From the Guidelines
Vocal cord dysfunction should be managed with a multidisciplinary approach, prioritizing speech therapy techniques such as education, symptomatic, and psychological interventions, as outlined in the consensus recommendations for speech and language therapy 1. The management of vocal cord dysfunction involves several key domains of intervention, including education and explanatory approaches, symptomatic strategies, and psychological support.
- Education and explanatory approaches are crucial, as they involve clearly explaining the nature of the disorder to the patient, reviewing laryngoscopy examination results, and emphasizing that voice disorders can result from excessive muscle tension, which can be brought under control 1.
- Symptomatic strategies include a range of techniques, such as natural, reflexive, or instinctive behaviors accompanied by sound, like coughing and clearing the throat, yawning followed by a sigh, or whimper sounds, as well as physical and postural maneuvers like reposturing or repositioning the larynx, and redirection of attentional focus through activities like bubble blowing or large body movements 1.
- Psychological interventions, such as communication counseling, identifying and addressing patterns of avoidance or excessive dependence on aids to communication, and supporting patients to increase exposure to feared situations, are also essential in managing vocal cord dysfunction, particularly in cases with underlying anxiety, depression, or medicolegal issues 1. Systematic reviews of randomized controlled trials have reported moderate-to-good evidence for the efficacy of symptomatic voice therapy for functional dysphonia, highlighting the importance of direct symptomatic and behavioral voice therapies, either alone or in combination with indirect therapies 1. By prioritizing these interventions and tailoring treatment to the individual patient's needs, healthcare providers can help patients with vocal cord dysfunction to effectively manage their symptoms, improve their quality of life, and reduce the risk of complications or misdiagnosis 1.
From the Research
Definition and Symptoms of Vocal Cord Dysfunction
- Vocal cord dysfunction involves inappropriate vocal cord motion that produces partial airway obstruction, often presenting with respiratory distress that is mistakenly diagnosed as asthma 2.
- Symptoms of vocal cord dysfunction include inspiratory stridor or wheezing, sudden severe dyspnea, throat or chest tightness, and anxiety, particularly in females 3.
- Vocal cord dysfunction can lead to dyspnea or dysphonia due to abnormal laryngeal muscle spasms 3.
Diagnosis of Vocal Cord Dysfunction
- Diagnosis of vocal cord dysfunction can be confirmed through pulmonary function testing with a flow-volume loop and flexible laryngoscopy 2.
- Nasolaryngoscopy and pulmonary function testing, with provocative exercise and methacholine, can help diagnose vocal cord dysfunction and evaluate for other etiologies 3.
- Laryngeal adduction on laryngoscopy may not predict disease severity or response to laryngeal retraining therapy 4.
Treatment and Management of Vocal Cord Dysfunction
- Treatment of acute episodes includes reassurance, breathing instruction, and use of a helium and oxygen mixture (heliox) 2.
- Long-term management strategies include treatment for symptom triggers, speech therapy, and therapeutic breathing maneuvers 2, 3.
- Laryngeal-respiratory retraining therapy (LRT) has emerged as a preferred treatment modality, with a response rate of 74.1% in patients with vocal cord dysfunction 4.
- OnabotulinumtoxinA injections may be helpful for spasmodic dysphonia and treating dyspnea in certain cases, although evidence is limited 3.
Triggers and Comorbidities of Vocal Cord Dysfunction
- Common triggers of vocal cord dysfunction include exercise, asthma, gastroesophageal reflux disease, postnasal drip, upper or lower respiratory tract infection, and irritants 3.
- Conditions that can trigger vocal cord dysfunction should be optimally treated, particularly asthma, gastroesophageal reflux disease, and postnasal drip, while avoiding potential irritants 3.
- Comorbidities such as gastroesophageal reflux disease, postnasal drip syndrome, and psychiatric conditions should be treated to manage vocal cord dysfunction 5.