Tag: vocal cord dysfunction

Living With Vocal Cord Dysfunction

The body, at times, gives us warning signs that something is askew. If we pay attention to them we can find out where the problem lies and work to improve the situation. Giving heed to symptoms lead to rectifying a health problem or at least making it tolerable. Yes many conditions can be well managed and therefore easier to live with.

One such issue that can arise is Vocal Cord Dysfunction. It often manifests itself by means of a tightening of the throat, shortness of breath, a wheezing or coughing. What is this condition? Well, let’s consider how the vocal cords should function and then we’ll discuss what can sometimes happen instead.

Where Are The Vocal Cords Located?

The vocal cords are a mucus membrane that covers muscle and cartiledge in the larynx, or voice box.

As we breathe in, they should open allowing air to flow through, and as we breathe out, they should close, thus restricting air flow. In an unhealthy vocal cord, however, a disorder occurs that causes them to close when they shouldn’t thus limiting the ability to take in air.

The cause of this malfunction is varied. The vocal cords begin to act out as they become inflamed. Sometimes this is due to overuse. Many people who use their voice as their living often experience this effect, such as singers. Another reason could be that an infectious organism is the culprit. Viruses that enter the body when the immune system is down, such as colds and flu, may also cause such inflammation. Even allergies that include post nasal drip may be an irritant to the vocal cords and have the same effect. So what can be done to deal with this situation if it becomes recurring? Since the voice is such a necessary and professional tool for most people and we depend on it so much for even the simplest of communication we must do all we can to alleviate this problem. For one who must live with it there are some simple steps to take to help cope a little better.

Diet

One thing to consider is our diet. It plays such a vital role in most of our health concerns. As we all know water is essential for life. It is also necessary for our vocal cords. It aids in thinning secretions that lubricate the cords thus facilitating ease of distribution and protecting them from dryness which can cause inflammation. So be sure to drink those 8 glasses a day as the doctor recommended.

Another great help is eating more healthy fat foods. Things like tuna, salmon, almonds, flaxseed. All of these have the Omega 3’s our body needs for self repair. And don’t overlook  those antioxidant-containing treats as well, such as blueberries, blackberries, cranberries and pecans, to name a few. Eating more of these and less dairy (which can act as an allergen) and alcohol will certainly help us in the fight toward vocal cord health.

Exercises

Not to be overlooked also is the need to exercise the vocal cords as well. Breathing exercises may help to relax them and thus aid in better air flow and less swelling. One such exercise is as follows: 1) Lie on the floor with knees bent up toward the ceiling. Place one hand on your abdomen to monitor how it moves during the exercise. 2) Inhale through the nose, keeping the chest and shoulders stationary. While taking air into the abdomen, watch the hand laying across it move upward as you inhale. 3) Exhale with your lips pursed as if you were going to whistle. Make a soft sigh and observe your hand lower as you breathe out. 4) Keep inhaling and exhaling for a few minutes. Alternate between quick breaths and slower ones as you go. Repeat this exercise 3-5 times a day. Soon you’ll notice the tightening in your throat may become less frequent and the cough may subside as the cords are trained to relax again.

Keeping in mind our diet as well as the need for plenty of water and exercise can put us well on the road to recovery from many situations. Or at least help us to cope with the ones we can’t remedy.

Asthma Or Vocal Cord Dysfunction: Which is it?

Vocal cord dysfunction (VCD) is also known as paradoxical vocal cord dysfunction. So what are the symptoms and how do you tell the difference?

Vocal Cord Dysfunction Symptoms (VCD Symptoms)

It can be difficult to diagnose whether or not a person has asthma or vocal cord dysfunction because they have similar symptoms and triggers. Breathing is made more difficult in both, as well as having a hoarse voice, tightness in the throat, wheezing, and coughing. They are however two totally separate disorders.

When you have VCD, vocal cord dysfunction, this means your vocal cords do not close properly when you are breathing in. If you are exposed to any lung irritant or contract an upper respiratory infection, this can trigger the symptoms, as also can exercise . The same is true with asthma. Asthma is the immune system having a reaction and involves  lower airway infection, whereas, VCD does not, therefore treatment will be different for each condition.

This is important because if improperly diagnosed, a person who suffers from vocal cord dysfunction and who is treated with prescribed asthma medication such as cortisteroids and bronchodilators will receive absolutely no benefit and may indeed suffer from unwanted side effects.

