From the Guidelines
Therapy for vocal cord dysfunction primarily involves speech therapy techniques and breathing exercises, as recommended by the most recent and highest quality study 1.
Key Components of Therapy
- Speech therapy focuses on teaching patients to control their vocal cords through techniques like pursed-lip breathing and relaxed throat breathing.
- Patients should practice these exercises daily, typically for 15-30 minutes, under the guidance of a speech-language pathologist.
- Breathing retraining is essential, with specific techniques including diaphragmatic breathing and the "sniff-blow" technique where patients take a quick sniff through the nose followed by a controlled exhale through pursed lips.
- For acute episodes, patients should try the "recovery breath" technique: inhale slowly through the nose, then exhale through pursed lips while making an "s" sound.
Additional Considerations
- Psychological counseling may help manage anxiety that can trigger symptoms.
- Medications are generally not first-line treatments, though inhaled ipratropium (Atrovent) 2 puffs every 4-6 hours may help some patients by relaxing the vocal cords, as suggested by other studies 1.
- Heliox (helium-oxygen mixture) may be used in emergency settings for severe cases.
Outcome
These approaches work by addressing the paradoxical vocal cord movement that characterizes this condition, where vocal cords inappropriately close during inhalation instead of opening. With proper therapy, most patients can significantly reduce the frequency and severity of episodes within 4-6 weeks of consistent practice.
From the Research
Treatment Options for Vocal Cord Dysfunction (VCD)
- Therapeutic breathing maneuvers and vocal cord relaxation techniques are first-line therapy for dyspnea that occurs with VCD 2
- Treatment of underlying disorders such as asthma, gastroesophageal reflux disease, postnasal drip, and anxiety is crucial in managing VCD 2, 3, 4
- Speech therapy and biofeedback play a critical role in teaching techniques to override dysfunctional breathing habits 3, 5, 6
- Heliox (80% helium/20% oxygen), topical lidocaine, anxiolytics, and superior laryngeal blocks with Clostridium botulinum toxin may be used during severe, acute episodes of VCD 3
- OnabotulinumtoxinA injections may be helpful for spasmodic dysphonia and for treating dyspnea in certain cases, although evidence is limited 2
- Patient education and speech therapy are the primary treatments for VCD, and in most cases, patients may resume their activities without significant limitation 5, 6
Long-term Management Strategies
- Treatment for symptom triggers such as exercise, psychological conditions, airborne irritants, rhinosinusitis, gastroesophageal reflux disease, or use of certain medications 4
- Speech therapy to improve vocal cord function and reduce symptoms 3, 5, 6
- Multidisciplinary approach, including highly trained speech therapists and psychological support, to manage VCD and coexisting conditions 3, 6