Vocal Cord Dysfunction

Vocal cord dysfunction (VCD) looks and feels a lot like asthma. It’s a condition where your vocal cords sometimes close instead of opening as you inhale and it’s closely related to stress, anxiety and exercise.

You can’t see your vocal cords in a mirror – but you can feel where they live. Put your hand on the front of your throat and swallow. That hard ball that moves up and down when you swallow (sometimes called the Adam’s apple) is your voice box, or larynx. Vocal cords are folds of tissue that stretch across your voice box. As you breathe in, your vocal cords open to let air go through into your lungs, then narrow as you breathe out. Most of us can’t control this opening and closing, but we do learn to use our vocal cords to talk and sing – it’s the vibration of our vocal cords that makes these sounds.

If you have VCD, your vocal cords suddenly close when they’re not supposed to, cutting off your air supply. Often this happens during exercise or when you’re emotionally upset or crying – just when you need air the most! 

In addition to stress and exercise, VCD can be set off by other factors often associated with asthma, including cigarette smoke, perfume and other strong scents, upper respiratory infections, air pollution and cold air.

Symptoms of VCD

  • wheezing or stridor (a high-pitched sound)

  • chronic cough or throat clearing

  • shortness of breath

  • upper chest or throat tightness

  • intermittent hoarseness

Diagnosing VCD

Diagnosing vocal cord dysfunction is tricky because it so closely resembles asthma – and will often occur alongside asthma – and because the symptoms may seem random. It may happen to an athlete during a game but not a practice, for instance. Or it may happen outside of exercise, when the person is laughing or crying.

If you suspect you have VCD, consult a board-certified otolaryngologist (ear, nose and throat specialist) or pulmonologist familiar with the condition. The most accurate way to identify VCD is to use a laryngoscope (a flexible, fiber optic tube with a tiny camera that is inserted down the back of the throat) to view the vocal cords. However, it must be done while symptoms are actually occurring – an uncomfortable technique many doctors hesitate to use. Instead, they have the patient exercise on equipment induce symptoms, then use a spirometer to measure patient lung function. When VCD is occurring, the spirometer reading will show very different results from those seen with asthma.

                   Ask the Allergist:   What’s the difference between
                             asthma and vocal cord dysfunction?


What Causes VCD?

VCD may be linked to chronic irritation of the throat that makes the vocal cords sensitive. The irritation could come from postnasal drip caused by chronic nasal and/or sinus congestion or from gastroesophageal reflux, where stomach acids leak up into the esophagus. In some people, the acids travel all the way up to the top of the esophagus, where it meets the windpipe and larynx. Even a small amount of this fluid spilling over onto the larynx can cause severe irritation and prompt the vocal cords to close

Quite often, people with vocal cord dysfunction don’t realize they have reflux  because they don’t experience the classic heartburn symptoms. This kind of ‘silent’ reflux that affects the upper airways is so common among VCD patients that doctors may recommend a trial run with reflux medications.”

Treating VCD

Beyond treating an underlying throat irritation, there is no specific medication available to treat VCD. However, many patients are referred to a speech pathologist (therapist).

When people think of speech therapy, they tend to think about learning to pronounce r’s and s’s correctly but your voice is an instrument you play by learning to control your breathing and the vibration of your vocal cords. A speech pathologist can help you learn to relax your breathing and teach you techniques that help keep the vocal cords from tightening in the first place.

Vocal cord dysfunction is very much a learned behavior that may have begun with a physical cause, such as silent reflux or sensitivity to an odor. It is very disturbing to patients, especially if they are athletes who have experienced very loud wheezing or even vomiting during exercise. They become embarrassed and afraid that it will happen again. That fear and stress tends to set it off again – whether through tensing the muscles or through reflux, since stress can influence reflux. Then it becomes a self-fulfilling prophecy.

Athletes with VCD have to learn new ways to breathe. Many athletes have been taught to relax by breathing in through the nose and exhaling through the mouth. But when you run or exercise heavily, you can’t do this – you don’t get enough air. So you need a different technique. They must learn to breathe with their jaw relaxed and mouth open, using small, rapid inhalations, then exhaling through pursed lips.

One reason so many teenagers have VCD is that they tend to eat a lot of junk food; even the power bars that athletes eat before exercising can cause problems if they contain chocolate.

VCD vs Asthma

Vocal cord dysfunction (VCD) is often mistaken for asthma, especially exercise-induced bronchospasm (EIB). This is no surprise, since symptoms of the two conditions are so similar. There are some differences, however, that you might notice. If you suspect you have VCD, consult this chart and talk with your physician.

 

VCD

EIB 

Timing of symptoms

less than 5 minutes after beginning exercise

5-10 minutes or more after beginning or ending exercise

Tightness

in throat

middle or lower chest

Wheezing or high-pitched sound

when breathing in; hoarse voice

when breathing out                

Recurrence

symptoms can recur immediately and more severely when exercise resumes

symptoms tend to be less severe when exercise resumes (after bronchodilator use)

Recovery time

may take less than 10 minutes

usually takes up to an hour without medication

Medications

bronchodilator won’t help

bronchodilator will help