Vocal Cord Dysfunctions (VCD)

What is Vocal Cord Dysfunction?

With vocal cord dysfunction your vocal cords don’t work properly and this can affect your breathing system because the vocal cords close over, or narrow at the wrong time when breathing, making it harder to get air into your lungs. It is often misdiagnosed as exercise-induced asthma and it is easy to confuse it with that because both conditions have similar symptoms. Vocal cord dysfunction can occur at any age but happens more commonly in teenagers and young adults. It is a serious disorder because your vocal cords are not functioning properly on the in-breath (inspiration). People with asthma may also have vocal cord dysfunction when breathing in. When you breathe in, your vocal cords ought to be wide open to allow air to flow to your lungs, but instead they are closed or partially closed. It is thought that maybe 1 in 20 of severe asthma sufferers may also have VCD and as much as 40 % of those thought to suffer from asthma may actually have VCD, although this may be in combination with asthma.

Diagram of the airways to show position of the vocal cords in vocal cord dysfunction

Diagram of Human airways showing the throat and vocal cords

What are the vocal cords?

The vocal cords are what help us to speak. They are tough bands of sinew that vibrate to make noise and this vibration is what allows us to talk and sing. These folds of tissue stretch across your voice box and relax during normal breathing, letting air pass through the trachea (air tube). Vocal cords can be damaged just from dryness, which is why singers always ensure they are well hydrated. While breathing, (exhaling or inhaling) the vocal cords remain apart but they close and vibrate over the airway to make sound when you are talking. In people with VCD, the vocal cords close over the airway just with breathing, making it extremely difficult to get a breath. In other words, the vocal cords are closed when they should be open.

Watch the Vocal Cords working

Is it the same as Asthma?

Because the symptoms of VCD are similar to those for asthma, that is, wheezing, coughing and shortness of breath, vocal cord dysfunction can be misdiagnosed as asthma. Just as with asthma, symptoms of vocal cord dysfunction can be triggered by exercise, by breathing in irritants, such as smoke or fumes or by having a cold. Asthma is an inflammatory disease of the airways and is commonly associated with symptoms of chest tightness, shortness of breath, coughing and/or wheezing and the symptoms can change over time. It affects about 17 to 20 million Americans and is a leading chronic illness among children and adolescents in the United States. It is the most common cause of childhood ER visits and is related to a number of factors, including family history, smoking, stress and allergies.

Asthma is a reversible airway disease and can be chronic or intermittent. It is characterized by variable and reversible airway obstruction and inflammation of the airways. It is a problem that occurs on expiration (breathing out) caused by a narrowing of the airways and an increase of airway resistance. It is a diagnosis that often is given to those with VCD and can co-exist in some patients.

How can you tell the difference?

Vocal cord dysfunction does not respond to asthma treatment, even though the symptoms may be similar to those of asthma. It may coexist with asthma and can make asthma look worse than it is. Vocal cord dysfunction does not respond to inhaler treatment.

What are the symptoms of VCD?

In children, vocal cord dysfunction is often seen in competitive athletes and can lead to a need for oxygen after finishing exercise. It can mimic exercised-induced asthma because both conditions have similar symptoms. A sudden attack may need emergency room treatment. At its worst, it may lead to a spasm in the larynx (voice box) – laryngospasm . The common signs are:

* Shortness of breath or feeling that it’s hard to get air in and out
* Frequent coughing or throat clearing, or feeling that you are choking
* Noisy breathing, with a raspy or wheezing sound and hoarse voice

Unlike snoring, it does not usually happen when you are sleeping.

What causes VCD?

There are a lot of possible causes but often, no cause in particular is found. An attack can be caused by exercise, or by having a cold, or by tobacco smoke, strong smells or fumes. It can also be caused by acid reflux (GERD) or by stress. The muscles of the vocal cords can weaken over time as we age, so it may also appear in older people.

How do I know if I have VCD?

Vocal cord dysfunction can be hard to detect, often because people are just assumed to have asthma when they wheeze. The triggers for asthma and VCD are very similar and there is no specific test for either asthma or VCD. But it should be suspected when you have breathing problems, or are short of breath, and asthma medication does not work.

