Vocal cord dysfunction: a review

Abstract

Vocal cord dysfunction (VCD) is a term that refers to inappropriate adduction of the vocal cords during inhalation and sometimes exhalation. It is a functional disorder that serves as an important mimicker of asthma. Vocal cord dysfunction can be difficult to treat as the condition is often underappreciated and misdiagnosed in clinical practice. Recognition of vocal cord dysfunction in patients with asthma-type symptoms is essential since missing this diagnosis can be a barrier to adequately treating patients with uncontrolled respiratory symptoms. Although symptoms often mimic asthma, the two conditions have certain distinct clinical features and demonstrate specific findings on diagnostic studies, which can serve to differentiate the two conditions. Moreover, management of vocal cord dysfunction should be directed at minimizing known triggers and initiating speech therapy, thereby minimizing use of unnecessary asthma medications. This review article describes key clinical features, important physical exam findings and commonly reported triggers in patients with vocal cord dysfunction. Additionally, this article discusses useful diagnostic studies to identify patients with vocal cord dysfunction and current management options for such patients.

Vocal Cord Dysfunction after an Inhalation Exposure

“…Even though the physical examination of the chest, chest x-ray interpretation and oxygen saturation are all negative/normal the diagnosis of RADS or asthma can persevere by the patient and health care provider. When an acute VCD attack is present, direct visualization of the vocal folds by flexible, trans nasal fiber-optic laryngoscopy represents the gold standard for the diagnosis of VCD [1,7]. Typically, there is closure of the anterior two-thirds of the vocal cords with posterior chinking that creates a diamond shape (Figure 1a and b).…”

“…There are four important clinical clues for better recognizing VCD following a claimed or actual inhalation exposure [1]. There are discrepancies, limited information and questionable facts about the exposure [2].…”

“…With VCD, there tends to be a fleeting obstruction of the upper airway maneuvered mainly by inspiratory closure of the vocal folds but also sometimes closing during expiration [1]. VCD manifests intensified closure of the glottic sphincter and perhaps inhibition of muscular abduction [16,17].…”

“…The clinical manifestations of VCD are because there is inappropriate adduction (closing) of the vocal cords (VC) during inspiration and sometimes also during expiration [1].…”

Exploring the Waveform Characteristics of Tidal Breathing Carbon Dioxide, Measured Using the N-Tidal C Device in Different Breathing Conditions (The General Breathing Record Study): Protocol for an Observational, Longitudinal Study (Preprint)

“…A cut-off of ≥ 4 yielded an 83 % sensitivity and 95 % specificity for the diagnosis of VCD. Upon application to a population with known VCD, this scoring system correctly diagnosed VCD in 77.8 % of patients [24].…”