Vocal Cord Dysfunction

What Is Vocal Cord Dysfunction?

Vocal cord dysfunction means that the vocal cords partially close during breathing, so air has more trouble getting through. The vocal cords are two pieces of tissue stretched across the voice box. They vibrate to make sound when a person speaks.

Vocal cord dysfunction is also called paradoxical vocal laryngeal dysfunction or paradoxical vocal fold movement.

What Are the Signs & Symptoms of Vocal Cord Dysfunction?

A child with vocal cord dysfunction may:

• have trouble breathing, especially when breathing in (inhaling or getting air in). This can be scary and need medical care.
• cough or clear the throat
• wheeze or make raspy sounds during breathing
• be hoarse or have other voice changes
• have chest pain or throat tightness

The symptoms of vocal cord dysfunction almost never happen while a child is sleeping.

What Causes Vocal Cord Dysfunction?

Children with vocal cord dysfunction have "triggers." These are things or situations that they're very sensitive to. The trigger makes the vocal cords partially close, which causes breathing problems.

Common triggers include:

• infections, such as a cold or the flu
• irritants in the air, such as perfumes, pollution, dust, pepper, etc.
• exercise and other physical activities, like dancing, playing hard, or jumping around
• stressful situations, such as worrying about school or family problems

Allergies and acid reflux (chronic indigestion) can make vocal cord dysfunction worse.

Who Gets Vocal Cord Dysfunction?

Most children with vocal cord dysfunction are 6 years of age or older. It happens more often in girls than boys.

How Is Vocal Cord Dysfunction Diagnosed?

To diagnose vocal cord dysfunction, doctors will:

• do an exam
• ask about the symptoms

Doctors also use tests such as:

• spirometry and pulmonary (lung) function tests: to measure how fast and how much air flows during breathing
• laryngoscopy: to see the vocal cords using a tiny camera on the end of a thin tube
• a challenge test: to make symptoms happen while the doctor looks at the vocal cords. To start symptoms, the child may run on a treadmill, ride a bike, or take a special medicine. 

The symptoms of vocal cord dysfunction and asthma can be similar. So doctors will check to see if a child has vocal cord dysfunction, asthma, or both. 

Vocal cord dysfunction is the most likely cause when:

• The breathing trouble happens during exercise. (In exercise-related asthma, symptoms tend to happen soon after exercise.)
• The doctor hears wheezing sounds coming from the child's neck when listening with a stethoscope. (In asthma, the wheezing sounds come from the chest.)
• Medicines that usually work well for treating asthma do not help the child's breathing.

How Is Vocal Cord Dysfunction Treated?

Vocal cord dysfunction is treated by an ear, nose, and throat doctor (ENT, also called an otolaryngologist), a pulmonologist, and a speech therapist. They work together to help the child learn to relax the vocal cords while breathing.

Treatment for vocal cord dysfunction may also include:

• practicing breathing exercises
• using biofeedback
• avoiding irritating fumes or dust
• staying hydrated to help the vocal cords work well

The doctor may recommend medicines to treat allergies or acid reflux if they make the vocal cord dysfunction worse.

If stress plays a role, the ENT doctor may ask a psychiatrist or psychologist to join the treatment team. They can help the child understand the cause of the stress and learn the best way to handle it.

Looking Ahead

With practice, most kids with vocal cord dysfunction can learn to avoid triggers, relax the vocal cords, and manage stress to help ease or stop symptoms. Sometimes symptoms come back and the health care team will start treatment again or use a different treatment.