Vocal Cord Dysfunction

What is vocal cord dysfunction (VCD)?

Vocal cord dysfunction (VCD) is when your vocal cords (vocal folds) close when they’re supposed to be open. Opening them is outside of your control and, because of that, you may have trouble breathing. VCD is also called inducible laryngeal obstruction, paradoxical vocal cord movement (PVFM) and laryngeal dysfunction.

Your vocal folds (cords) are inside of your larynx, which is above your trachea (windpipe). They are two bands of muscle. When you take in a breath, the vocal folds open. When you talk and they close, they each stretch towards the other until they meet in the middle, and vibrate. If you have vocal cord dysfunction, the folds move toward the middle when you breathe in and out, blocking the airway.

Vocal cord dysfunction causes asthma-like symptoms, and is often mistaken for asthma. Nearly 80% of VCD episodes are wrongly diagnosed as asthma, especially asthma caused by exercise. You can have both VCD and asthma – even episodes at the same time.

Is vocal cord dysfunction life-threatening?

Don’t hesitate to go to the emergency department if you’re having trouble breathing. But, it’s likely that tests will show you’re getting enough oxygen even though it doesn’t feel like it. VCD can feel life-threatening, but it actually isn’t.

Most people have VCD episodes only once in a while, with mild or minor symptoms. Others have episodes that are severe or occur more frequently.

What does vocal cord dysfunction (VCD) feel like?

People report that they feel like they have a lump in their throat or that it’s tight. You may struggle to inhale enough air, which can be painful or cause tension. Patients also may hear noise when they are breathing in, called stridor. This is different from a wheeze when breathing out, which is more consistent with asthma.

What are the types of vocal cord dysfunction?

• Laryngospasm: A laryngospasm is where your vocal cords seize or contract. You may lose your ability to speak and struggle to breathe. This can be caused by a reflux (GERD), environmental irritants and more.
• Exercised induced VCD: This is when the vocal cords move toward the middle when you are breathing during high intensity exercise, making it difficult to take air in.
• Irritant-induced VCD: Irritant-induced VCD is when the vocal cords contract with certain environmental triggers, such as strong scents, fumes, pollutants, chemicals and more.
• Stress-induced VCD: Vocal folds contract as a response to stress and anxiety.

Who gets vocal cord dysfunction (VCD)?

Women experience vocal cord dysfunction more often than men. It can happen to anyone, including kids as young as eight years old, but it’s most common in women ages 20 to 40.

What’s the difference between vocal cord dysfunction and vocal cord paralysis?

Individuals with VCD typically have fully mobile vocal cords. Most of the time, the vocal cords can open and close appropriately. Vocal cord paralysis is when one or both vocal cords are stuck in one position, unable to open or close. If a vocal cord is fixed closer to the middle of your airway, it may cause breathing trouble. If it’s fixed to the side of your airway, you may have trouble with you voice and trouble protecting your trachea and lungs from food and liquid when you swallow.

How do you get vocal cord dysfunction? Is VCD contagious?

Experts are aware of what can trigger (start) an episode of vocal cord dysfunction, but it’s unclear what really causes it. VCD isn’t contagious.

What causes vocal cord dysfunction? How do you get it?

There are several reasons why you might experience a vocal cord dysfunction episode:

• Breathing in irritants. If you inhale ammonia, dust, fumes, cleaning chemicals or smoke, you could have an episode of vocal cord dysfunction.
• Exercise.
• A cold or viral infection.
• Gastroesophageal reflux disease (GERD).
• Psychological conditions. Stress, posttraumatic stress disorder (PTSD), anxiety, depression and panic attacks have all been linked to episodes of vocal cord dysfunction. Anxiety is more likely to trigger an episode in kids and teenagers than adults.
• Rhinosinusitis (sinus infection). Some medications. Neuroleptic drugs like phenothiazines can trigger VCD.

What are the symptoms of vocal cord dysfunction?

• Difficulty breathing. Feeling short of breath or feeling that it’s hard to get air into or out of your lungs.
• A feeling of choking or suffocation.
• A high-pitched wheezing sound when you inhale, called stridor.
• Frequent cough or clearing your throat.
• A feeling of tightness in the throat or chest.
• Voice changes.
• Hoarseness.

Does the weather make vocal cord dysfunction worse?

No. Weather does not appear to affect VCD.

Do certain foods or drinks worsen or improve vocal cord dysfunction?

No. Experts have not noted that anything in your diet affects VCD.

Is vocal cord dysfunction (VCD) a sign of asthma?

No, VCD is not a sign of asthma. It doesn’t cause asthma, and asthma doesn’t cause VCD.

Can VCD cause sleep apnea?

No, vocal cord dysfunction cannot cause sleep apnea.

Can VCD cause chest pain?

Yes. Chest pain is one of the symptoms.

How is vocal cord dysfunction diagnosed? What tests are done?

