Vocal Cord Dysfunction: Analysis of 27 Cases and Updated Review of Pathophysiology & Management

Abstract

Introduction Vocal cord dysfunction is characterized by unintentional paradoxical vocal cord movement resulting in abnormal inappropriate adduction, especially during inspiration; this predominantly manifests as unresponsive asthma or unexplained stridor. It is prudent to be well informed about the condition, since the primary presentation may mask other airway disorders.

Objective This descriptive study was intended to analyze presentations of vocal cord dysfunction in a tertiary care referral hospital. The current understanding regarding the pathophysiology and management of the condition were also explored.

Methods A total of 27 patients diagnosed with vocal cord dysfunction were analyzed based on demographic characteristics, presentations, associations and examination findings. The mechanism of causation, etiological factors implicated, diagnostic considerations and treatment options were evaluated by analysis of the current literature.

Results There was a strong female predilection noted among the study population (n = 27), which had a mean age of 31. The most common presentations were stridor (44%) and refractory asthma (41%). Laryngopharyngeal reflux disease was the most common association in the majority (66%) of the patients, with a strong overlay of anxiety, demonstrable in 48% of the patients.

Conclusion Being aware of the condition is key to avoid misdiagnosis in vocal cord dysfunction. Fiberoptic laryngoscopy is the diagnostic gold standard to demonstrate paradoxical vocal cord adduction during an attack. A multidisciplinary approach should be adapted for the management, which should be specific and tailored for individual patients.

Keywords

Vocal Cord Dysfunction - paradoxical vocal cord motion - laryngopharyngeal reflux - asthma

• References

• 1 Patterson R, Schatz M, Horton M. Munchausen's stridor: non-organic laryngeal obstruction. Clin Allergy 1974; 4 (03) 307-310
• 2 Brugman S. The many faces of vocal cord dysfunction. What 36 years of literature tells us. Am J Respir Crit Care Med 2003; 167: A588
• 3 Morris MJ, Allan PF, Perkins PJ. Vocal cord dysfunction: aetiologies and treatment. Clin Pulm Med 2006; 13: 73-86
• 4 Perkner JJ, Fennelly KP, Balkissoon R. , et al. Irritant-associated vocal cord dysfunction. J Occup Environ Med 1998; 40 (02) 136-143
• 5 Powell DM, Karanfilov BI, Beechler KB, Treole K, Trudeau MD, Forrest LA. Paradoxical vocal cord dysfunction in juveniles. Arch Otolaryngol Head Neck Surg 2000; 126 (01) 29-34
• 6 Murry T, Tabaee A, Aviv JE. Respiratory retraining of refractory cough and laryngopharyngeal reflux in patients with paradoxical vocal fold movement disorder. Laryngoscope 2004; 114 (08) 1341-1345
• 7 Morrison M, Rammage L, Emami AJ. The irritable larynx syndrome. J Voice 1999; 13 (03) 447-455
• 8 Leo RJ, Konakanchi R. Psychogenic Respiratory Distress: A Case of Paradoxical Vocal Cord Dysfunction and Literature Review. Prim Care Companion J Clin Psychiatry 1999; 1 (02) 39-46
• 9 Lacy TJ, McManis SE. Psychogenic stridor. Gen Hosp Psychiatry 1994; 16 (03) 213-223
• 10 van der Graaff MM, Grolman W, Westermann EJ. , et al. Vocal cord dysfunction in amyotrophic lateral sclerosis: four cases and a review of the literature. Arch Neurol 2009; 66 (11) 1329-1333
• 11 Maschka DA, Bauman NM, McCray Jr PB, Hoffman HT, Karnell MP, Smith RJ. A classification scheme for paradoxical vocal cord motion. Laryngoscope 1997; 107 (11 Pt 1): 1429-1435
• 12 Doshi DR, Weinberger MM. Long-term outcome of vocal cord dysfunction. Ann Allergy Asthma Immunol 2006; 96 (06) 794-799
• 13 Newman KB, Dubester SN. Vocal cord dysfunction: masquerader of asthma. Semin Respir Crit Care Med 1994; 15: 161-167
• 14 Rundell KW, Spiering BA. Inspiratory stridor in elite athletes. Chest 2003; 123 (02) 468-474
• 15 Morris MJ, Allan PF, Perkins PJ. Vocal cord dysfunction: etiologies and treatment. Clin Pulm Med 2006; 13 (02) 73-86
• 16 Reybet-Degat O. [Pathology of craniocervical junction and sleep disorders]. Rev Neurol (Paris) 2001; 157 (11 Pt 2): S156-S160
• 17 Reisner C, Borish L. Heliox therapy for acute vocal cord dysfunction. Chest 1995; 108 (05) 1477
• 18 Maillard I, Schweizer V, Broccard A, Duscher A, Liaudet L, Schaller MD. Use of botulinum toxin type A to avoid tracheal intubation or tracheostomy in severe paradoxical vocal cord movement. Chest 2000; 118 (03) 874-877
• 19 Altman KW, Mirza N, Ruiz C, Sataloff RT. Paradoxical vocal fold motion: presentation and treatment options. J Voice 2000; 14 (01) 99-103
• 20 Kenn K, Balkissoon R. Vocal cord dysfunction: what do we know?. Eur Respir J 2011; 37 (01) 194-200
• 21 Sullivan MD, Heywood BM, Beukelman DR. A treatment for vocal cord dysfunction in female athletes: an outcome study. Laryngoscope 2001; 111 (10) 1751-1755
• 22 Mathers-Schmidt BA, Brilla LR. Inspiratory muscle training in exercise-induced paradoxical vocal fold motion. J Voice 2005; 19 (04) 635-644
• 23 Guglani L, Atkinson S, Hosanagar A, Guglani L. A systematic review of psychological interventions for adult and pediatric patients with vocal cord dysfunction. Front Pediatr 2014; 2: 82