Vocal Cord Dysfunction (or VCD)
One of the most common vocal problems that sends patients to their physicians or to South Tampa Voice Therapy is a condition called Vocal Cord Dysfunction (VCD).
The patients may never have heard of VCD, but they do know that they have vocal problems. Their voice may be hoarse or raspy. They may have a chronic cough or clear their throat more frequently than usual. Many people ignore these symptoms, deciding that it’s “just a cold,” and sometimes it is exactly that. However, if symptoms persist or get worse, it might be a good idea to find out what else those symptoms might be telling you and whether you need to seek help.
VCD goes by many names: it’s also called laryngeal dysfunction, paradoxical vocal cord/fold movement disorder, or paradoxical vocal cord motion.
The easiest way to explain VCD is that it is a disorder that occurs when the vocal cords move toward each other when a person breathes, narrowing the airway and causing difficulty breathing. There are a number of things that can trigger VCD.
Possible triggers of vocal cord dysfunction (VCD) are often similar to asthma triggers. However, it is important to know that not all people who experience VCD have asthma.
Like asthma, VCD’s common triggers include: breathing in lung irritants (strong odors, fragrances or smoke), having an upper respiratory infection, stress and anxiety or even exercising. Some vocal maneuvers (such as singing, laughing or even talking) can also trigger an episode of VCD.
Is VCD the Same As Asthma?
Although both of these conditions can make breathing difficult, and both can include coughing, throat tightness and hoarseness, they are actually two distinct and separate disorders.
Unlike asthma, vocal cord dysfunction isn’t an immune system reaction and doesn’t involve the lower airways. Accurate diagnosis is essential since treatment for the two conditions is quite different.
When VCD is misdiagnosed as asthma (based on similar triggers and symptoms), that diagnosis can lead to inappropriate use of asthma medications. Those medications won’t help a patient with VCD and can, in fact, cause side effects. To further complicate matters, some people have both VCD and asthma and require appropriate treatment for each condition.
Few patients walk into a doctor’s office and tell their doctors that they are having trouble with “stridor.” Instead, they may say that they are “wheezing.” But stridor (a symptom of VCD) and wheezing (a symptom of asthma) are distinctly different.
But What If I AM Wheezing…
A simple way to think of it is that wheezing almost always involves the lower airway, including the lungs. Wheezing is often described as a high-pitched or whistling sound, which is most prominent when breathing out (expiration). True wheezing is a symptom of asthma.
Stridor is often described as “a loud musical sound of constant pitch,” typically found in patients with tracheal or laryngeal (upper airway) obstruction. Stridor is most prominent when breathing in and is a symptom of VCD.
How Can You Tell If You Have VCD?
Chronic cough is often a symptom of VCD. Other symptoms include:
- Shortness of breath
- Chest and/or throat tightness
- Feeling that you are “breathing through a straw”
- Difficulty with inhalation and/or exhalation
- Frequent throat clearing
- Intermittent hoarseness.
Some patients self diagnose and call their doctors, asking for an inhaler. They assume that they have asthma, because they are experiencing what they think of as wheezing. For that reason, it’s important to give your doctor a detailed description of all of your symptoms. For example:
- While breathing problems occur in both asthma and VCD, a VCD patient will find it harder to breathe in than breathe out when symptoms flare up.
- If asthma medications don’t ease the symptoms, it’s important for the patient to discuss that with the doctor.
- If the results of breathing (pulmonary function) tests or other tests for asthma are normal or only show mild changes, asthma may not be the culprit.
Many VCD patients tell their doctors that their chest and/or throat feels tight – “like a hand around my throat” is a common description.
Other VCD patients say they feel like they are breathing through a straw.
Assessment and Evaluation
You shouldn’t have to decide whether you have asthma or VCD or just a bad cold. You should begin by talking with your doctor.
Physicians – especially ENT physicians and allergists – hear about vocal symptoms every day, and they are accustomed to taking an extensive voice history to narrow the diagnosis.
Before a physician refers a patient to South Tampa Voice Therapy, they usually are able to share that history with us, so that we can become part of your health care team.
In the past, the greatest challenge surrounding the evaluation of vocal problems was diagnostic confidence. How much certainty could we have that we were right? But recent advances in medical imaging have changed that.
Today, Videostroboscopy is state-of-the-art technology which provides a magnified view of the larynx and simulates slow-motion vibration of the vocal cords. This procedure allows a qualified Voice Pathologist to identify vocal cord conditions and abnormalities with confidence.
During an evaluation, the Voice Pathologist will trigger the patient’s VCD symptoms if possible, then directly visualize the throat muscles through stroboscopy. The patient too will have the ability to visualize their throat muscles while VCD symptoms are occurring, and high-definition images are then transmitted to the doctor.
Stroboscopy removes the uncertainty and guesswork from the diagnosis of vocal pathologies.
South Tampa Voice Therapy is the only stand-alone speech pathology clinic in the Tampa Bay area that provides comprehensive voice and swallowing assessments that include Videostroboscopy and Fiberoptic Endoscopic Evaluation of Swallowing (FEES). This capability enables us to be an important contributor to your health care team.
When VCD is the result of reflux or allergies or other medical conditions, a physician’s input and treatment plan are almost always required. However, the symptoms of VCD can sometimes be a learned behavior which is amenable to Voice Pathology intervention once it is properly diagnosed.
In cases where the Voice Pathologist implements a treatment strategy, it typically involves:
- Special breathing exercises, including pursed lip breathing
- Relaxed inhalation
- Self-monitoring tools to prevent VCD symptoms
- Voice therapy techniques to reduce/eliminate hoarseness
- Biofeedback and
- Avoidance of irritants.
For More Information…
Think about how you use your voice at work, at home, in conversation, in community groups, and pay attention to how well your voice is serving you. If you think you might have a problem, ask your doctor. Many vocal problems – including VCD – can be treated and alleviated or cured.
Don’t try to go it alone. Please contact your doctor if you have vocal problems or let us know if we can help.