Vocal Cord Dysfunction

Abstract

Vocal cord dysfunction, a syndrome of paradoxical inspiratory closure of the vocal cords, is becoming more frequently recognized and diagnosed recently since its initial modern description 30 years ago. Initially described as single case reports, the first case series in 1983 helped to clarify the typical patient and findings of vocal cord dysfunction. Recent investigations have elucidated specific etiologies such as gastroesophageal reflux, exercise, and irritants as causative factors in addition to the numerous associated psychologic factors. Speech therapy and psychotherapy have been used extensively with vocal cord dysfunction patients, but the optimal treatment has yet to be prospectively studied. This manuscript provides a comprehensive review of the reported causative factors and treatments for vocal cord dysfunction.

Vocal cord dysfunction: a review

“…In addition, there tends to be a female predominance among patients with VCD. Brugman and colleagues found a 3:1 female predominance among their patients, while Morris and colleagues studied 1161 patients in another literature review and found a 2:1 female predominance [8]. …”

“…It is still thought that psychological stimuli can trigger VCD, including anxiety disorder, stress, depression, somatoform disorder, conversion disorder, psychiatric illness, history of sexual abuse, and mass psychogenic illness [18]. In a case series published in 1983 of five patients with “uncontrolled” asthma and dramatic wheezing all found to have VCD, a psychiatrist performed personality testing prior to any physiologic or laryngoscopic studies and established a psychiatric diagnosis in four of the five patients [8]. In a review by Lacy and McManis in the late 1990s, 45 of 48 patients had a psychiatric condition, including conversion disorder (52 %), major depression (13 %), factitious disorder (10 %), obsessive-compulsive disorder (4 %) or adjustment disorder (4 %) [30].…”

“…Endoscopic examination with direct visualization of the vocal folds via flexible, transnasal fiber-optic laryngoscopy during an acute attack is the gold standard for diagnosis of VCD [8, 11, 31]. The presence of inspiratory adduction is key to making the diagnosis [18].…”

“…Patients should be instructed to perform various maneuvers during laryngoscopy including sniff, sequential phonation, normal breathing, panting and repetitive deep breaths in order to fully evaluate vocal cord movement [8, 18, 20]. A forced expiratory and inspiratory vital capacity maneuver that simulates generation of a flow-volume loop may be helpful in discovering abnormal vocal cord movement [18].…”

A Systematic Review of Psychological Interventions for Adult and Pediatric Patients with Vocal Cord Dysfunction

“…The exact incidence or prevalence of this condition is not clearly known, as there are no large-scale studies for this disorder. Most case series have noted a greater prevalence in females (5, 6) and 29% cases occurring in those <18 years of age (7), with an average age of 14.5 years in adolescents and 33 years in adults (2). Nevertheless, prompt recognition and treatment is crucial, as inappropriate treatment has been associated with significant costs and morbidity.…”