Diagnosis and Management of Vocal Cord Dysfunction

Shannon Munro Cohen, PhD, APRN, BC, FNP

Disclosures

Journal for Nurse Practitioners. 2010;6(9):675-682. 

In This Article

Treatment

The mainstay of treatment for VCD is performing pursed lip breathing and taking slow, deep diaphragmatic breaths that relax the chest and throat and reduce the sensation of constriction.[4,15] Panting may result in immediate improvement in VCD symptoms as well.[13] Adequate hydration is important in the management of this disorder to decrease laryngeal irritation from inhaled irritants, reflux, and postnasal drainage and moisten vocal cord mucosa.[15] Oral decongestants and cough suppressants can worsen the symptoms of VCD by thickening secretions and drying the vocal cord folds, which also increases the subglottal pressures needed for speech.[15]

There is no evidence of the benefit of using mucolytics in the literature on VCD, but guaifenesin 1200 mg twice daily, with adequate hydration, may be tried to thin thickened secretions. Postnasal drainage that irritates the vocal cords and stimulates a cough can be reduced with nasal saline lavage, nasal steroids, and treatment of atopy and chronic sinusitis.[10,13]

Prevention and treatment of gastroesophageal reflux is important as it is often a trigger for vocal cord symptoms; reflux has been found in 95% of young patients with confirmed VCD and is often silent with no perceived heartburn.[1,8] For exercise-induced symptoms, inhaled Atrovent (ipratropium) may be beneficial in patients with this disorder as it decreases smooth muscle tone in the vocal cords.[13] Biofeedback, speech therapy, heliox, botulinum toxin injections, hypnosis, and psychotherapy have also been cited in the literature as successful treatments.[4,10,13]

Speech therapists offer valuable input in the evaluation and treatment of VCD patients. They evaluate patient reported triggers; use instruments to assess the voice and swallowing; observe for muscle tension in the neck, shoulders, and chest; and evaluate abnormal breathing patterns.[20] Speech therapists teach patients rhythmic breathing and voice exercises and use respiratory muscle strength trainers and other behavioral treatments to reduce VCD symptoms.[20]

Last and perhaps most important is to gradually taper and discontinue unnecessary asthma medications, which is done once a collaborative, trusting relationship with the nurse practitioner is established.[11] Asthma medications are not beneficial in this disorder and should raise the index of suspicion for VCD; use of prednisone or inhalers only delay patient acceptance of this diagnosis.[10,11] Nurse practitioners need to be mindful of the possibility of VCD before diagnosing patients with asthma. Referral to an ENT for direct examination of the vocal cords, evaluation by a speech therapist, and assessment by an asthma and allergy specialist may be needed for assistance in diagnosis and management of these patients.

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