Gal Levy, M.Sc., CCC-SLP

VCD (Vocal Cords Dysfunction)

This letter will shed some light on:
VCD (Vocal Cords Dysfunction).
What is VCD?
In 1983, doctors at National Jewish Center described a condition that
has the potential to mimic asthma, thus leading to inaccurate
diagnosis and inappropriate, potentially harmful treatment. This
condition is called vocal cords dysfunction, or VCD. The condition is
characterized by vocal cord closure, usually on inspiration, leading
to air-flow obstruction, wheezing, and occasionally stridor.
VCD has been reported from ages 3 to 82, but most often it occurs between
the ages 20-40 especially in women and for as-yet-unidentified reason
particularly among health care workers. Among teenagers, VCD has a
strong link to participation in competitive sports activities and to
personal and family orientation towards high achievement.

This is a mysterious disorder which underlying mechanisms are still
unknown. No biochemical, physiologic, or structural abnormalities
have been associated with this syndrome.
Psychogenic factors clearly contribute to many cases of VCD, but patients usually
do not exhibit psychopathology on evaluation. While mental stress can
induce paradoxical vocal cord motion, no evidence points to a
voluntary component to VCD. Most common clinical features are
episodic or recurrent wheezing and dyspnea, usually with sudden onset
and cessation. Most VCD patients carry a diagnosis of asthma
unresponsive to bronchodilators and steroids.

VCD poses a very real, potentially debilitating health problem to
patients. The symptoms are not imagined or voluntarily induced and in
some cases can be life-threatening. A definitive VCD diagnosis requires Laryngoscopy or Stroboscopy, with
the vocal cords under direct observation, the patient should
sequentially pant, breathe deeply and phonate. Classically, VCD
appears as adduction of the anterior two-thirds of the vocal cords
with posterior chinking that will create a diamond shape during

Treatment of VCD.
Speech therapy is the first line of treatment for VCD. Special exercises
increase the patient awareness of abdominal breathing and special
vocal cords physiotherapy relaxes the patient’s throat muscles.
This enables the patient to have more control of his vocal folds and
throat. Learning to focus on expiration rather than inspiration can
also be extremely helpful. Practicing these techniques when symptom
free ensures effective use of them during an episode. All of the
exercises are aimed at overcoming abnormal vocal cord movements,
controlling the vocal folds with the breath stream, and
improving airflow into the lungs. State of the art techniques like
AGIN technique will focus on doing all these exercises during body
movements like pace walking, running etc.