Vocal Cord Dysfunction (VCD)

Vocal Cord Dysfunction (VCD) is a breathing and voice symptom that is caused by restriction of the airway when you inhale. This unintended closure of the vocal cords (folds) causes the gasping sound you sometimes hear when exercising heavily. Those with VCD can have this inhalatory stridor (gasping) even when resting. During normal breathing, the vocal folds open (ABduct) to allow air into the trachea and lungs. When you exhale, the vocal folds remain open as well. However, when you speak, sing, swallow, cough, or lift heavy things, the vocal folds close (ADduct) with varying degrees of force. While VCD has a higher prevalence in athletes and World Trade Center responders, it has been reported in all age groups including adolescents, children and even infants.

VCD is also known by other names such as paradoxical vocal fold motion, Munchausen stridor, hysterical stridor, functional laryngeal stridor, pseudoasthma, factitious asthma, emotional laryngeal wheezing, psychogenic upper airway obstruction, episodic laryngeal dyskinesia, episodic paroxysmal vocal fold closure. This variety of names highlights two important characteristics of VCD. First, there is usually no observable physical reason for the condition, and second, the difficulty with inhaling can cause emotional distress.

At the Grabscheid Voice and Swallowing Center of Mount Sinai, our voice and airway experts have more than 25 years of experience treating patients with this disorder. Our specialists have researched and published new methods of treating many of the causes of VCD.

One of the most important functions of the vocal folds is to protect the trachea and lungs from materials that should not be inhaled. We’ve all experienced the coughing that occurs when even a small amount of liquid goes the ‘wrong way.’ To protect the airway, the vocal folds, laryngeal tissues and trachea are highly innervated with sensory receptors to forestall the entrance of materials into the lungs. VCD is a symptom. It is a maladaptive learned reaction to laryngeal hypersensitivity. This hypersensitivity can be acquired through large or repeated exposures of the vocal folds and the airway to irritants. These can include inhaled irritants, repeated or large amounts of acid reflux, mechanical triggers, or even emotional trauma. As the repetition or dose of these irritants increase, the reflex pathways learn to ‘over-protect’ the airways by closing even when air enters. The anxiety that this sensation causes can itself increase the emotional burden of this condition and exacerbate the VCD itself.

Symptoms of Vocal Cord Dysfunction

People with VCD experience difficulty inhaling. This is often associated with a stridor (noise) when inhaling that comes from the throat and not the lungs themselves. VCD can be progressive, and may start with wheezing in response to certain triggers such as heavy exercise, cold air, irritating smells (frying oil, chemicals, cleaners, perfume, smoke, etc), shouting, singing or loud speaking, and even emotional stress. In extreme variants, these symptoms can result in the feeling of not being able to breath.

Vocal Cord Dysfunction is an acquired condition. It is a behavior of the muscles and nerves. Usually this results from the vocal cords over-protection of the airway. They are supposed to close when you are swallowing, or if irritants like dust or strong chemical smells enter the trachea. However, if this closure occurs often, or if the noxious stimulus is strong enough, this pattern may become more frequently used. Sometimes the pattern becomes so habituated that the patient will have noisy inhalations even when speaking.

People at increased risk for VCD include athletes, especially those who play outside during winter months, and swimmers (likely related to the chlorine exposure). Those whose jobs expose them to strong chemicals or dust and particulates can also develop VCD. Emotional trauma, physical or mental abuse can also be risk factors for developing VCD. And finally, World Trade Center 9/11 responders are at a higher risk for this condition.

Diagnosis of Vocal Cord Dysfunction

VCD is a symptom and is easily determined by looking at the vocal folds with a scope while the stridor (inhalatory noise, gasping) is happening. What is more important and difficult is determining the cause of the closure of your vocal folds when inhaling. These diagnostics are made by clinicians who are experienced in listening to breathing patterns and voice, and can have you do tasks that may make the symptoms worse or better. Frequently patients with VCD will have seen a pulmonologist, and may be on inhaled steroids as many of the symptoms are similar to those of asthma or other restrictive airway conditions. While steroids can help to manage asthma, they will not work on VCD unless they are having a placebo effect.

Treatment Options for Vocal Cord Dysfunction

At the Grabscheid Voice and Swallow Center we are researching the process of this acquired hypersensitivity, as well as treatments for reversing the hypersensitivity that may have caused the VCD.

  • Speech and Breathing Therapy
    In the great majority of cases, VCD is an unconsciously learned behavior. The longer you’ve had it, usually the more of a habit it has become. Our team of laryngologists and therapists are at the forefront of therapies for correcting this behavior. Usually this involves only several therapy sessions. However, as with all new habits, success requires that you take the new behavior and make it a constant habit by doing the exercises that the therapist devises for you when you are outside of the clinic.
  • Surgery
    Surgery is not an appropriate option for VCD unless your vocal folds are paralyzed in a closed position.

What to Expect at Your AppointmentTreatment of benign vocal cord lesions

Evaluation

Often patients are referred for a breathing or voice problem and the diagnosis of Vocal Cord Dysfunction may not be secured. Therefore, when you call the Grabscheid Voice and Swallow Center, your initial visit will likely be scheduled with our team of voice clinicians. You will see a laryngologist and a speech language pathologist on the same visit who will evaluate your breathing and voice production with a scope to see how the vocal folds are moving. They will discuss with you their impressions as a team and your treatment options.

Treatment

If you elect for treatment, we will likely suggest that you attempt voice therapy first. If you have been receiving treatment elsewhere and wish to switch your care to our center, we can attempt to get insurance carrier approval for treatment on your initial visit.

Pulmonary Evaluation

Because VCD strongly affects you breathing a pulmonologist may be a part of the evaluation and/or treatment team.

Neurologic Evaluation

If we feel there may be a neurologic component to you Vocal Cord Dysfunction symptoms, we are able to refer you to our colleagues in neurology for evaluation and treatment recommendations.