Management and Treatment of Vocal Cord Dysfunction (VCD)
(Also Known as Paradoxical Vocal Cord Motion or PVFM)
How is VCD diagnosed?
Are there any associations with other conditions?
What about breathing tests?
What about laryngoscopy?
What can trigger VCD symptoms?
How is VCD treated?
What about speech-language pathology (speech therapy)?
What about counseling?
How is VCD diagnosed?
Making a diagnosis of VCD can be very difficult. If the doctor suspects VCD she/he will ask many questions about symptoms. Common symptoms include a chronic cough, chronic throat clearing, shortness of breath, difficulty breathing, chest tightness, throat tightness, intermittent hoarseness and wheezing. Many people diagnosed with VCD complain that they "just have trouble getting air in".
Are there any associations with other conditions?
Many people with VCD have problems with postnasal drip (from chronic nasal and/or sinus congestion), gastroesophageal reflux disease (GERD), or laryngopharyngeal reflux (LPR). This relationship may be one of cause and effect because these two conditions can lead to chronic irritation of the throat that then causes the vocal cords to become hypersensitive to irritant stimuli.
What about breathing tests?
Breathing tests like spirometry can be useful in diagnosing VCD, but only if they are done when symptoms are occurring. In the absence of any other complicating condition like asthma, breathing tests for VCD will be normal. However, if spirometry is conducted when symptoms are present, and if the doctor obtains what is called a "flow volume loop," VCD will cause a flattening of the inspiratory (and/or expiratory) part of the loop.
What about laryngoscopy?
While spirometry is important and useful, a procedure called a laryngoscopy is the most important test in making the diagnosis of VCD. Using a flexible, fiber optic tube and tiny camera inserted into the back of the throat, a specialist can see how the vocal cords open and close. Like spirometry, this test should only be performed when symptoms are present because the vocal cords function normally in the absence of symptoms. Since people with VCD cannot trigger symptoms voluntarily, different tests to trigger symptoms may be required.
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What can trigger VCD symptoms?
Possible triggers of VCD are often similar to asthma triggers. Triggers may include upper respiratory infections, air pollution , strong chemical fumes and odors, cigarette smoke, singing, laughing, emotional upset, post-nasal drip, gastroesophageal reflux disease, laryngopharyngeal reflux (or, "silent reflux"), cold air, and exercise. Sometimes the trigger is not known.
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How is VCD treated?
Once diagnosed with VCD, a specific treatment program can begin. If VCD is the only condition, asthma or other medications may be stopped. If both asthma and VCD are diagnosed, asthma medications may be continued, but are often decreased. Treatment for gastroesophageal reflux disease (GERD), laryngopharyngeal reflux, and postnasal drip should be started if these are present.
What about speech-language pathology (speech therapy)?
There are many special exercises and therapies that help control VCD. Speech-language pathology (speech therapy) is a very important part of the treatment for VCD. Special exercises increase your awareness of abdominal breathing and relax your throat muscles. This enables you to have more control of your vocal folds and throat. Learning cough suppression and throat clearing techniques can also be extremely helpful. Practicing these techniques when symptom free ensures effective use of them during an episode. All of the exercises are aimed at overcoming abnormal vocal cord movements, controlling the vocal folds with the breath stream, and improving airflow into the lungs.
What about counseling?
Another important part of treatment is supportive counseling. Counseling can help adjust to a new diagnosis and a new treatment program. Counseling can also help identify and deal positively with stress that may be an underlying factor in VCD. Most people with VCD find counseling to be very beneficial.
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