Vocal Cord Dysfunction (Inducible Laryngeal Obstruction)

What is inducible laryngeal obstruction?

Vocal cord dysfunction (VCD), also known as inducible laryngeal obstruction (ILO) or paradoxical vocal cord movement, happens when your vocal cords or other parts of your voice box don’t work as they should. In this condition, your voice box tends to close when you breathe in instead of remaining open, making it more difficult for you to move air into your lungs. Some people have frequent, severe episodes of VCD where they struggle to breathe.

To understand vocal cord dysfunction, it may help to know more about your vocal cords. These cords are two folds (bands) of muscle that are inside of your larynx (voice box). When you take a breath, your vocal folds open. When you talk, the folds come together and close, meet in the middle and vibrate. That vibration is what creates your voice so you can swallow, clear your throat or cough. It’s also the reason why you can talk, sing and make many other sounds.

What are the symptoms of vocal cord dysfunction?

Inducible laryngeal obstruction (ILO) can make it feel like there’s a lump in your throat (pharynx) or your throat feels tight. Other VCD symptoms include:

• Difficulty breathing in
• Feeling like you need to clear your throat
• Lightheadedness
• The sensation that you’re choking or suffocating
• Stridor or noisy breathing on the inhalation
• The sensation of a lump in the throat
• Tingling sensation in your hands and feet

What causes vocal cord dysfunction?

Experts don’t know the exact cause of inducible laryngeal obstruction. They believe there’s more than one thing that may trigger episodes. They group potential ILO causes into the following categories:

• Exercise-induced laryngeal obstruction (EILO). This type is triggered by exercise. It’s most common in young athletes.
• Medical conditions. Conditions like asthma, gastrointestinal reflux disease (GERD) and upper respiratory infections can trigger episodes.
• Mental health conditions. Generalized anxiety disorder, clinical depression, obsessive-compulsive personality disorder (OCPD) and post-traumatic stress disorder (PTSD) are common mental health conditions that may make ILO worse.
• Irritants that you inhale. Cold dry air, toxins like ammonia or bleach, cleaning chemicals, strong smells or perfumes and smoke are examples of substances that may trigger ILO.

How is inducible laryngeal obstruction diagnosed?

The condition can be challenging for healthcare providers to diagnose. For example, studies suggest providers often mistakenly diagnose vocal cord dysfunction as asthma or croup.

To diagnose the condition, a healthcare provider may do a physical examination, ask about your medical history and ask about activities or exposures that could result in VCD. They may order the following tests:

• Laryngoscopy. Your provider will use a camera mounted on a flexible tube that they insert through your nose or throat to examine your vocal cords. They’ll ask you to breathe and speak while they watch to see when your vocal cords open and close. They may do a provocation test to trigger an episode of VCD while looking in your throat so they can understand better what is causing the shortness of breath.
• Pulmonary function tests and spirometry. In these tests, you breathe into a spirometer, a device that measures how much air you inhale and exhale and how quickly you exhale. Your provider may do this test to rule out asthma. Sometimes, the test will show changes in the flow-volume loop that can be a sign of VCD. It’s important to know that these tests can’t diagnose ILO.

How is inducible laryngeal obstruction treated?

Treatments vary depending on your situation, including what triggers your episodes, how often you have episodes, and if they cause mild, moderate or severe symptoms. Typical treatments for vocal cord dysfunction include:

• Respiratory retraining therapy. Specially trained speech-language pathologists will demonstrate breathing exercises that may help manage VCD episodes. For example, pursed lip breathing and diaphragmatic breathing may help you manage breathing during episodes. It may take just a few sessions of breathing therapy for symptoms to get better.
• Treating trigger conditions. For example, providers may treat a chronic condition like GERD and recommend ways to manage or treat colds and other infections that may cause VCD symptoms.

Is there a cure for this condition?

No, there isn’t a cure, but healthcare providers can help identify triggers like medical conditions that can set off vocal cord dysfunction episodes. They can also recommend treatments that help you manage your breathing, so episodes don’t leave you breathless.

How can I prevent inducible laryngeal obstruction?

Avoiding situations and managing conditions that cause your episodes may keep them from happening. For example, if you know that exposure to certain workplace chemicals often leads to ILO symptoms, protecting yourself from exposure by wearing protective breathing gear may reduce the chance you’ll have an episode.

Is vocal cord dysfunction life-threatening?

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

How do I take care of myself?

A consultation with a team of healthcare professionals with expertise in inducible laryngeal obstruction is very important for you to understand what’s happening and what to do when you have an episode.

When should I see my healthcare provider?

Contact your provider if you still have symptoms even though you’re doing your breathing exercises, managing underlying conditions and avoiding situations that lead to episodes. Call 911 or go to the emergency room if you have shortness of breath that doesn’t go away.