Best Practice Case Studies-Case 132 Asset 1 Vocal Cord Dysfunction

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Vocal cord dysfunction (VCD), also called inducible laryngeal obstruction or paradoxical vocal fold motion, occurs when the vocal cords close during inspiration instead of opening. It most often affects females and is commonly diagnosed in adults ages 30 to 40, though it can occur at any age. VCD may coexist with asthma, gastroesophageal reflux disease (GERD), and anxiety.<br /><br />It should be suspected in patients with poor response to asthma treatment or with sudden, severe shortness of breath without hypoxia, tachypnea, or increased work of breathing. Common symptoms include inspiratory stridor, upper-airway wheezing, throat or chest tightness, anxiety, and sometimes chronic cough. In less severe cases, abnormal laryngeal muscle spasm causes voice changes such as dysphonia or aphonia.<br /><br />Triggers include exercise, asthma, GERD, postnasal drip, respiratory infections, irritants, dry cold air, workplace chemicals, and psychiatric stressors. The differential diagnosis includes poorly controlled asthma, anatomic airway problems, laryngeal edema, foreign body, nerve injury, and neurologic disease.<br /><br />The main diagnostic test is direct visualization with nasolaryngoscopy, ideally during symptoms and sometimes with exercise or methacholine provocation. Pulmonary function testing may show a flattened inspiratory flow loop and can help distinguish VCD from asthma. Chest radiography or review of patient-recorded videos may also help in evaluation.<br /><br />First-line treatment for acute episodes and chronic management is breathing maneuvers and vocal cord relaxation techniques, usually taught by speech therapy. Coexisting conditions such as asthma, GERD, and postnasal drip should be treated, and triggers should be avoided. Behavioral counseling may help when anxiety or depression is present. OnabotulinumtoxinA may be useful in selected cases, especially spasmodic dysphonia, but evidence is limited.<br /><br />A multidisciplinary approach can reduce emergency visits and improve symptoms.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 132

Topic HEENT

Keywords

vocal cord dysfunction

inducible laryngeal obstruction

paradoxical vocal fold motion

inspiratory stridor

nasolaryngoscopy

asthma

GERD

anxiety

speech therapy

breathing maneuvers

4th Edition

4th Edition, Case 132

HEENT