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Vocal Cord Dysfunction

(Paradoxical Vocal Cord Motion)

By Noah Lechtzin, MD, MHS, Associate Professor of Medicine and Director, Adult Cystic Fibrosis Program, Johns Hopkins University School of Medicine

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Paradoxical or dysfunctional movement of the vocal cords is defined as adduction of the true vocal cords on inspiration and abduction on expiration; it causes inspiratory airway obstruction and stridor that is often mistaken for asthma. Vocal cord paralysis (unilateral and bilateral) is discussed elsewhere. The general evaluation of patients with stridor is discussed elsewhere.

Vocal cord dysfunction occurs more commonly among women aged 20 to 40. Etiology is unclear, but it appears to be associated with anxiety, depression, posttraumatic stress disorder, and personality disorders. It is not considered a factitious disorder (ie, patients are not doing it consciously).

Symptoms are usually inspiratory stridor and less often expiratory wheezing. Other manifestations can include hoarseness, throat tightness, a choking sensation, and cough (1).

Diagnosis is made by observing inspiratory closure of the vocal cords with direct laryngoscopy. Sometimes a diagnosis of vocal cord dysfunction is entertained only after patients have been misdiagnosed as having asthma and then not responded to bronchodilators or corticosteroids.

Treatment involves educating the patient about the nature of the problem; counseling from a speech therapist on special breathing techniques, such as panting, which can relieve episodes of stridor and obstruction; and avoiding asthma misdiagnosis and treatment.

Vocal cord dysfunction associated with psychiatric diagnoses is often resistant to these measures. Referral for psychiatric counseling is indicated in these cases.