1. Vocal Cord Dysfunction Alison Stoeri, BS

2. DEFINITION Abnormal adduction of the vocal cords mostly during inspiration also called paradoxical vocal cord motion (PVCM)  Often confused with asthma due to the symptoms, however there is not inflammation of the airways with VCD. This causes obstruction at the level of the larynx

3. A little history VCD was first discovered in 1842 and was thought to be a psychological condition. By 1900 it was accepted as a sign of physical or emotional stress. 1980 scientists began to study it more, but it was still not understood by 2007.

4. Pathophysiology The cause is unknown but is thought that intervention of the vagus nerve may alter the laryngeal tone and lower the threshold for stimuli to produce vocal cord spasm or abnormal adduction. New research also suggests GERD, laryngopharyngeal reflux, sinusitis, post nasal drip, and neurological issues.

5. Frequency and Demographics Most often occurs in young females  If found in patient under 18, 85% are female Found in all ages, but mostly between ages 20-40 in adulets or ages 14-15 for children.  Associated with competitive and families oriented with high achievement  In adults, associated with stress and anxiety More than 10-15% of patients with refractory asthma actually have VCD 40% of individuals who have asthma also have VCD

6. Signs and Symptoms VCD usually occurs suddenly SOB and stridor Hoarseness or wheezing Chronic cough or throat clearing Chest and throat tightness Feeling of not being able to get air in which causes panic and anxiety Hypoxia and cyanosis

7. Diagnosis Often mimics asthma or anxiety attacks ABGs, PFTs, and methacholine challenges are usually done first, but often show no positive results  Flow/volume loops may show a flattened inspiratory loop demonstrating extrathoracic obstruction

8. Diagnosis The gold standard of diagnosis is a larygoscopy during an exercise stress test or irritant challenge.  Diagnosis is confirmed when the cords move inward and leave a small hole when the patient breaths in  This does not happen with asthma or during an anxiety attack

9. Treatment A multiple disciplines are often needed to treat VCD such as a speech therapist, psychologist, and physician. Heliox therapy is used in acute situations to ensure adequate oxygenation. If heliox does not work, a tracheotomy is performed to bypass the obstruction.

10. Treatment cont’d Speech therapy is used to teach breathing exercises and vocal cord relaxation techniques Psychotherapy is frequently used to help control anxiety and stress  Anti-anxiety meds may be given Biofeedback can be used to help the patient manipulate their bodily functions

11. Treatment cont’d Botulinum toxin can be injected directly into the vocal cords  This blocks acetylcholine so muscles cannot spasm  Experimental, shows both positive and negative results Lidocaine may be injected to break the hyperactive glottal and supraglottal contractions

12. Prognosis The prognosis is still unknown since so much is not known about this disorder Many patients show much progress with treatment of underlying disorders, along with psychotherapy