When people have had an exercise induced cough and wheezing after exercise, it has often been assumed in the past that they had asthma. There is no good diagnostic test for asthma, with the presence of a cough and wheeze generally having been considered to be sufficient diagnosis. The vocal cords may show decreased movement. They can usually be seen using a mirror placed at the back of the tongue. The Royal Brompton Hospital in London is investigating VCD with the use of a small camera that watches the vocal cords while you do exercise. The tiny camera is threaded up your nose after the area has been numbed with local anaesthetic. It sits at the top of your nose and looks down on the vocal cords and provides a picture of them while you are speaking and exercising. As VCD often occurs during or after exercise, the patient is sat on a stationary bike and asked to pedal. The vocal cords are observed while the person works quite hard and also when they speak. The cough and wheeze do not respond to asthma medications.

Very often, someone with VCD will wheeze when they breathe IN, whereas those with asthma may wheeze when they breathe OUT. It is possible to suffer from both asthma and VCD.

What is the treatment?

Treating underlying conditions that might be triggering your vocal cord dysfunction can help reduce symptoms but voice therapy is recommended to help ensure easier breathing and better breath control. Techniques to control breathing and calm down spasms of the vocal cords are the mainstay of treatment. In addition, visual imaging techniques are taught as a method of keeping the vocal cords open during rapid breathing. Asthma treatment mainly consists of inhalers, whereas VCD treatment is a form of physiotherapy which teaches breathing control. Often 3 or 4 sessions are booked but the sufferer may well find they can control their breathing well even after just the first session. If you have VCD, it is important to know this, as the use of the blue inhaler often provided to asthma sufferers can actually make the airways respond less well over time in those who do not have asthma.

Hoarseness From Allergies

Hoarseness and Allergies

Vocal Cord Dysfunction

Some people with VCD may find their voice is hoarse but hoarseness by itself does not necessarily mean you have vocal cord dysfunction. The hoarseness may be caused by allergies or for some other reason, such as smoking or irritants in the air. Some singers have suffered from hoarseness by straining their vocal cords, overworking them and even rupturing them! Some of these require urgent medical attention.


Hoarseness can occur for many reasons. Sometimes, the cause is as simple as singing in the shower. Your voice box is the opening in your throat where air travels and hits two bands called vocal cords, which vibrate to produce sound. If your throat is irritated, you will notice your voice becoming croaky. If you have trouble speaking, consider consulting a physician.

While many causes of hoarseness are not serious, if you notice that your hoarseness is persistent or has worsened, you should see a doctor. The definition of “persistent” may vary depending on your healthcare provider, but it generally means that your symptoms have lasted at least two weeks and have been accompanied by other symptoms. If you suspect a serious condition, your doctor will perform a physical examination of your mouth and vocal cords, including a visual inspection with a mirror or camera attached to a thin tube.

If your hoarseness is severe, it’s best to consult an otolaryngologist. An otolaryngologist specializes in the health of the ears and throat. An otolaryngologist will examine your voice with a lighted, flexible tube called an endoscope. Your ENT will likely recommend special tests and prescribe treatment to alleviate your hoarseness.

Home Remedies For Hoarseness

If the cause is not obvious, you can try a few home remedies. Using a humidifier or chewing lozenges can relieve the symptoms. Taking a hot shower can also be beneficial. For chronic cases of hoarseness, you may need to visit a doctor. Home remedies for hoarseness include avoiding smoking and drinking lots of water, keeping hydrated, and using a humidifier. A few of these changes can relieve symptoms and even cure the condition.

Treatment for chronic hoarseness is dependent on the underlying cause. A physical examination and a detailed medical history help your doctor identify the underlying cause. Your physician will also ask questions about the cause of your hoarseness and may conduct a fiberoptic scope test to see if there is an infection. Early treatment is important, as it can reduce damage to your throat and avoid complications. If you don’t seek treatment immediately, you may be unable to overcome your condition.


Smoking raises the risk of throat cancer. In addition to making you voice sound drier, smoking can damage your vocal cords, lowering the pitch and blocking your airway. If your hoarseness persists for more than a few weeks, it is time to visit an ENT. Smokers also tend to experience hoarseness. You can reduce your risk by cutting down on your intake of tobacco and alcohol.


Common causes of hoarseness include cold, allergies, and inhaled irritants. You may find that your hoarseness appears only at certain times of the year or in certain environments. Take note of this to check if you may be allergic to something. Seek healthcare help if you have persistent hoarseness. It can be very disruptive to your quality of life and affect your ability to communicate. Hoarseness can also affect your ability to speak, making it difficult to communicate with others and even impossible to understand what you are saying. Symptoms of hoarseness include a raspy or weak voice and difficulty in making smooth, clear vocal sounds. Sometimes, these symptoms are produced because of nodules on the vocal cords or a burst blood vessel. These require surgery and a period of total silence to recover, which may mean not speaking or using the voice at all for some weeks or even months.

