Vocal Cord Dysfunction Treatment & Management

  • Author: Praveen Buddiga, MD; Chief Editor: Michael A Kaliner, MD   more...
 
Updated: Feb 7, 2011
 

Medical Care

A multidisciplinary approach with a physician and speech therapist and a psychiatrist, if needed, is usually effective.[6]

Speech therapy [2, 7, 10]

The mainstays of treatment for vocal cord dysfunction (VCD) involve teaching the patient vocal cord relaxation techniques and breathing exercises. These procedures have been very successful and are used concomitantly with psychological support in difficult cases.

The role of the speech therapist is to effectively teach and communicate a comprehensive speech therapy plan with appropriate breathing exercises. When a knowledgeable speech therapist is not available, the patient can be taught a breathing relaxation exercise with the use of a simple handout. See the image below.

Relaxed throat breathing exercises. Relaxed throat breathing exercises.

Psychotherapy [2, 7, 14, 10]

The role of the psychiatrist is to implement cognitive behavior psychotherapy or general psychotherapy based upon evaluation of psychiatric and/or personality disorders.

A recent study shows psychotherapy directed towards somatoform and conversion disorders may increase efficacy when added to traditional treatment regimens.[12]

Helium-oxygen therapy [10, 26, 27, 6]

This therapy consists of administration of a helium-oxygen mixture (heliox), which is less dense than air and thus reduces the turbulence in the airway during inspiration.

Heliox administration provides only a short-term benefit, but it may be very helpful in the emergent treatment of acute VCD.

Anticholinergic agent

Inhaled ipratropium may be helpful treatment in patients with exercise-induced VCD. In a series of 6 patients receiving treatment with inhaled ipratropium, all patients reported improvement in symptoms.[24, 25]

Botulinum toxin [28, 29, 6]

An intralaryngeal injection of botulinum toxin relieves symptoms by blocking acetylcholine release at the motor end plate and creating a laryngeal muscle weakness, thus facilitating inspiratory and expiratory airflow.

Its use is considered experimental, and equivocal reports in the literature illustrate both effectiveness and lack of benefit.

Panting

This maneuver causes the adducted vocal cords to relax, which increases the glottic aperture.

Topical lidocaine [30]

This may be applied to the larynx.

The mechanism of action is to break the cycle of hyperactive glottal and supraglottal muscle contractions.

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Consultations

  • Otolaryngologist
  • Pulmonologist
  • Allergist/immunologist
  • Speech therapist
  • Psychiatrist
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Diet

No diet restrictions are necessary.

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Contributor Information and Disclosures
Author

Praveen Buddiga, MD  Physician, Allergy, Asthma and Immunology, Baz Allergy, Asthma and Sinus Center, Fresno, California

Praveen Buddiga, MD, is a member of the following medical societies: American Academy of Allergy Asthma and Immunology and American College of Allergy, Asthma and Immunology

Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Meda Honoraria Speaking and teaching; Teva Honoraria Speaking and teaching

Specialty Editor Board

Stephen Rosenfeld, MD  Professor Emeritus, Department of Medicine, Allergy, Immunology and Rheumatology Unit, University of Rochester School of Medicine and Dentistry

Stephen Rosenfeld, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American Federation for Clinical Research, Clinical Immunology Society, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Michael R Simon, MD, MA  Clinical Professor Emeritus, Departments of Internal Medicine and Pediatrics, Wayne State University School of Medicine; Adjunct Staff, Division of Allergy and Immunology, Department of Internal Medicine, William Beaumont Hospital

Michael R Simon, MD, MA is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Physicians, American Federation for Medical Research, Michigan Allergy and Asthma Society, Michigan State Medical Society, Royal College of Physicians and Surgeons of Canada, and Society for Experimental Biology and Medicine

Disclosure: Secretory IgA, Inc. Ownership interest Management position

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Michael A Kaliner, MD  Clinical Professor of Medicine, George Washington University School of Medicine; Chief, Section of Allergy and Immunology, Washington Hospital Center; Medical Director, Institute for Asthma and Allergy

Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, and Association of American Physicians

Disclosure: Alcon Consulting fee Consulting; Greer Consulting fee Consulting; Sanofi Consulting fee Consulting; Schering/Merck Consulting fee Consulting; Teva Consulting fee Consulting; Meda Honoraria Speaking and teaching; Ista Consulting

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Flow volume loops.
Laryngoscopic views of the vocal cords.
Vocal cord dysfunction treatment plan.
Relaxed throat breathing exercises.
 
 
 
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