Medical Edge Newspaper Column

Treatment of Vocal Fold Dysfunction Involves Learned Breathing Techniques

October 23, 2009
Dear Mayo Clinic:
Please explain vocal fold dysfunction. How is it diagnosed? Are there effective treatments for it?

Answer:
In cases of vocal fold dysfunction (VFD), also called paradoxical vocal fold motion, the vocal folds don't move properly, making it hard to breathe. Diagnosis of VFD is based on symptoms, along with an examination of the vocal folds. Treatment relies primarily on learned breathing techniques to help correct vocal fold motion.

The two vocal folds — also called vocal cords — are located just behind the Adam's apple, which is part of the voice box (larynx). Vocal folds consist of muscle and soft tissue that act like a gate between the airway and mouth. During breathing, the vocal folds open. During speech, they close and vibrate as you breathe out to create the sound of your voice.

During a VFD episode, the vocal folds close when you breathe in, rather than remaining open. Symptoms commonly include a noisy, high-pitched sound when you breathe in (stridor); shortness of breath; difficulty getting air into and sometimes out of your lungs; throat or chest tightness; a feeling of choking or suffocation; and hoarseness or loss of voice.

Although the underlying cause of VFD is unknown, a number of factors seem to trigger symptoms, including exercise, strong odors or fumes, tobacco smoke, postnasal drip, acid reflux, and strong emotions or stress. Symptoms can occur suddenly, lasting minutes rather than hours.

Vocal fold dysfunction can be hard to diagnose. It's sometimes mistaken for asthma because the symptoms and triggers for VFD and asthma can be similar. One way to differentiate between the two is that, for those who have asthma, medicines used to open breathing tubes (bronchodilators) can improve breathing. But some people can have both VFD and asthma, complicating diagnosis further.

The most accurate way to determine if you have VFD is for your physician to examine your vocal folds when you're having symptoms. Because that's not always possible, it's helpful if you can describe your symptoms and anything that seems to trigger them.

To examine your vocal folds, your physician may use a test called flexible laryngoscopy. During this procedure, a small, flexible tube with a light (laryngoscope) is passed through your nose to the back of your throat so the physician can see your vocal cords. You are awake during the test and may be asked to talk, so your doctor can determine if your vocal folds are moving normally. In some cases, vocal folds may be examined during or after exercise, especially if exercise triggers symptoms.

Spirometry is a breathing test that can be helpful in diagnosing VFD. You take deep breaths and forcefully exhale and inhale into a tube connected to a machine called a spirometer. The test includes a flow-volume loop, which graphically shows the rate of airflow and helps your doctor determine how well air moves into and out of your lungs.

Treatment of vocal fold dysfunction differs from many other breathing disorders because medication is not the primary treatment option. Instead, standard treatment involves learning breathing techniques. These techniques help you control your vocal folds by improving your ability to prevent the folds from coming together when they shouldn't. Typically, a speech pathologist teaches these breathing techniques.

Although breathing techniques can effectively control VFD, practice is necessary to learn them successfully. These breathing techniques should be practiced in the absence of an attack, to help prepare a person to control symptoms when they occur.

Also important is controlling other medical conditions that can contribute to VFD, such as asthma, postnasal drip or acid reflux. Take medications for these conditions as directed by your physician. It helps to know what triggers VFD symptoms. Try to note what's going on around you when symptoms begin. If certain factors — such as cigarette smoke or strong perfume — seem to cause symptoms, try to avoid them.

If you have questions about VFD, or suspect you have this condition, talk to your doctor. He or she may refer you to an ear, nose and throat specialist and a speech pathologist for evaluation and treatment. You may also be referred to a pulmonologist, allergist or gastroenterologist, depending on your situation.

— Diana Orbelo, Ph.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.