Vocal Cord Dysfunction: Causes, Symptoms, Treatment, Prognosis, Risk Factor

Vocal cord dysfunction or paradoxical vocal fold motion is a medical condition associated with abnormal physiology of the vocal cords which obstructs the flow of air during the process of respiration. In a normal scenario, the vocal cords open during the process of inhalation as well as exhalation, to allow the passage of air. However, in case of vocal cord dysfunction, the vocal cords close themselves during inhalation and exhalation, making it tough to breathe.

Vocal cords are an important organ for speech in the human body. The voice that is produced by us involves the meticulous work of three systems, which are the air pressure system, vibratory system and resonating system. The air pressure system allows the regulation of air pressure to allow folding and vibration of the vocal cords. The vibratory system causes the vocal cords to vibrate in response to change in the pressure of the air, which in turn produces sound waves. Furthermore, the resonating system gives the sound waves a recognizable voice. Apart from the production of recognizable sound, the voice cord also helps in breathing, coughing and swallowing.

When the air pressure system is not coordinated effectively with the vocal cords, then vocal cord dysfunction arises. Amidst the process of breathing, whether be inhalation or exhalation, the vocal cords allow the passage of air that creates an air pressure. In case of vocal cord dysfunction, the sensory and motor nerve gets irritated and excited excessively, leading to in-coordinated reflexes associated with the opening and closing of vocal cords. These further result in choking feeling.

Vocal cord dysfunction is many a time misunderstood as asthma and medication and treatments for the latter is provided to the patient. The condition is usually diagnosed through laryngoscopy, when the medications and treatments show limited recovery.

The common causative factors for vocal cord dysfunction are:

• Acid refluxes can cause vocal cord dysfunction
• Inhalation of strong odors and fumes
• Smoking of tobacco
• Suffering from upper respiratory infections like cold
• A runny nose or a post nasal drip
• Going through strong emotional phases
• Excessive stress
• Too much of exercising.

The cause of vocal cord dysfunction can be only one or a combination of two or more causes.

The risk factors that pose a threat of vocal cord dysfunction are:

• Females gender; females tend to suffer more from vocal cord dysfunction.
• Vocal cord dysfunction is common in individuals aged between twenty to forty years of age.
• Inflammation of the upper respiratory airway due to chronic sinusitis, recurrent respiratory infections, allergic and non-allergic rhinitis.
• Traumatic injury related to breathing like suffocation, drowning, etc.
• Playing wind instruments or a competitive sport.
• Suffering from mental distress and emotional trauma.
• Occurrence of pulmonary aspiration or inhalation of foreign matter like foods, liquids, saliva or vomit, along with air.

The symptoms that come up when a sudden attack of vocal cord dysfunction happens and with which one can identify the occurrence of vocal cord dysfunction are:

• Feeling of congestion and tightness within the throat and the chest
• Increased frequency of coughing
• Continuous need to clear the throat
• A sense of choking and suffocation
• Wheezing kind of noise while breathing
• Husky and rough voice.

Complications that may arise due to presence of vocal cord dysfunction are:

• Difficulty in proper ventilation or respiratory depression
• Collapsing of lungs
• Difficulty in speaking due to spasms in vocal cords or laryngospasms
• Obstruction of airways.

The process for diagnosis of vocal cord dysfunction is very important to avoid the complications and is done as follows:

• Physical Examination and Medical History Analysis to Diagnose Vocal Cord Dysfunction: The health care provider checks the complete medical history as well as performs the physical examination of the patient.
• Spirometry Test for Diagnosing Vocal Cord Dysfunction: Spirometry is a breathing test, in which the strength and ability of the lungs to inhale and exhale the air is assessed. The test can be conducted only in the presence of symptoms of vocal cord dysfunction.
• Laryngoscopy to Diagnose Vocal Cord Dysfunction: It is a test done to assess the back of the throat, larynx and the vocal cords. The test allows the effective visualization of upper airway and assesses it for vocal cord dysfunction.
• Speech Therapy: Speech therapy can be used effectively to diagnose vocal cord dysfunction by assessment of patient’s history, symptoms and the response to the treatment.

The treatment for vocal cord dysfunction is of two types:

• Short Term Treatment and Management of Vocal Cord Dysfunction: For short term treatment and management of vocal cord dysfunction, the patient should be made comfortable as much as possible, with reassuring attitude towards the patient. If possible provide helium and oxygen, to facilitate breathing. Further, the patient can be helped in breathing properly by providing instructions on breathing behaviors like:
  • Panting: Instruct the patient to take short and quick breaths.
  • Diaphragmatic Breathing: Instruct the patient to breathe, by the contraction of diaphragm. It is also called belly breathing.
  • Pursed-lip Breathing: This technique involves air inhalation via nose and exhalation through tightly pressed lips.
• Long Term Treatment and Management of Vocal Cord Dysfunction: The long term treatment and management involves below measures:
  • Abstinence from factors that can trigger the attack of vocal cord dysfunction like smoke, airborne irritants and medicinal irritants.
  • Treatment of causative factors like anxiety, depression, acid reflexes and sinusitis.
  • Inhalation of ipratropium (Atrovent) to aid breathing, when the vocal cord dysfunction attack is due to excessive exercising.
  • Speech therapy is a therapeutic measure which can be taken up as the solution of symptoms and for management of vocal cord dysfunction.
  • Follow laryngeal airway control to prevent obstruction of air passage.

Since vocal cord dysfunction is often misguided by asthma, therefore, about ten percent of the patients treated for asthma tend to actually suffer from vocal cord dysfunction. A high incidence rate of vocal cord dysfunction is observed in individuals suffering from psychiatric disorders and obesity.

The outlook for the condition is quite vague as the response to treatments as well as recovery in the patients is limited. Acute therapies like bronchodilators, corticosteroids and other medications like Botox, show minimal response with a resolution time of up to two months. Even the pediatric and adolescent patients that undergo hypnosis therapy, respiratory retraining therapy and speech therapy, have a resolution time of four to five months. Thus, one can infer that the natural prognosis is not well described.

Vocal cord dysfunction is the obstruction of the air passage due to non-coordinated functioning of vocal cords. This leads to a sense of choking and suffocation. The attack can instigate due to multiple factors like smoke, acid reflux, stress, post nasal drip, fumes, respiratory infections and exercising. These may lead to symptoms like sensation of suffocation, excessive coughing, hissing sound while breathing and congestion of the chest and throat. These symptoms are many a time confused with that of asthma. Thus, treatments and medication for the same are advised for the patient, but when the appropriate response and recovery is not obtained then diagnosis for vocal cord dysfunction is conducted and treatments specific to the condition are prescribed.