VCD Symptoms

One way to suspect vocal cord dysfunction instead of asthma is if

  • Result of pulmonary function test comes back normal
  • Asthma medication does not work
  • Tightness in your throat
  • When your symptoms flare up you have more difficulty breathing in rather than out
  • You have no respiratory infection
  • Nothing is present obstructing your airway

Asthma Symptoms

With asthma you will have

  • Tightness in your lower or middle chest
  • More difficulty breathing out, with high pitched or wheezing sound
  • Respiratory infections are more prevalent
  • Bronchodilator or other asthma medications work
  • As many as 25% of those who suffer from vocal cord dysfunction also have asthma so they may not realize that they have both of the disorders until the vocal cord dysfunction starts to worsen.

It Is NOT A Panic Attack

Vocal cord dysfunction has also been misdiagnosed as panic attacks because it can be triggered by psychological distress. It is important to note that it is not caused by stress but when a person is under extremely stressful situations, this can trigger the symptoms. Other factors that seem to bring on symptoms are having a post nasal drip and suffering from gas reflux. At times environmental causes, such as shouting or singing, tobacco smoke exposure, chemical fumes or even physical exercise can trigger the symptoms.

How To Improve VCD

There is no specific medication for those with vocal cord dysfunction other than to treat any sinus infections or acid reflux symptoms that may occur. There are, however, techniques to control the vibration of the vocal cords and to relax when you breath, that have proven to be helpful; and consultation with a speech therapist can help you to learn these.

Asthma is when the bronchial tubes are inflamed. This causes sticky secretion to be produced inside of the tubes. This mucus clogs the airway and restricts oxygen flow to the lungs. Those at risk the most for asthma are those who suffer from allergies and those who have family histories of asthma. If a parent suffers from asthma, their children are from 3 to 6 times more likely to have it also. In childhood it is more common for boys to be diagnosed while girls are diagnosed more as adults. If you have frequent coughing, sleeping difficulties, fatigue that cannot be explained and feeling as if you’re out of breath, you may consider being checked for asthma.

Asthma sufferers use long term medications to control the bronchial inflammation. Even so there are sometimes flare ups (called asthma attacks) in which an inhaler filled with medications much be used immediately. These medications will work very quickly to relax the muscles that tighten around the airways and allow the flow of air to the lungs to be restored. These inhalers must be carried by the asthmatic at all times since they could be exposed to a trigger and have to use it.

In cases that are severe, asthma can be life threatening because it closes off the airway. Vocal cord dysfunction, however uncomfortable and whatever terrible feelings it produces, does not close off the airway. It is not life threatening. It can of course, still be the source of much anxiety so it is important that you get checked out by a doctor right away if you have any of the symptoms mentioned, to get the proper diagnosis.

Exercises to Improve Vocal Cord Dysfunction

Vocal cord dysfunction (VCD) is a condition that that can often be mistaken for asthma. The vocal cords are in your throat and are also known as the voicebox. Normally the vocal cords will relax and open when you breath, allowing air to get into your lungs. In people with VCD, the vocal cords do not function properly and actually will, on occasion, close down the air passageway while breathing. The result is a wheezing or choking sensation that can mimic an asthma attack. However, the treatment of VCD is quite different from that for asthma, as speech therapy and a variety of vocal exercises form the basis of an effective treatment regimen.

VCD is a problem that doctors still do not know a lot about. A wide variety of things are known to trigger an attack. Reflux of gastric acids into the throat, exercise, coughing, laughing, or exposure to certain chemicals can all lead to an attack. Understanding the cause or causes of an attack in an individual is the first step towards treating the disease. In some severe cases, surgery might be necessary to treat an underlying anatomical problem with the vocal cords. However, since the vocal cords are technically voluntary muscles that we can control, speech therapy and exercises can be enough to treat the disease in many cases.

There are a number of exercises that can be useful in treating the disease. These serve two purposes. The first is that exercises can help one better take control of the vocal cords in order to prevent an attack. The other goal is that exercises will help to show a person what to do in the midst of an attack to keep the vocal cords from closing completely. By practicing these exercises constantly when one is not having an attack, the hope is that when an attack arises, instead of panicking, a person will calmly perform the exercise as trained.

Ideally all patients should seek out diagnosis and treatment by a team of specialists if they believe they might suffer with VCD. Each speech therapist will custom tailor a set of exercises based on the specific underlying causes of the VCD. Some sample exercises are listed in this article, although one should always check with a physician before beginning any treatment regimen.


