Merck Manual

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Vocal Cord Dysfunction

(Paradoxical Vocal Cord Motion)


Rebecca Dezube

, MD, MHS, Johns Hopkins University

Reviewed/Revised Sep 2021 | Modified Sep 2022
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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 General reference Vocal cord dysfunction involves paradoxical or dysfunctional movement of the vocal cords and is defined as adduction of the true vocal cords on inspiration and abduction on expiration; it causes... read more ).

Diagnosis is suggested by a characteristic pattern on flow-volume loop. It is confirmed 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.

General reference

Treatment of Vocal Cord Dysfunction

  • Education and counseling

Treatment of vocal cord dysfunction 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

Rarely, severe cases have been treated with tracheostomy.

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

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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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