Ask the Allergist: Vocal Cord Dysfunction
Q: What’s the difference between asthma and vocal cord dysfunction?
Stephen Tilles, MD: There’s coughing, shortness of breath and wheezing, which are asthma symptoms. There’s also tightness in your throat, but not your chest. The wheezing occurs when you breathe in, not out. And when you try to speak, your voice is hoarse. These signs point to vocal cord dysfunction, a condition in which your vocal cords unexpectedly close while you’re trying to breathe.
Vocal cords are located in your throat and are part of the larynx – it’s often called the voice box because the vibration of vocal cords allows us to speak and sing. They open and close automatically as we breathe.
When vocal cords close due to vocal cord dysfunction, air cannot get through. Symptoms are very similar to asthma, and misdiagnosis is common. Some people develop both asthma and vocal cord dysfunction, but treatment for each condition is very different.
Q: How common is vocal cord dysfunction?
A: Overall prevalence is not known, but small studies indicate it is common in adolescent athletes – particularly females who play sports that involve intense running. We don’t know why this is – some believe it’s due to the effect of puberty on the developing larynx, but that’s just one possibility.
Q: What causes vocal cord dysfunction? And what can trigger a reaction?
A: One contributing cause is chronic irritation of the vocal cords. The most common irritant is gastroesophageal reflux disease (GERD), where stomach acid leaks up into the esophagus and irritates your throat. Another common irritant is postnasal drip resulting from nasal or sinus congestion.
Exercise is the most common trigger for adolescents. In adults, it’s often irritants or strong odors such as secondhand smoke or perfume. Stress, anxiety and depression are triggers affecting all age groups.
Q: How is vocal cord dysfunction diagnosed?
A: Vocal cord dysfunction is often diagnosed when a patient starts asthma treatment and has no response to medications. In some cases, the diagnosis of vocal cord dysfunction is obvious based on the patient’s description of symptoms. The best way to confirm a diagnosis is by undergoing a laryngoscopy, a procedure in which a scope is inserted through the nose to view what’s happening in the voice box while symptoms occur. This is usually done by an otolaryngologist (ear, nose and throat physician) or allergist, though some pulmonologists and speech pathologists also perform the procedure.
It’s sometimes necessary to recreate the symptoms before or during a laryngoscopy so the doctor can see the vocal cords react. This is usually done in specialized centers and may involve an exercise challenge or exposing the patient to an irritant.
Q: What happens after the diagnosis?
A: Patients meet with a speech pathologist highly trained in how to control and relax breathing muscles in the voice box. The muscles in the voice box are targeted so they don’t improperly move or tighten up when you breathe.
Patients will work with the speech pathologist and practice a series of breathing exercises to create muscle memory in the larynx and help normalize breathing, especially during exercise. This is the primary treatment for vocal cord dysfunction.
Secondary treatment addresses the irritation in the voice box and the medical conditions behind it. Talk with your doctor about treatment options and lifestyle changes. If you have reflux, for example, you may want to adjust your dietary choices or, if overweight, lose weight.
Stephen Tilles, MD, is vice president with the American College of Allergy, Asthma & Immunology (ACAAI) and is a board-certified allergist with Northwest Asthma & Allergy Center in Seattle.
Have a medical question? Email editor@AllergyAsthmaNetwork.org or write to “Ask the Allergist,” Allergy & Asthma Network, 8229 Boone Blvd., Suite 260, Vienna, VA 22182.
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