Vocal Cord Dysfunction (VCD)

What is Vocal Cord Dysfunction (VCD)?

Vocal Cord Dysfunction (VCD), also called paradoxical vocal cord motion, is a condition caused by an abnormal closing of the vocal cords. The vocal cords are located within the larynx (voice box) and vibrate when air is exhaled to produce the voice.

Normally, when a person inhales, the vocal cords open to allow the air to pass through easily. When vocal cord dysfunction (VCD) occurs, the vocal cords close together while inhaling, making it more difficult for the air to pass through to the lungs.

What are the symptoms of VCD?

VCD most commonly occurs while exercising. The affected person typically feels short of breath, tightness in the throat, and has noisy breathing (stridor). If the symptoms are present for several minutes, dizziness may result. 

How is VCD different from asthma?

Asthma is the result of inflammation of the airways, and VCD is the result of abnormal closing of the vocal cords. Often, VCD symptoms are similar to asthma symptoms. As a result, many people with VCD are treated with asthma medications including inhalers and sometimes steroids. However, since VCD is not asthma, the symptoms do not improve or only improve a little with this treatment. It is possible, however, to have both VCD and asthma.

How is VCD diagnosed?

VCD can be difficult to diagnose. The evaluation is typically performed by an Ear, Nose and Throat specialist (Otolaryngologist), and a speech-language pathologist. First the physician will ask questions about the symptoms; then a flexible laryngoscopy is performed, where a small fiberoptic scope is passed through the nose and used to view the larynx (voicebox). The patient and family will be able to see the exam on a video screen. It is best to perform the laryngoscopy when the patient is having symptoms. In an effort to bring on the symptoms, the patient will often be asked to run, do jumping jacks or other exercise during the visit. While the scope is in the nose and the vocal cords are visible on the monitor, the speech pathologist will teach the patient and family how to relax the vocal cords. The evaluation also may include lung function tests to evaluate for possible asthma. 

How is VCD treated?

Once the diagnosis is made, an individualized treatment plan can begin. If VCD is the only condition, asthma medications can be stopped. If post-nasal drip, gastroesophageal reflux, and/or laryngopharyngeal reflux are present, they should be treated. 

Speech therapy is the primary treatment for VCD. The patient will typically need to attend 3-4 speech therapy sessions to learn breathing techniques to control VCD. During these sessions the patient may be asked to run on a treadmill to bring on the symptoms of VCD. Relaxation techniques are also taught to help relax the muscles of the throat. 

Supportive counseling is another important part of treatment. Counseling can help the person with VCD adjust to their diagnosis and treatment program. It can also help the person identify and deal positively with stress that may be an underlying factor in VCD.