What Is Vocal Cord Dysfunction

Introduction

Vocal cord dysfunction (VCD) is a condition that affects the vocal cords, significantly impacting breathing and even speech. Due to its impact on breathing, it can also affect respiratory health. In this comprehensive article, we will delve into the anatomy of the vocal cords, explore the causes and triggers of dysfunction, and understand the symptoms, diagnosis, and treatment. 

Anatomy of vocal cords 

Vocal cords, often referred to as vocal folds, are delicate folds of tissue located inside the voice box or larynx. Their role is fundamental in creating the sounds we use for speech.¹ 

When we breathe, our vocal cords stay apart, letting air move in and out of our lungs smoothly. However, when we speak, they come together and vibrate, producing the sounds needed for words. 

The larynx, where our vocal cords sit, is made up of cartilage, muscles, and connective tissue. These elements work together to make speech possible, allowing us to control the movement and tension of our vocal cords. 

Understanding this structure not only gives us insights into how our voice is produced but is also critical in comprehending when something isn't functioning as it should—like in cases of vocal cord dysfunction. 

Understanding vocal cord dysfunction 

In individuals with VCD, the vocal cords fail to open properly during inhalation and exhalation. This obstructs the airway, leading to symptoms similar to those of asthma, such as wheezing, shortness of breath, and coughing.² 

The main difference between asthma and VCD lies in where this obstruction is. Asthma involves the narrowing of the airways due to inflammation and increased mucus production, while VCD involves the malfunctioning of the vocal cords. It’s important that we understand the difference in order to manage the condition effectively.

Causes of vocal cord dysfunction 

Physical factors 

Structural abnormalities

Conditions like laryngomalacia, where the laryngeal tissues are softer than usual, vocal cord paralysis involving impaired movement due to nerve damage, or subglottic stenosis characterised by a narrowed airway can all contribute to VCD. These abnormalities alter the mechanics of vocal cord movement, leading to symptoms such as shortness of breath and stridor. 

Muscle tension

When the muscles surrounding the larynx become overly tense, they affect the normal movement of the vocal cords during breathing and speaking. This heightened muscle tension often arises from stress, anxiety, poor vocal habits, or psychological factors. The tightened muscles restrict the smooth movement of the vocal cords, resulting in symptoms like breathing challenges and alterations in voice quality. 

Trauma or injury

Any form of injury or trauma inflicted on the neck or larynx can cause damage to the vocal cords, which, therefore, affects their function. This damage may arise from accidents, surgical procedures, or other traumatic events, leading to changes in vocal cord structure and how they move. 

Environmental triggers 

Allergens and irritants

Exposure to allergens such as pollen, dust, and pet dander, or irritants like smoke, strong odours, or chemicals can trigger episodes of vocal cord dysfunction, especially if you’re sensitive to these. 

Respiratory infections

Infections in the respiratory tract, such as upper respiratory infections, can cause temporary dysfunction of the vocal cords. These infections may irritate the vocal cords, leading to abnormal functioning and speech. 

Symptoms of vocal cord dysfunction 

The symptoms of vocal cord dysfunction can vary in intensity and presentation, making diagnosis challenging. Common symptoms include: 

• Shortness of breath: This is a result of the restricted airflow caused by the malfunctioning vocal cords. 
• Stridor: This is a high-pitched, wheezing sound that occurs during inhalation, originating from the throat. It is similar to the wheezing observed in asthma, but the source is the vocal cords rather than the lower airways. Stridor can be particularly pronounced during physical exertion or stress. 
• Hoarseness: Changes in voice quality, making it rough, raspy, or weak. The hoarseness is a result of the irregular movement and positioning of the vocal cords, impacting the production of sound during speech. 
• Chronic cough: Persistent, dry coughing that may worsen during episodes of VCD. This coughing is a reflex response triggered by the irritation caused by the abnormal vocal cord movement. 
• Throat tightness: A feeling of tightness or discomfort in the throat, often mistaken for a lump or swelling. This sensation is due to the muscles around the larynx tensing up or the vocal cords not moving as they should. 

