Vocal Cord Dysfunction: A Review

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Vocal cord dysfunction (VCD) is a functional disorder of the vocal folds, characterized by an abnormal adduction of the cords, resulting in respiratory symptoms, generally during inspiration. VCD poses diagnostic challenges for providers, as it can both mimic and coexist with asthma. The most common symptoms seen in VCD are dyspnea, throat tightness, dysphonia, and wheezing or stridor. Several mechanisms for VCD have been suggested, namely vocal cord inflammation due to irritating processes such as gastroesophageal reflux disease and after nasal drainage, although exercise and inhaled irritants are also known triggers. Common comorbidities include asthma, psychiatric illnesses, irritable bowel syndrome, and chronic pain syndromes. Direct visualization of the abnormal vocal cord adduction via laryngoscopy is the gold standard for diagnosing VCD, although other methods of diagnosis are being explored. More recently, several screening questionnaires have been developed to aid in the diagnosis of VCD. The mainstay of VCD treatment requires a multidisciplinary approach and involves recognizing triggers, appropriately managing comorbid diseases, and utilizing breathing exercises and/or speech therapy. Education for both patients and health care providers on the signs and symptoms of VCD and how these differ from asthma can reduce unnecessary emergency department visits, health care utilization, and prevent patients from undergoing potentially harmful interventions.

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