Vocal cord dysfunction involves paradoxical or dysfunctional movement of the vocal cords and is defined as adduction of the true vocal cords on inspiration and abduction on expiration; it causes inspiratory airway obstruction and stridor that is often mistaken for asthma.
Vocal cord paralysis (unilateral and bilateral) is discussed elsewhere. The general evaluation of patients with stridor is discussed elsewhere.
Vocal cord dysfunction occurs more commonly among women aged 20 to 40. Etiology is unclear, but it appears to be associated with anxiety, depression, posttraumatic stress disorder, and personality disorders. It is not considered a factitious disorder (ie, patients are not doing it consciously).
Symptoms are usually inspiratory stridor and less often expiratory wheezing. Other manifestations can include hoarseness, throat tightness, a choking sensation, and cough (1).
Diagnosis is suggested by a characteristic pattern on flow-volume loop. It is confirmed by observing inspiratory closure of the vocal cords with direct laryngoscopy. Sometimes a diagnosis of vocal cord dysfunction is entertained only after patients have been misdiagnosed as having asthma and then not responded to bronchodilators or corticosteroids.
General reference
1. Christopher KL. Wood, II RP, Eckert RC, et al: Vocal-cord dysfunction presenting as asthma. N Engl J Med 308: 1566–1570, 1983. doi: 10.1056/NEJM198306303082605
Treatment of Vocal Cord Dysfunction
Education and counseling
Treatment of vocal cord dysfunction involves
Educating the patient about the nature of the problem
Counseling from a speech therapist on special breathing techniques, such as panting, which can relieve episodes of stridor and obstruction
Rarely, severe cases have been treated with tracheostomy.
Vocal cord dysfunction associated with psychiatric diagnoses is often resistant to these measures. Referral for psychotherapy is indicated in these cases.
