History

Symptoms of vocal cord dysfunction (VCD) may include:^[4]

Wheezing
Cough
A feeling of tightness in the throat
Hoarseness and voice change
Stridor
Shortness of breath
Dyspnea on exertion
Inspiratory difficulty
Sudden episodes of shortness of breath
Unresponsiveness to bronchodilators and corticosteroids

Physical

Laryngeal auscultation may reveal harsh stridulous sounds during symptoms.

Wheezing may be heard in the chest (transmitted from the upper airway).

Causes

Problems associated with vocal cord dysfunction (VCD) include the following:

Gastroesophageal reflux disease, laryngopharyngeal reflux
Upper airway inflammation due to allergies (rhinitis), sinusitis, or recurrent viral infections
Strenuous exercise^{[20, 21, 22, 23, 24]}
Occupational or other exposure to irritant fumes^{[25, 14, 3]}
Environmental allergens and/or pollutants
Psychogenic causes (eg, severe emotional stress)

Bodily sensations such as throat tightening, wheeze, and cough can feed into a cycle of panic that exacerbates symptoms.^[26]

Differential Diagnoses

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Media Gallery

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

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Table 1. Differential diagnosis of laryngeal movement disorders^[29, 30, 31]

Table 1. Differential diagnosis of laryngeal movement disorders ^{[29, 30, 31]}

VCD
Psychogenic	Somatoform disorder, conversion disorder, abuse, anxiety disorder, depression, Munchausen syndrome, malingering
Exercise	Exercise
Irritant	Extrinsic (chemical irritants, olfactory stimuli) Intrinsic (GERD, laryngopharyngeal reflux rhinits/post nasal drip, sinusitis)
Laryngospasm	Intubation, airway manipulation, IgE mediated, nocturnal aspiration
Vocal Cord Paresis/Paralysis	Prolonged intubation, recurrent laryngeal or vagus nerve damage during chest or thyroid surgery, idiopathic
Infectious	Epiglottis, bronchiolitis, laryngotracheobronchitis (croup), laryngitis, pharyngeal abscess, diphtheria, pertussis, laryngeal papillomatosis
Neoplastic	Head and neck malignancy, cystic hygroma, hemangioma, rhabdomyosarcoma, teratoma, lymphoma, papilloma
Endocrine	Thyroid goiter

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Author

Praveen Buddiga, MD, FAAAAI Founder, BUDDIGA Family Allergy Asthma & Skin Immunology; Assistant Clinical Professor, Fresno Medical Education Program, University of California, San Francisco, School of Medicine

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

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: PFIZER; GLAXO-SMITH-KLINE; ASTRA-ZENECA; MYLAN; TEVA RESPIRATORY; ALCON OPHTHALMICS; MERCK RESPIRATORY.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael R Simon, MD, MA Clinical Professor Emeritus, Departments of Internal Medicine and Pediatrics, Wayne State University School of Medicine; Professor, Department of Internal Medicine, Oakland University William Beaumont 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, Society for Experimental Biology and Medicine

Disclosure: Have a 5% or greater equity interest in: Secretory IgA, Inc. ; siRNAx, Inc.<br/>Received income in an amount equal to or greater than $250 from: siRNAx, Inc.