First, there is varied opinion as to whether the classic features of VCD must be present to make this diagnosis or whether any abnormal adduction of the vocal cords should be considered potentially significant. Further, the variability in the amount of anesthesia used by various operators influences how much vocal cord movement may be artifact due to irritant effects by the laryngoscope or other factors. Finally, the obstructive narrowing may occur at levels other than the vocal cords and escape detection during laryngoscopy. Management of individuals with upper airway dysfunction is challenging. Patients should be referred to speech therapists familiar in treatment of this disorder.
Individuals learn throat relaxation and cough suppression techniques.
Success with speech therapy is highly variable. Reassurance to the patients that their condition is treatable and that it generally will improve over time assists in encouraging them to return to work. When appropriate, letters to the patient's employer alerting them to the possibility of high level irritant exposures may lead to industrial hygiene investigations and action to reduce levels. Treatment for associated GERD or rhinosinusitis will often reduce symptoms. These patients should be treated as if they have reactive airways disease until proven otherwise.