Vocal fold dysfunction involves paradoxical or dysfunctional movement of the vocal folds and 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 fold paralysis (unilateral and bilateral) is discussed elsewhere. The general evaluation of patients with stridor is discussed elsewhere.
Vocal fold dysfunction occurs more commonly among women aged 20 to 40 years. Its etiology is unclear, but it has been associated with anxiety, depression, posttraumatic stress disorder, and personality disorders. It is not considered a factitious disorder (ie, patients are not doing it consciously). Organic pathologies such as gastroesophageal reflux disease (GERD), nonspecific airway irritants, and exercise have also been associated with intermittent laryngeal obstruction, dyspnea, and noisy breathing (1).
Symptoms are usually inspiratory stridor and less often expiratory wheezing. Other manifestations can include hoarseness, throat tightness, a choking sensation, and cough (2).
The diagnosis is suggested by a characteristic pattern on flow-volume loop on pulmonary function testing. It is confirmed by observing inspiratory closure of the vocal folds upon direct laryngoscopy. Several patients have been misdiagnosed as having asthma without adequate clinical response to bronchodilators or inhaled corticosteroids (glucocorticoids).
General references
1. Morris MJ, Christopher KL: Diagnostic criteria for the classification of vocal cord dysfunction. Chest 138(5):1213–1223, 2010. doi:10.1378/chest.09-2944
2. Christopher KL. Wood, II RP, Eckert RC, et al: Vocal-cord dysfunction presenting as asthma. N Engl J Med 308: 1566–1570, 1983. doi: 10.1056/NEJM198306303082605
Treatment of Vocal Fold Dysfunction
Patient education
Counseling and speech therapy
Treatment of associated organic pathology
Education and counseling are important measures. Referral to a speech therapist for training in special breathing techniques, such as panting, can relieve episodes of stridor and obstruction Vocal fold dysfunction associated with psychiatric diagnoses is often resistant to these measures. Referral for psychotherapy is indicated in these cases. Behavioral therapy may also be helpful.
Rarely, severe cases have been treated with tracheostomy.