Diagnosing vocal cord dysfunction is difficult because it resembles asthma. Your healthcare provider may perform a variety of tests, both to rule out asthma and other issues, and to diagnose vocal cord dysfunction. Tests may include:

• Flow-volume loop. This test shows how air flows into your lungs and if there’s blockage. Usually the expiratory loop (exhale, breathing out) will be normal in a patient with VCD, but the inspiratory loop (inhale, breathing in) will be flat. The test may be performed while you’re at rest or when you're exercising.
• Laryngoscopy. This test uses a camera on a flexible tube to look at your vocal cords. Your nose and throat will be numbed before the tube is inserted. Your healthcare provider will have you breathe and speak, and note when the vocal cords open and close, or if they don’t move at all. The test is usually done as an outpatient procedure so you don’t need to stay in the hospital. During the test, you are awake, and you may be asked to talk.

Who treats VCD?

An allergist/immunologist. Such a healthcare provider specializes in allergies, asthma and other immunologic disorders (disorders caused by a problem with your immune system). Some specialize in VCD in addition to immunologic disorders.

You may also see any of the following healthcare providers:

• Psychologist.
• Gastroenterologist.
• Neurologist.
• Otolaryngologist (an ear, nose and throat specialist).
• Speech-Language Pathologist.

How is vocal cord dysfunction treated?

The treatment you’ll receive for vocal cord dysfunction will depend on whether or not you’re in an acute (severe) episode, or not. Treatments you’ll receive during an episode may include:

• Breathing exercises. Your healthcare provider in the emergency department will help you calm down and get control of your breathing. You may also work with a speech-language pathologist who can help teach breathing exercises to control episodes.
• Heliox. In the emergency department you might have you inhale a mix of helium and oxygen. This may reduce airway resistance.
• Tracheostomy. If nothing else works, and you’re in severe distress, your healthcare provider may perform a tracheostomy. This is a procedure where they’ll create an opening in your neck (below your vocal cords) and put a tube into your windpipe. Air can then go into your lungs.

Treatments you’ll receive after an episode may include:

• Managing what triggered the episode. Treatment for GERD, for example, may include antacids and proton pump inhibitors. Treatment for depression may include antidepressant medication and counseling.
• Speech therapy. Speech-language pathologists (SLPs) can help you relax your throat, breathe with your abdomen and teach you to keep your vocal folds open. 90% of patients improve with SLP intervention.
• Psychotherapy. Learning to manage stress may prevent vocal cord dysfunction.

How should I sleep with vocal cord dysfunction?

There’s no known sleeping method that can help you manage or prevent VCD. Vocal cord dysfunction can even start when you’re asleep.

How can vocal cord dysfunction be prevented? What can I do to reduce my risk?

Do your best to avoid what triggers your vocal cord dysfunction. Stay away from smoke, get off problematic medications and don’t eat foods that might make your GERD worse.

One medication called ipratropium (Atrovent®) may be prescribed by your healthcare provider. If you take it before you work out, it may help prevent exercised-induced VCD.

Are there any foods or drinks that prevent vocal cord dysfunction?

No. There’s nothing you can change about your diet that may prevent vocal cord dysfunction.

What’s the outlook for people with vocal cord dysfunction?

It’s likely that you’ll have more than one episode of vocal cord dysfunction. VCD can’t be cured, but it can be managed. Remember that it’s not life-threatening.

Can vocal cord dysfunction come back after it’s treated?

Vocal cord dysfunction can happen repeatedly, yes. Your healthcare provider will help you prevent and/or manage VCD.

Can I live a normal life with VCD?

Absolutely. If you practice your exercises, take any recommended medications and avoid triggers, you’re likely to have fewer and fewer episodes of vocal cord dysfunction. VCD shouldn’t permanently interfere with your day-to-day activities.

When should I see my healthcare provider?

Keep your healthcare providers up to date about your vocal cord dysfunction symptoms. Take all of your prescribed medications for VCD and for what triggers it. Attend all of your appointments with your healthcare providers.

When should I go to the emergency department?

If you’re having trouble breathing, and your breathing exercises aren’t working, don’t hesitate to go to the emergency department.

What questions should I ask my healthcare provider about VCD?

• Do I have VCD or a subtype?
• What’s the best treatment for me?
• What specialist should I see?
• Should I be on medication?
• Do I have asthma?
• What triggered my vocal cord dysfunction?

A note from Cleveland Clinic

If you’re struggling to breathe, feel like your chest is tight and there’s a lump in your throat, and traditional asthma treatments aren’t working, it’s possible that you have vocal cord dysfunction. Fortunately, after you identify the triggers and learn breathing techniques, VCD shouldn’t interfere with your everyday life.

One of the most important things to remember is that you need to practice your breathing exercises whether you’re in a vocal cord dysfunction episode or not. Train yourself to manage your vocal cords.

Finally, don’t pause if you think you need to go to the emergency department. It’s better to get treatment at the hospital than it is to wait too long and find yourself in serious trouble with asthma or another type of condition that affects your breathing.