Vocal cord dysfunction: A practical approach to diagnosis

Since its signs and symptoms can be seen in other respiratory disorders, such as asthma, vocal cord dysfunction (VCD) may be misdiagnosed. The common signs of VCD may be episodic and include cough, wheeze, stridor, dyspnea, hoarseness, and choking. Some patients report difficulty in swallowing or tightness in the chest or throat. If spirometry and exercise challenge test results do not confirm the diagnosis, flexible rhinolaryngoscopy during symptomatic periods may help; it provides direct visualization of paradoxical vocal cord movement. Once the diagnosis of VCD has been established, management includes patient reassurance and maneuvers directed at laryngeal relaxation. A mixture of helium and oxygen may be effective in interrupting severe episodes, and assisted ventilation (continuous positive airway pressure or bag-valve-mask) may benefit some patients. Referral for speech therapy and psychological counseling is indicated.