Some of the symptoms of hoarseness are self-limiting, and they may go away on their own after a few days. However, the hoarseness may persist for a week, so it is important to get treatment if you experience these symptoms. It’s also important to get your voice checked regularly to avoid getting worse in the meantime. Hoarseness may also occur as a side effect of recent neck surgery. Regardless of its cause, however, the main objective of treatment is a quick and effective return to your normal voice.

Causes Of Hoarseness

When you have a hoarse voice, your health care provider will want to find out exactly what’s causing the condition. A comprehensive examination will rule out any other cause of hoarseness, including VCD and gastro-oesophageal reflux disease. A physician will perform a comprehensive examination to determine the cause of your hoarseness, and they will also look for underlying causes of your condition.

Another possible cause of hoarseness is a neurological condition. The vocal cords are affected by blunt trauma, such as while using an endotracheal tube. Besides, some people develop spasmodic dysphonia, a local problem of the muscles in the larynx that results in hoarseness. In some cases, the cause is unknown, but there are several treatments available for hoarseness.

Why You Suffer From Vocal Cord Dysfunction

Finding the Answer to  Vocal Cord Dysfunction (VCD)

https://www.vocalcorddysfunctions.com/Also known as Paradoxical Vocal Fold Movement (PVFM), VCD is a vocal and breathing symptom which is usually caused by a restriction of your airway at the larynx. This unintended restriction of your vocal cords (folds) results in the breathing or squeaking sound you often hear when exercising excessively. The most common cause of VCD is injury or disease of your vocal cord. It is not known why some people are prone to it while others are not, but there are a number of factors which can be taken into consideration, including age, genetics, medical history and lifestyle.

In addition, it is possible for vocal cord injuries to be a result of a trauma to the neck or head. The symptoms that are often associated with VCD include hoarseness, choking, coughing, wheezing, hacking, humming, whistling and lisping.

Some of the triggers for VCD are the same as those for asthma, but others are different. These can include:

  • Stress or Anxiety
  • Exercise
  • Psychosocial issues
  • Post Nasal Drip
  • Cough from irritants or viral illness
  • Voice strain – yelling, singing or excessive talking

There are various treatments available, such as surgery, physiotherapy and vocal exercises like singing. However, unless you experience only one or two of these symptoms in a minor way, it is important to seek out an explanation for the discomfort, to ensure that your problems are actually caused by vocal cord dysfunction, rather than asthma, or something else.

After seeking advice from your doctor, to ensure you have a correct diagnosis, you may choose to look at alternative treatment methods.  One popular solution is to seek assistance through vocal training with a speech therapist. There are several different techniques, and some work well for some people while others do not. The technique that works best depends on the person, and what kind of treatment they are looking for.

Another way of solving vocal cord problems is with surgery.

Whichever method you choose to solve your vocal cord dysfunction, it is important to bear in mind that it can take time for you to notice an improvement. It may seem like your condition is improving, only to find that a couple of weeks later that your symptoms have returned. If you have had VCD for a long period of time, or if your condition has been chronic, it may be difficult to correct the problem quickly, so consult your medical adviser to see if an alternative treatment might help.

What You Need to Know About Vocal Cord Dysfunction

vocal cord dysfunction












Is Breathing Hard For You

Both vocal cord dysfunction (VCD) and asthma can make breathing hard. Symptoms of both conditions may include hoarseness, wheezing and coughing, but they are two different diseases. Vocal cord dysfunction is the abnormal closing of the soft vocal cords during breathing. The result is a sound that is not pleasant to the listener – stridor.

Asthma is a condition where the airways in the lungs are narrow and can cause difficulties with breathing.  People with asthma have a decreased ability to breathe due to an increased airway sensitivity. It is possible to have both VCD and asthma.

If you think you have either of these conditions, it is important to get a medical appointment with your physician to rule out any other conditions. You need to determine what the source of your respiratory problem is and to know how to treat it properly to control it.

Once you know the source of your condition, you will be able to find the treatment that works for your body. Your doctor will most likely want to run tests to see if the causes of your vocal cord disorder are not more serious than you first thought.

