Paradoxical Vocal Motion or Vocal Cord Dysfunction

Overview

Vocal cord dysfunction is the abnormal closure of the vocal cords, which causes sudden, severe attacks of breathing difficulty. It can occur in patients of any age, although it is most common in young, healthy females. It can occur in combination with asthma, or may exist alone. It is probably a reflex mechanism that the voice box uses to protect the lungs, involuntarily closing the vocal cords when exposed to any irritants.

Causes

The following can trigger a VCD attack:

  • Strong scents
  • Smoke
  • Breathing cold air
  • Breathing through the mouth
  • Laughing
  • Coughing
  • Vigorous exercise
  • Drinking very cold liquids.

Try to avoid these triggers until the VCD is under control.

Most common associated conditions:

  • asthma
  • reactive airway disease or “exercise-induced” asthma
  • gastroesophageal reflux disease
  • allergic rhinitis

Symptoms

Signs and Symptoms:

  • difficulty moving air in or out of lungs
  • sensation of “air being cut off” or “throat closing off”
  • wheezing or squeaky sounds from the throat not the lungs
  • voice changes: can vary from hoarseness to aphonia (inability to speak)
  • tightness or discomfort in the throat or neck
  • “lump in the throat” sensation
  • Cough

Treatments

Treatment involves:

  • avoiding triggers of VCD
  • treating any underlying disorders (asthma, GERD, allergies)
  • exercises to promote vocal cord relaxation

Treatment of underlying disorders:

  • controlling asthma with preventative and rescue inhalers
  • avoiding exercise-induced VCD by starting to exercise slowly, with "warm-ups" and using nasal inhale, oral exhale breathing
  • controlling any acid reflux with medication
  • if you don’t have symptoms of acid reflux, you may have “silent reflux”, or laryngeal reflux; it is very important that you take the medication prescribed by your doctor
  • avoiding acid stimulants like caffeine, alcohol, tobacco, spicy foods, chocolate, and eating before exercising or before going to bed at night
  • controlling allergy symptoms with prescription or OTC medications

Vocal Cord Exercises to shorten an attack

These breathing exercises help stop VCD attacks by relaxing the vocal cords. 

  • slowly INHALING through the nose and then EXHALING through slightly pursed lips (like gently blowing out a candle)
  • whispering a gentle "fffffffffff". This may sound like a gentle wind or breeze, or it may be silent. Do this, using breath & lips, without vibrating the vocal cords. Keep lips in a position that is not quite as puckered, as for whistling. Keep lips SYMMETRICAL around teeth. Do NOT have lower lip touching upper teeth. It's like gently blowing out a candle, but with lips not pushed out. Some prefer whispering "ssssssss", or, "shhhhhhh".
  • Some people prefer to whisper an exhaled "ffff", "ffff", "ffff", against a little resistance, in somewhat short, quick bursts, all in the same exhalation. This is like blowing out a slightly stubborn "trick" candle, and you can hear the windy sound of the "ffff", "ffff", "ffff".

RESISTIVE BREATHING (pretending to breathe through a straw):

  • step 1: as soon as there is any tightness in the voice box area, pretend to slowly suck air through a straw for 6 to 8 seconds, then pretend to exhale slowly through a straw for 6 to 8 seconds.
  • step 2: breathe normally for 2 regular cycles (in and out, in and out), if possible. If the vocal cords are still closed, patient can repeat step one, followed by step 2. If the vocal cords are still not opening up, patient can repeat step one, one last time, followed by step 2.

ABDOMINAL/diaphragmatic breathing: these exercises teach relaxed breathing and should be used between attacks. To focus attention on using the lower abdominal muscles (belly muscles), gently put one hand on the abdomen, with thumb on navel ("belly button"), and with other fingers below the thumb.

  • While exhaling, bring the abdomen in (towards the back) just a little bit, making the belly seem a bit smaller; then, just allow the belly move out. This allows inhaling to happen easily, with the abdomen gently expanding--the belly seems to get larger, like a pot belly.
  • During abdominal/diaphragmatic breathing, try to NOT use chest or throat muscles. Try to RELAX the chest & throat muscles.