Diagnosis of vocal cord dysfunction 

Laryngoscopy 

This involves inserting a flexible scope (like a small camera) through the nose or mouth to visualise the vocal cords and assess their movement properly. This procedure is minimally invasive and is performed under local anaesthesia to make the procedure more comfortable. Laryngoscopy helps identify any structural abnormalities or irregular movement which may be responsible for the symptoms. 

Pulmonary function tests 

These tests help evaluate lung function and can aid in distinguishing VCD from other respiratory conditions like asthma. PFTs measure various aspects of breathing, such as lung capacity and airflow.³ Individuals with VCD often show normal results during these tests, whereas people with asthma will have abnormal results, thereby formally distinguishing between both. 

Exercise challenge 

Sometimes, exercise challenge tests are used to induce VCD symptoms during physical exertion, aiding in diagnosis. This is particularly important in patients who present with exertional dyspnoea (breathlessness). This test can involve activities that simulate the conditions under which VCD symptoms typically occur, like strenuous exercise. 

Treatment and management 

Speech therapy 

Speech therapy, conducted by a speech-language pathologist, involves learning techniques to relax and strengthen the vocal cords. These techniques can help you gain better control over your vocal cord movements and improve your ability to coordinate breathing and speaking. 

Breathing exercises 

Learning and practising specific breathing exercises can improve vocal cord movement and teach individuals to control their breathing, reducing the occurrence of VCD episodes. Techniques like pursed-lip breathing and diaphragmatic breathing can be particularly beneficial. 

Stress management

Techniques to manage stress, anxiety, and muscle tension, such as meditation, yoga, or counselling, can be beneficial in preventing VCD episodes triggered by psychological factors. Stress reduction helps in minimising muscle tension around the larynx, promoting normal vocal cord movement. 

Medications 

Antihistamines

Antihistamines work by blocking histamine, a substance that causes allergy symptoms like throat irritation or inflammation, which helps reduce discomfort in the vocal cords.

Inhaled corticosteroids

In some cases, inhaled corticosteroids may be recommended if there is underlying inflammation in the respiratory system, including the vocal cords.

Bronchodilators

Bronchodilators are commonly used to relieve symptoms associated with conditions like asthma, but they can also be beneficial for individuals with VCD.⁴ These medications work by relaxing the muscles around the airways, including those in the vocal cords. This can, therefore, help ease breathing issues caused by VCD.

Prevention and outlook

While it may not always be possible to prevent VCD, certain measures can reduce the risk or severity of episodes: 

Avoiding triggers

Identifying and avoiding environmental triggers, such as smoke, allergens, pollutants, or strong odours, can help avoid VCD episodes. By taking steps to reduce exposure to substances, you can minimise the risk of symptom exacerbation. 

Practising relaxation techniques

Regularly engaging in relaxation exercises, mindfulness, or stress-reduction techniques can help reduce muscle tension in the vocal cords. Techniques such as progressive muscle relaxation or guided imagery can be effective in promoting relaxation. 

Staying hydrated

Maintaining proper hydration by drinking adequate fluids helps keep the vocal cords flexible and functioning optimally. Drinking plenty of water ensures the mucous membranes in the larynx stay moist so that the movement of vocal cords can stay smooth. 

Seeking prompt treatment

If symptoms of VCD occur, seeking prompt medical attention for an accurate diagnosis and appropriate management is especially important to ensure a good outcome. Early intervention and appropriate treatment can significantly improve the outlook and quality of life for individuals with VCD. 

Summary

Understanding vocal cord dysfunction is crucial if you are experiencing respiratory symptoms that may mimic asthma. Awareness of its causes, symptoms, diagnosis, and available treatments can be empowering.  

If you suspect you may have symptoms of VCD, it is essential to consult a healthcare professional for a thorough evaluation and appropriate guidance to enhance your quality of life.