Children With Asthma And Vocal Cord Dysfunction

Asthma and Vocal Cord Dysfunction can both begin at an early age. so if you notice your child has difficulty breathing, seek help. The earlier you seek treatment, the more likely you are to keep your child healthy.

Breathing Exercise


Here is a video of a breathing exercise that will help with relaxation and with VCD. It comes from yoga and the exercise is demonstrated on video.

Speech-Language Pathology: The Vocal Cords in Action

melvil [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

These are a person’s vocal cords. If you want to see what “normal” vocal cords look like in action, watch the short video below. The person whose vocal cords are shown working is a professionally trained singer.

The previous video did not include the sounds the person was making, just a video of the movements. The next video includes sounds at different pitches and different words and shows how the vocal cords work to make those sounds.

Vocal Cord Dysfunction Breathing and Exercise Videos

What Is Vocal Cord Dysfunction

When you breathe, the  vocal cords in your voice box open as you breathe in and then close over, though not fully, while you breathe out. When you speak or sing, the vocal cords vibrate to make a noise.

If it is suspected that you have VCD, you may be given a breathing test, called spirometry that looks at how air moves in and out of your lungs. Unfortunately if your suspected VCD is not active when you go for testing, your results may be normal so it can be difficult to check whether you actually have VCD.

In this case, it is possible to trigger an attack, so the cords can be watched. This can be done using an irritant or an exercise stress test, so the vocal cords can be watched in the VCD situation. The classic form of VCD shows that the vocal cords move towards each other when you breathe IN (instead of opening fully) leaving a small triangular hole for air to move through.  This is the opposite of what happens with people who have asthma, where the vocal cords close over on breathing OUT and they do not show the triangular shaped hole. VCD can often be mistaken  for asthma, which is the most common chronic illness among children.

The big difference between vocal cord dysfunction and asthma is that VCD causes more difficulty breathing in than breathing out and the opposite for asthma. It is possible to suffer from both.

Voice Therapy

It is possible to improve VCD by the use of voice therapy. This can include singing exercises. You should consult your voice therapist for exercises that will suit your condition. Many people use voice exercises from singing to help train and improve their vocal cord functions.

Singing is a great way to express yourself. You can stand or sit right where you are and sing. It is a way to communicate, creatively and effectively. Singers who want to extend their range or improve their voice, take lessons and practice various exercises. Many of these can also help improve VCD.

For some people, exercise of any sort may mean losing some sleep but for opera singers, for instance, physical fitness, as well as voice fitness is essential to their performance. Using some of these exercises may help but it will depend on the reason, (if any) nature and extent of your VCD  as to how much your voice will improve.

If you decide to practice singing, consult your voice therapist and they may advise you to keep any practice sessions to an hour or less to prevent injury to your vocal chords. You may even need to start out with ten minute sessions to build up your vocal cords. If you feel pain when practising singing exercises, consult your voice therapist.


Managing VCD generally involves using several techniques, such as speech therapy with emphasis on vocal cord relaxation and breathing techniques. Speech therapists can prescribe special exercises to help you be more aware of abdominal breathing and learn to relax your throat muscles. This can give you more control over your throat and breathing. The exercises should be practised when you have no symptoms, so you already know how to use them when you need to during a VCD bout. These exercises will help you improve your vocal cord movements and also improve airflow to the lungs.

Vocal Exercises

Warm up your voice first. There are many different types of good singing exercises that can be use to warm up the voice. If you are doing this to improve VCD, consult your therapist first.

Is VCD An Allergic Response

VCD and Asthma Symptoms

With Vocal Cord Dysfunction, sufferers may have a cough and wheezing and difficulty in breathing; and they may feel they have a tightness in their throat or they may find their voice goes hoarse. These symptoms are very similar to those of asthma and both can be triggered by such things as colds or viruses, breathing in lung irritants, such as smoke or even exercising. Reflux from the stomach (GERD) can also be a trigger.

An Allergy Or Not?

Unlike asthma, however, VCD is NOT an allergy nor an allergic response and the treatments for both are very different. They are also different in that asthma sufferers have more difficulty breathing out than in, whereas VCD suffers have more difficulty on the in breath. Also, the allergic response of asthma means the bronchial tubes constrict (tighten), whereas it is the muscles in the vocal cords that tighten with VCD. VCD can also result from paralysis of one (unilateral paralysis) or both (bilateral paralysis) of the vocal cords.


