From the Guidelines
Inhalation vocal cord dysfunction (VCD) 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 treatment of VCD involves several key components, including:
- Education and explanatory approaches, which are crucial in helping patients understand the nature of their disorder and the rationale for the diagnosis, as well as explaining that voice disorders can result from excessive muscle tension that can be brought under control 1.
- Symptomatic strategies, such as natural, reflexive, or instinctive behaviors usually accompanied by sound, like coughing and clearing the throat, yawning followed by a sigh, or whimper sounds, which can help patients manage their symptoms 1.
- Psychological interventions, including communication counseling, identification of patterns of avoidance of speaking or excessive dependence on aids to communication, and support to increase exposure to feared situations, which can be beneficial in addressing underlying issues that may be contributing to the patient's VCD 1. It is essential to note that outcomes are more likely to be positive if the patient understands the relationship between the voice problem and any ongoing psychosocial issues and has strategies in place to deal with them, as highlighted in the study by Baker et al. 1. In terms of specific techniques, speech therapy may involve postural manipulations, such as phonating while bending over or leaning back and looking at the ceiling, redirection of attentional focus, like bubble blowing into water with vocalization, and use of amplification or headphones to alter or enhance auditory feedback 1. Overall, a comprehensive treatment plan that incorporates these various components can help patients with inhalation VCD manage their symptoms and improve their quality of life.
From the Research
Definition and Characteristics of Inhalation Vocal Cord Dysfunction
- Inhalation vocal cord dysfunction, also known as vocal cord dysfunction (VCD), is a condition characterized by intermittent paradoxical adduction of the vocal cords, mainly during inspiration, leading to airflow obstruction and dyspnea 2.
- VCD can mimic or coexist with asthma, leading to overtreatment with corticosteroids and consequent morbidity 2, 3.
- The condition is often underappreciated and misdiagnosed in clinical practice, and recognition of VCD in patients with asthma-type symptoms is essential for adequate treatment 4.
Diagnosis of Inhalation Vocal Cord Dysfunction
- The diagnosis of VCD may be difficult because physical exam and spirometry may be normal between episodes 2.
- During symptomatic episodes, spirometry typically reveals variable extrathoracic airway obstruction (truncated inspiratory flow volume loop) 2.
- The gold standard for identifying VCD is flexible fiberoptic rhinolaryngoscopy, also known as videolaryngostroboscopy 2, 3, 5.
- Nasolaryngoscopy and pulmonary function testing, with provocative exercise and methacholine, can also help diagnose VCD and evaluate for other etiologies 6.
Treatment and Management of Inhalation Vocal Cord Dysfunction
- Management of VCD includes identification and treatment of underlying disorders, such as chronic postnasal drip, laryngopharyngeal reflux (LPR), gastroesophageal reflux (GER), anxiety, and depression 2.
- A multidisciplinary approach, including highly trained speech therapists, is essential for teaching techniques to override dysfunctional breathing habits 2, 3, 5.
- Therapeutic breathing maneuvers and vocal cord relaxation techniques are first-line therapy for dyspnea that occurs with VCD 6.
- OnabotulinumtoxinA injections may be helpful for spasmodic dysphonia and for treating dyspnea in certain cases, although evidence is limited 6.