Medical Care

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

Speech therapy

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.^{[2, 7, 10]}

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.

View Media Gallery

Psychotherapy

The role of the psychiatrist is to implement cognitive behavior psychotherapy or general psychotherapy based upon evaluation of psychiatric and/or personality disorders.^{[2, 7, 14, 10]}

According to a systematic review of psychological interventions for patients with VCD, techniques such as psychotherapy, behavioral therapy, use of anti-anxiety and anti-depressant medications, and hypnotherapy in conjunction with breathing exercises may be effective treatment methods.^[30]One study shows psychotherapy directed towards somatoform and conversion disorders may increase efficacy when added to traditional treatment regimens.^[12]

Helium-oxygen therapy

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.^{[31, 32]}

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.^{[28, 29]}

Botulinum toxin

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.^{[33, 34]}

Panting

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

Topical lidocaine

This may be applied to the larynx.

The mechanism of action is to break the cycle of hyperactive glottal and supraglottal muscle contractions.^[35]

Consultations

See the list below:

Otolaryngologist
Pulmonologist
Allergist/immunologist
Speech therapist
Psychiatrist

Diet

No diet restrictions are necessary.

Medication

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Media Gallery

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

of 4

Table 1. Differential diagnosis of laryngeal movement disorders^[69, 70, 71]

Table 1. Differential diagnosis of laryngeal movement disorders ^{[69, 70, 71]}

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 Physician, Allergy, Asthma and Immunology, Founder, Family Allergy Asthma Clinic; 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.