It is possible to suffer from both simultaneously and in this case, it’s important to see a specialist who has experience with these types of complex situations.

Treatment for the allergic type reactions in Asthma may include the use of an inhaler to expand (dilate) the bronchial tubes, whereas treatment for VCD may include relaxation techniques and muscle control exercises for the throat muscles.

Vocal Cord Exercises

Vocal cords, or vocal folds as they are more properly known, are what allow us to control the sounds that come out of our mouths. For professional singers, vocal cords need to be maintained in top condition so that they can perfectly control the pitch of their voice while performing. Like any muscle group, practice can help strengthen the control of your vocal cords. There are a wide variety of vocal cord exercises that can be done to improve your voice or help you recover from vocal cord dysfunction or injury.

The first exercise starts with a yawn. You need to open your mouth as wide as possible. By stretching your arms out, the movement will become more natural in some people. When you have finished exhaling, bring the tip of your tongue to the bottom of your mouth and take in a deep breath. On exhaling the second time you want to make the “ahhhh” sound as if you are letting go a sigh for about four seconds. The sound should come from deep within the throat, and you need to be careful to continue to make the sound throughout the exhale.

This process should be repeated at least ten times. The sounds should be done as softly as possible. It is much more important that you pay attention to the sound itself, rather than trying to strive for a loud volume. When the exercise is finished, the throat should feel very open.

The next exercise exercise starts with a deep breath taken in from your belly. This time on the exhale you will make the “oo…” sound like in stool. You should also form an “O” with your lips when exhaling the sound out. Again, the emphasis here is on form and not volume. The sound should be as low as possible. Make the sound for approximately 10 seconds.

Next, relax the cheeks and breath in through your mouth and nose. The breath should be intense enough to slightly press out the cheeks. If done correctly, you will notice the vibration in your lips. Once the breath is taken in, make the “oo” sounds again as in the first step. Repeat this exercise ten times.

The next exercise is slightly different from the last one. Again, you will begin with a deep abdominal breath. This time when blowing out you want to keep your lips together, protruding slightly from your mouth. The cheeks and lips should be relaxed as much as possible. From this position, you will make the “brrrr” sound as if you are freezing cold. You should feel the rapid vibration of the sound against your lips. Take in a deep breath as before and then repeat. Do this exercise ten separate times.

The next exercise will work within a larger range of sound. You want to start with the lowest pitched sound that you can make with your voice, and gradually work your way to the highest pitched sound that you can make. The sound you will be making this time while changing pitch is “whoop-puh” with most of the emphasis on the “whoop” while scaling up the pitch. Again, the sound should be soft with an emphasis on precise form. Ideally there should be no pause in the voice as one climbs up towards a higher pitch.

Repeat the previous exercise ten different times. When finished, reverse the process. This time you want to start with a high pitch and work down to the lowest pitch. Say the word “boom” this time. This should also be completed ten times with an emphasis in keeping the sound continuous, as before.

The above exercises help you to gain better control of your voice, and are especially good for singers. However, if your vocal cords ever become physically injured you might need some additional exercises to help to restore the function.

One of the best ways of strengthening weakened vocal cords is to repeat words starting with vowels (such as “Easter”, “old”, and “air”) over and over. Repeating “Ah, Ah, Ah” ten times in a row, putting a hard emphasis on the first word can help to strengthen your vocal cords. In addition, saying “Ah” once with a sharp voice as well as a very prolonged “Ah….” for about 10 seconds will also help. Ideally each of these exercises should be done ten times in a row for three times per day if suffering from weakened vocal cords.

Learning to relax the throat is also important to recover from some vocal cord injuries. This is particularly important for people who have conditions such as vocal cord dysfunction where the cords tighten up on an inward breath, mimicking the symptoms of asthma.

To practice relaxing the vocal cords, start on your back with your feet touching the floor. Concentrate on relaxing your upper body, particularly your head, shoulders, and throat. Inhale slowly in through the nostrils and exhale through slightly pursed lips making a “shhhh” sound. Make sure to be cognizant of your abdomen to gauge the breath as you perform this exercise. After doing it on the floor, try it in different postures while seated.

Your vocal cords can exercised like other voluntary muscles in your body. Whether you are a singer looking for a more melodious voice or a person who has suffered severe trauma to the throat, you can use the techniques outlined in this article to improve the function of your voice box.

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