page_title: Vocal cord dysfunction
section_title: Presentation
hierarchical_section_title: Vocal cord dysfunction / Signs and symptoms / Presentation
caption_attribution_description: English: Vocal cords in position for speaking or singing
context_page_description: Vocal cord dysfunction, is a pathology affecting the vocal folds characterized by full or partial vocal fold closure causing difficulty and distress during respiration, especially during inhalation.
  Due to the similarity in symptoms, VCD attack are often mistaken for asthma attacks or laryngospasms. Symptoms of VCD are not always present. Rather, they often occur episodically, often defined as "attacks," where the sufferer will be symptomatic for a short period of time. Although several contributing factors have been identified, the exact cause of VCD is unknown.
  Diagnosis of VCD may include a series of evaluations including pulmonary function tests, medical imaging, and the evaluation or visualization of the vocal folds during an episode through the use of videolaryngoscopy. Such evaluations can also help to rule out other conditions that can affect the upper and lower airway. Treatment of VCD often combines behavioural, medical and psychological approaches, most often including an otolaryngologist, a psychologist, and a Speech-Language Pathologist. Although information on the incidence and prevalence of VCD is limited, it is known to occur most frequently in young women.
context_section_description: VCD can mimic asthma, anaphylaxis, collapsed lungs, pulmonary embolism, or fat embolism, which can lead to an inaccurate diagnosis and inappropriate, potentially harmful, treatment. Some incidences of VCD are misdiagnosed as asthma, but are unresponsive to asthma therapy, including bronchodilators and steroids. Among adult patients, women tend to be diagnosed more often. Among children and teenage patients, VCD has been linked with high participation in competitive sports and family orientation towards high achievement.
  Vocal cord dysfunction co-occurs with asthma approximately 40% of the time. This frequently results in a misdiagnosis of asthma alone. Even young children can tell the difference between an asthma attack (primarily difficulty exhaling) and a VCD attack (primarily difficulty inhaling). Knowing the difference between the two will help those who have both know when to use the rescue inhaler prescribed or when to use the breathing recovery exercises trained by a speech-language pathologist.
  Episodes can be triggered suddenly or develop gradually and triggers are numerous. Primary causes are believed to be gastroesophageal reflux disease (GERD), extra-esophageal reflux (EERD), exposure to inhaled allergens, post-nasal drip, exercise, or neurological conditions that can cause difficulty inhaling only during waking. Published studies emphasize anxiety or stress as a primary cause while more recent literature indicates a likely physical etiology. This disorder has been observed from infancy through old age, with the observation of its occurrence in infants leading some to believe that a physiological cause such as reflux or allergy is likely. Certain medications, such as antihistamines for allergies, cause drying of the mucous membranes, which can cause further irritation or hypersensitivity of the vocal cords.
caption: Closed vocal cords as seen during a VCD episode (or when speaking)
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