November 10, 2020 | Black & Kletz Allergy
The vocal cords are V-shaped tissue folds within our voice box (i.e., larynx). The gap between the arms of the V is the opening into our windpipe (i.e., trachea). These are dynamic structures and move with the contraction and relaxation of the muscles attached to them. Normally the vocal cords open when we inhale and exhale, allowing the air to get in and out of lungs. They close while we eat, blocking food from entering into the windpipe. The vocal cords become narrowed when we speak. It is the vibration of the vocal cords that generates voice.
When the vocal cords malfunction, they may become narrowed or even close when we inhale. This narrowing or closing will result in difficulty for air to enter the lungs which may cause a feeling of breathlessness. This shortness of breath may be confused with the symptoms of asthma. When this situation occurs, it is referred to as paradoxical vocal fold movement (PVFM) or vocal cord dysfunction (VCD).
In asthma, the airways (i.e., bronchial tubes) constrict and tighten, making breathing difficult. In vocal cord dysfunction, the vocal cord muscles tighten, which also makes breathing difficult. Unlike asthma, vocal cord dysfunction is not an allergic response. It is usually more difficult to inhale during an episode of vocal cord dysfunction. On the contrary, it is usually more difficult to exhale during an exacerbation of asthma. It is very important to differentiate vocal cord dysfunction from asthma since the treatments are quite different. One study showed that approximately 40% of individuals with vocal cord dysfunction are misdiagnosed as having asthma. It should be noted that in some instances, asthma and vocal cord dysfunction can coexist in a person at the same time.
Vocal cord dysfunction is found in people of all ages, although it tends to be more prevalent in individuals between the ages of 20-40. It is more common in women.
Symptoms:
- Tightness of the throat
- Hoarseness
- Choking or suffocation feeling
- Difficulty in breathing
- High pitched noise during Inhalation (i.e., stridor)
- Coughing
- Wheezing
- Frequent throat clearing
Causes and Triggers:
- Strong odors, fumes, or other irritants
- Upper respiratory infections (URI’s)
- Post-nasal drip associated with allergic rhinitis (i.e., hay fever) or a URI
- Acid reflux [i.e., gastroesophageal reflux disease (GERD)]
- Exercise
- Emotional stress
Diagnosis:
- Comprehensive history of the symptoms and triggers
- Breathing test (i.e., spirometry) with a flow/volume loop demonstrating diminished air entry into the lungs during an episode
- Direct inspection of the of the vocal cord through a laryngoscope (i.e., flexible fiberoptic tube with a camera attached) during the episode revealing paradoxical movements
- An episode may need to be “induced” either by exercise or by inhalation of a chemical called methacholine
Treatment:
There is very little role of medications in the management of this vocal cord dysfunction. The mainstay of treatment is behavioral techniques to relax the muscles in the throat that control the vocal cord movements.
- Speech therapy by a trained and qualified speech pathologist and therapist is the main course of treatment. One may need several sessions of speech therapy and regular practice at home even during asymptomatic periods in order to manage vocal cord dysfunction.
- Deep breathing techniques to reduce the discomfort and fear
- Relaxation techniques, biofeedback, and psychotherapy have been shown to be helpful in controlling vocal cord dysfunction by reducing emotional stress
- Better control of asthma, if it is co-existent
- Managing post-nasal drip and acid reflux
The board certified allergy specialists at Black & Kletz Allergy have 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. The allergy specialists at Black & Kletz Allergy are extremely knowledgeable about the most current treatment options for patients with vocal cord dysfunction, asthma, and related conditions and can promptly answer any of your questions. The allergy specialists at Black & Kletz Allergy diagnose and treat both pediatric and adult patients. To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day. We have been servicing the greater Washington, DC area for more than 50 years and we look forward to providing you with state-of-the-art allergy and asthma care in a welcoming and pleasant environment.
