help. Some individuals find relief by bending forward slightly and placing their hands on their knees, as this posture stabilizes the torso and encourages diaphragmatic breathing. Practicing these maneuvers regularly ensures the patient can deploy them automatically when an episode begins.
Long-Term Self-Management and Trigger Avoidance
Effective long-term management of VCD relies heavily on the patient’s ability to identify and proactively avoid personal triggers. Common environmental irritants that can provoke a reaction include strong odors (such as perfumes, cleaning chemicals, or paint fumes) and airborne particles like dust and smoke. Minimizing exposure to these substances, or wearing a protective mask in unavoidable situations, is an important preventative measure.
Emotional stress and anxiety are frequently reported factors that can lower the threshold for a VCD episode. Incorporating stress management techniques, such as mindfulness or cognitive behavioral therapy, can help reduce laryngeal tension and the overall frequency of attacks. Maintaining good vocal hygiene is also beneficial, which includes ensuring sufficient hydration and avoiding behaviors like chronic throat clearing or coughing that can further irritate the vocal cords. By consistently applying the techniques learned in therapy and managing their environment, patients can significantly reduce the impact of VCD on their daily lives.