Vocal Cord Dysfunction - Presentation

Presentation

Symptoms can include shortness of breath dyspnea, wheezing, coughing, tightness in the throat, skin discoloration due to oxygen deprivation, noise during inhalation stridor, and in severe cases, loss of consciousness. The differential diagnosis for Vocal Cord Dysfunction, also referred to as paradoxical vocal fold motion (PVFM) and paradoxical vocal cord movement (PVCM), includes vocal fold swelling from allergy, asthma, or some sort of obstruction of the vocal folds or throat area that may cause breathing difficulty. Anyone suspecting this condition should be evaluated by a physician and the vocal folds (voice box) should be looked at to rule out any sort of obstruction that may create difficulty breathing.

For individuals who experience a persistent difficulty with inhaling, a neurological evaluation is warranted to discover if there is a neurologic cause for the breathing difficulty. Neurologic causes for persistent difficulty inhaling can include brain stem compression, cerebral palsy, etc.

VCD "episodes" can be triggered suddenly, or come on gradually. Many different things can trigger an episode. The primary causes for a VCD episode are believed to be gastroesophageal reflux disease (GERD), extra-esophageal reflux (EERD), exposure to inhaled allergens, post nasal drip, exercise, or neurological conditions that can cause difficulty inhaling only during waking. Other published scientific articles emphasize anxiety or stress as the primary cause; however, more recent literature indicates a likely physical etiology for this disorder. This disorder has been observed throughout the lifespan, from infants through old age, with the observation of its occurrence in infants leading clinicians to believe that a physiological cause is likely, such as reflux or allergy. Also certain medications, such as antihistamines for allergies, can provide a drying effect to the mucus membranes, which can further cause the vocal cords to be irritated or hypersensitive.

This syndrome can mimic asthma, anaphylaxis, collapsed lungs, pulmonary embolism, or fat embolism, and can lead to an inaccurate diagnosis and inappropriate treatment which may be harmful to the patient. Many VCD patients are diagnosed with asthma, but are unresponsive to asthma therapy, including bronchodilators and steroids. Among adult patients, women tend to be diagnosed more often. Among children and teenage patients, VCD has been linked with high participation in competitive sports and family orientation towards high achievement.

Vocal cord dysfunction co-occurs with asthma approximately 40% of the time. This frequently results in a misdiagnosis of only asthma. Even young children can tell the difference between an asthma attack (primarily difficulty exhaling) and a VCD attack (primarily difficulty inhaling). Knowing the difference between the two will help those who have both know when to use the rescue inhaler prescribed or when to use the breathing recovery exercises trained by an experienced speech language pathologist.