II. Definition
- Inappropriate vocal cord motion transiently obstructs airway
- Vocal Cords remain in adduction despite inspiration
III. Symptoms
IV. Causes: Precipitating factors of Vocal Cord Dysfunction
- Exercise
- Psychiatric conditions
- Common in adolescents, but anxiety may also be triggered related to the unsettling nature of this condition
- Anxiety Disorder (e.g. Panic Attack, Generalized Anxiety Disorder, PTSD)
- Major Depression
- Environmental Irritants (airborne)
- Ammonia and other cleaning chemicals
- Dust
- Smoke
- Fumes
-
Sinusitis
- Consider nasal steroid trial (e.g. Flonase)
- Consider antibiotic course
-
Gastroesophageal Reflux disease
- Proton Pump Inhibitors are variably effective in improving Vocal Cord Dysfunction even when GERD is primary trigger
-
Extrapyramidal Side Effects
- Focal Dystonic Reaction to Neuroleptic drugs (Antipsychotics)
V. Diagnostics
- Lateral Neck XRay
- Consider for evaluation of the epiglottis in the acute setting
-
Pulmonary Function Test (PFT)
- Flow volume loop shows flattened inspiratory portion of the curve
-
Nasolaryngoscopy (flexible Laryngoscopy)
- Diagnostic with direct visualization of the cords
- Directly observe abnormal vocal cord movement to the midline on inspiration or expiration
- Provocative maneuvers performed under direct visualization improve Test Sensitivity
- Panting
- Deep breathing
- Phonating
VI. Differential Diagnosis
- See Stridor
- Asthma (most common)
- Hypothyroidism
- Acute upper airway conditions
- Chronic airway structural conditions
- Laryngomalacia (adults)
- Tracheal stenosis
- Other vocal cord specific disorders
- Vocal Cord Paralysis
- Vocal Cord Polyp and other vocal cord neoplasm
VII. Management: Emergency Department evaluation of undifferentiated Stridor
- See Awake Nasotracheal Intubation
- Maintain airway and consider differential diagnosis
- Ready all airway management equipment (RSI, intubation, failed airway)
VIII. Management: Short-Term symptomatic relief
- Remember that patients do not have volitional control over airway obstruction
- Be prepared for Advanced Airway and failed airway measures if case Stridor cause is not functional
- Maneuvers that help relieve acute symptoms
- Panting
- Diaphragmatic breathing
- Nasal breathing
- Breathing through a short straw
- Pursed-lip breathing
- Make hissing sound during expiration
- Other measures: Severe or persistent symptoms
- Epinephrine neb (5 ml of 1 mg/ml, 1:000 Epinephrine)
- Ipratropium Bromide (Atrovent) Inhaler
- Heliox
- Anxiolysis with Benzodiazepine (e.g. 1 mg Ativan)
- Ketamine
- Not studied, but has been used anecdotally with good success in acute severe Stridor
- Paradoxical Vocal Cord Dysfunction episodes often resolves (anecdotally) with Ketamine
- Ketamine may uncommonly cause laryngospasm (be ready with paralytics and Advanced Airway)
- Braude et al in Herbert (2015) EM Rap 15(2): 3-4
IX. Management: Long-Term elimination of underlying causes
- Treat causes above
- Consider Sinusitis Management (e.g. nasal steroid, antibiotic)
- Consider GERD management (e.g. Proton Pump Inhibitor)
- Eliminate airborne irritants
- Review possible medication triggers (e.g. Antipsychotic Medications)
- Speech therapy
- Relaxed throat breathing
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Related Studies
Definition (MSH) | A disorder characterized by an intermittent abnormal VOCAL CORDS movement toward the midline during inspiration or expiration resulting in upper AIRWAY OBSTRUCTION. |
Concepts | Finding (T033) |
MSH | D064706 |
SnomedCT | 134290008 |
Dutch | stembanddisfunctie |
French | Dysfonctionnement de corde vocale, Mouvement paradoxal d'adduction des cordes vocales, Mouvement paradoxal des cordes vocales, Dysfonction des cordes vocales, Adduction paradoxale des cordes vocales, Dysfonctionnement des cordes vocales |
German | Funktionsstoerung der Stimmbaender, Paradoxical vocal fold motion disorder, Paradoxical vocal cord dysfunction, Paradoxical vocal fold motion, Vocal cord dysfunction, Paradoxical vocal cord motion, Inspiratorischer Stimmritzenkrampf |
Portuguese | Disfunção das cordas vocais, Not Translated[Vocal Cord Dysfunction] |
Spanish | Disfunción de las cuerdas vocales, Not Translated[Vocal Cord Dysfunction], disfunción de la cuerda vocal (hallazgo), disfunción de la cuerda vocal |
Japanese | 声帯機能障害, セイタイキノウショウガイ |
Czech | Dysfunkce hlasivek, dysfunkce hlasivek, dysfunkce hlasových vazů |
English | cord dysfunction vocal, vocal cord dysfunction, Vocal Cord Dysfunctions, Vocal Cord Dysfunction, Dysfunction, Vocal Cord, Dysfunctions, Vocal Cord, Paradoxical Vocal Fold Motion, Paradoxical Vocal Fold Motion Disorder, Vocal Cord Dysfunction [Disease/Finding], Vocal cord dysfunction, Vocal cord dysfunction (finding) |
Hungarian | Hangszalag dysfunctio |
Italian | Disfunzione delle corde vocali, Disturbo motorio paradosso delle corde vocali |
Norwegian | Paradoksal stemmebåndsbevegelse, Stemmebåndsdysfunksjon |
Russian | ГОЛОСОВЫХ СВЯЗОК ДИСФУНКЦИЯ, GOLOSOVYKH SVIAZOK DISFUNKTSIIA |