Dyspnea Due to Vocal Cord Dysfunction and Other Laryngeal Sources

Mark T. O'Hollaren, MD

Disclosures

August 26, 2002

In This Article

Treatment of VCD

The appropriate treatment of VCD is best initiated with a careful explanation of the disorder and treatment recommendations. It is helpful for patients to have a description of the anatomy of the vocal cords, as well as the abnormalities that occur that produce the symptoms. It may also be useful to compare the psychological factors related to VCD with asthma, in which emotions are also seen as a common trigger, but not the positive factor of the disorder. Patients need to be reassured that they are not being told that the physician does not believe their symptoms to be real, or that it is "all in their head."

Speech therapy is the foundation of treatment of VCD. A speech therapist who is familiar with this disorder, and who can coach a patient on appropriate laryngeal and neck relaxation techniques, panting breathing, breath holding, slow relaxed expiration techniques, etc., may be extremely helpful in preventing and treating these episodes.

Vocal cord paralysis may be unilateral or bilateral and may result from damage of the recurrent laryngeal nerve during past thyroid or parathyroid surgery. The left vocal cord is more commonly affected than the right due to the somewhat longer path of the recurrent laryngeal nerve and its anatomic relationship to structures in the mediastinum. There also may be other neuropathies and degenerative neurologic conditions that may result in vocal cord paralysis. This condition may result in an abnormal voice, but the voice may be near normal in other patients with unilateral vocal cord paralysis. There may be problems, including aspiration while drinking liquids or eating solid foods, and once again the appropriate diagnosis is made by direct visualization of the vocal cords with documentation of abnormal vocal cord movements while coughing or during phonation. Other neurologic problems such as Meige syndrome, a neurologic condition accompanied by episodic spastic closure of the vocal cords, may lead to episodic shortness of breath, which may be severe enough to result in loss of consciousness. Spastic dysphonia, a somewhat poorly understood condition causing abnormal motion of the vocal cords, may occur in both an abductive and an adductive variety. Some patients who have abductive spastic dysphonia may experience some dyspnea. Treatment may be difficult, but is best referred to an otolaryngologist and appropriate speech therapist for management.

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