Vocal cord dysfunction: a review

Abstract

Vocal cord dysfunction (VCD) is a term that refers to inappropriate adduction of the vocal cords during inhalation and sometimes exhalation. It is a functional disorder that serves as an important mimicker of asthma. Vocal cord dysfunction can be difficult to treat as the condition is often underappreciated and misdiagnosed in clinical practice. Recognition of vocal cord dysfunction in patients with asthma-type symptoms is essential since missing this diagnosis can be a barrier to adequately treating patients with uncontrolled respiratory symptoms. Although symptoms often mimic asthma, the two conditions have certain distinct clinical features and demonstrate specific findings on diagnostic studies, which can serve to differentiate the two conditions. Moreover, management of vocal cord dysfunction should be directed at minimizing known triggers and initiating speech therapy, thereby minimizing use of unnecessary asthma medications. This review article describes key clinical features, important physical exam findings and commonly reported triggers in patients with vocal cord dysfunction. Additionally, this article discusses useful diagnostic studies to identify patients with vocal cord dysfunction and current management options for such patients.

Keywords: Asthma-comorbidity; Paradoxical vocal fold movement; Vocal cord; Vocal cord dysfunction.

Fig. 1

a Images taken during laryngoscopy showing paradoxical adduction detected during mid-inspiration in a patient with vocal cord dysfunction b Appropriate movement of the vocal cords during mid-inspiration in the same patient following speech therapy

Fig. 2

a Normal flow volume loop in asymptomatic patient. b Example of flattening, early truncation and saw-tooth pattern of inspiratory limb of flow volume loop in a patient with vocal cord dysfunction