Vocal cord dysfunction

Vocal Cord Dysfunction
Classification and external resources
ICD-10	J38.3
ICD-9-CM	478.3-478.5
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Vocal cord dysfunction (VCD) is a pathology affecting the vocal folds, commonly referred to as the vocal cords. VCD is characterized by full or partial vocal fold closure that usually occurs for short periods during inhalation but can also occur during exhalation. Alternate terms for VCD include paradoxical vocal fold motion (PVFM) and paradoxical vocal cord movement (PVCM). Although several contributing factors have been identified, the exact cause of VCD is unknown. An evaluation or visualization of the vocal folds during an episode are recommended to diagnose VCD and to rule out other conditions that can affect the upper and lower airway. Treatment of VCD often combines behavioral, medical and psychological approaches. Although information on the incidence and prevalence of VCD is limited, it is known to occur most frequently in young women.

"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.

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.

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