Vocal Chord Dysfunction
What is vocal cord dysfunction?
Vocal cord dysfunction is a condition caused by abnormal movement of the vocal cords.
Symptoms of vocal cord dysfunction include:
* Shortness of breath
* Intermittent hoarseness and/or wheezing
* Chronic cough and/or throat clearing
* Chest and/or throat tightness
* “Just having trouble getting air in.”
Unlike asthma, which is caused by contraction of airway muscles in the chest (bronchospasm) resulting from inflammation of the airways, the symptoms of vocal cord dysfunction is related to narrowing of the large airway in the neck. Although many patients with vocal cord dysfunction feel more symptoms in the neck and upper chest, the only symptom may be a sensation of not getting adequate air.
Because of the similar symptoms, many people with vocal cord dysfunction may be misdiagnosed with asthma and treated with asthma medications, often with poor results. If vocal cord dysfunction is still not diagnosed, oral steroids (used in other chronic lung diseases like severe asthma) may be prescribed. Significant side effects can develop with long-term use of these medicines. Additionally, a misdiagnosis can also lead to frequent emergency room visits and hospitalizations – even intubation.
Some people have both vocal cord dysfunction and asthma, which complicates both the diagnosis and the treatment.
What happens with vocal cord dysfunction?
To understand vocal cord dysfunction, it is helpful to understand how the vocal cords function. The vocal cords are located at the top of the windpipe (trachea). To produce the sounds of speech, the vocal chords tighten and partially block the airway. As exhaled air moves across the partially closed cords, they vibrate producing sound which is then shaped by our mouth and throat as speech. The vocal cords are relaxed during normal breathing, allowing air to easily pass through the trachea. However, with vocal cord dysfunction, the vocal cords close together, or constrict, during one or both parts of the breathing cycle, partially blocking the windpipe and creating a sensation of not getting enough air.
So what causes the vocal cords to tighten during normal breathing? In many, vocal cord dysfunction is a type of involuntary stress reaction. The vocal cords tighten when they are under pressure. This may be the case even though an individual does not feel particularly stressed or anxious. Vocal cord
dysfunction had recently been recognized a cause of exercise induced shortness of breath, particularly in children involved in school sports. A child, who has a strong internal drive to win or feels pressure from a coach or parents to do better, may exhibit vocal chord problems.
Diagnosing vocal cord dysfunction can be quite difficult because the symptoms are a lot like those of asthma including chronic cough, shortness of breath, difficulty inhaling enough air, chest tightness, throat tightness, hoarseness, and wheezing. In addition, symptoms of vocal cord dysfunction can be trigged by conditions that also trigger asthma symptoms, such as upper respiratory infections, gastroesophagel reflux (severe heartburn), fumes, odors, cigarette smoke, singing, emotional stress, and exercise. Because vocal cord dysfunction doesn’t respond to asthma treatment, however, it can cause frequent emergency room visits and hospitalizations.
Because the symptoms of vocal cord dysfunction mimic asthma, differentiating between the two can be a challenge. Often, the first clue is finding that symptoms do not respond to routine asthma medications. The most specific test for the disease is direct visualization of the vocal cords through laryngoscopy or bronchoscopy during an attack. Because the vocal cords may appear normal between attacks, a negative test may be misleading.
Treatments and Tips
Once a diagnosis of vocal chord dysfunction is made, specific treatment can be recommended. Speech therapy can be helpful to guide relaxed breathing and special exercises can help relax throat muscles and reduce the abnormal movement of vocal cords.
Because stress can worsen the symptoms of vocal chord dysfunction – and vocal chord dysfunction can increase levels of stress – many people with vocal chord dysfunction have found counseling to be an important part of their treatment. Counseling can help identify stresses and build coping skills that aid in minimizing the effects of vocal chord dysfunction on daily life.