The first exercise that can help improve vocal cord dysfunction begins with lying on your back on the floor. Place your feet on the floor with your knees pointed upward into the air. Let your entire upper body relax, especially in the throat, head, and neck area. Have a book handy to place on your belly which will help you to monitor and be conscious of your breathing as you inhale and exhale (breathe in and breathe out).

Start the exercise by breathing in through your nose using your abdomen. Leave the muscles of the upper chest completely relaxed. You only want to use your belly to take in the breath. Once you have finished inhaling, you will exhale through your mouth. Your lips should be puckered as if you are blowing out a candle. As you exhale (breathe out) use your vocal cords to make the soft “shhhhh” sound. Allow your belly to contract naturally without pushing it, observing the book as this happens.

This exercise should be continued for several minutes at a time. As your perform it, you want to vary the length of your breaths from short to longer. This exercise should be performed from three to five times daily.

The next exercise takes place in the upright position while sitting in a chair. Make sure to sit up straight with your spine straight. Do not slouch. You can improve your posture by making sure your shoulders stack back and relaxed while the chin is tucked in roughly parallel to the floor. It can be difficult for some people to maintain this position because we are so used to reclining chairs that don’t provide our backs with the proper exercise to keep our muscles in trim.

Now place your hands at the sides on your lower rib cage and allow your elbows to flare out. You want to use them to be conscious of your breathing as you were with the book earlier. You will proceed just as before. Keep your upper body, throat, and neck relaxed while slowly drawing in a breath with your belly. Be sure to keep your awareness on the breath using your hands.

Your exhale will also be as before. Let the rib cage relax and contract naturally, keeping a relaxed upper body. As you exhale, whisper “shhhh” with your vocal cords through pursed lips. Continue this process for several minutes, varying the length of your breaths periodically.

Once you have finished breathing in this position, the next step is to vary your posture. Lean forward while performing the same exercise for a few minutes. The entire circuit in the seated position should be completed three to five times per day, preferably after you finish the parallel exercise on your back.

If you encounter a VCD attack in the future, then you should immediately stop what you are doing and focus on your breathing. Start to do one of the above exercises in the posture that is most convenient for your situation. These should be initiated at the first signs of trouble whether it be shortness of breath or just any sort of tightening in the throat.

Vocal cord dysfunction is not a problem that many physicians know about, and thus often goes misdiagnosed and not properly treated. By seeing a qualified specialist and learning specific breathing exercises such as the ones outlined above, you can begin to reclaim your life from the clutches of VCD.

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Paradoxical Vocal Fold Movement or Paradoxical Movement of Vocal Cords

PVFM or PMVC

Paradoxical Movement of Vocal Cords (PMVC) or Paradoxical Vocal Fold Movement (PVFM) are older terms previously used for what is now known as Vocal Cord Dysfunction (VCD). All three of these terms will be used interchangeably in this article. VCD happens when the vocal cords close inappropriately on the in-breath, which results in obstruction of the airway. During normal breathing, the vocal cords move apart from each other when we breathe in, allowing air into the airway. The vocal cords move towards each when we breathe out, when we speak and when we cough. The key feature of VCD is that, during breathing, the vocal cords can try to close over rather than stay open and it is this squeezing that reduces the size of the air passages, making it harder to get air into the lungs. In order to diagnose VCD, the doctor will watch the vocal cords moving. Between attacks the vocal cords may appear to move normally, resulting in a false negative test, so it can be necessary to trigger an attack.

The tem “paradoxical” is used in medicine to denote something happening in the opposite direction to what is expected. When a person is breathing, it would be expected that the vocal cords would be open to allow the greatest possible air flow. But in some people, the vocal cords close over when they are breathing, squeezing the air passage. This lessens or restricts the air flow and so this movement of the vocal cords is termed “paradoxical” because they close over when they should be open. http://en.wikipedia.org/wiki/Paradoxical_reaction

Intermittent paradoxical closure of the vocal cords can bring on a major attack of breathlessness, or air hunger (dyspnea). The paradoxical movement of the vocal cords or decreased movement during attacks can be recorded on video by a doctor or can also be seen by using a mirror placed at the back of the tongue. Paradoxical movement of the vocal cords can also cause noisy breathing, raspiness or wheezing (stridor). PMVC / PVFM / VCD is not the only cause of noisy breathing: it can also be caused by laryngitis, inflammation of the vocal cords and vocal polyps or nodules (little swellings). (more…)

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.