Our Summary

This research paper talks about Vocal Cord Dysfunction (VCD), a condition where the vocal cords close when they should be open, especially during breathing in. This can cause symptoms like wheezing, sudden severe difficulty in breathing (without signs like low oxygen levels, rapid breathing, or increased effort to breathe), tightness in the throat or chest, and anxiety. It’s more common in women, and can be triggered by things like exercise, asthma, acid reflux, postnasal drip, respiratory infections, and irritants.

To diagnose VCD, doctors can use techniques like looking at the nose and throat with a special scope, and testing lung function, including how the person responds to exercise and a drug called methacholine. These tests can also help rule out other causes of the symptoms.

To manage VCD, it’s important to treat conditions that can trigger it, like asthma, acid reflux, and postnasal drip, and to avoid irritants. Therapies that focus on controlling breathing and relaxing the vocal cords can help manage the difficulty in breathing that comes with VCD.

There’s a specific type of VCD that leads to voice disorders (dysphonia), rather than breathing difficulty (dyspnea), due to abnormal spasms of the muscles in the voice box (the spasms cause less severe closure of the vocal cords). In these cases, injections of a drug called OnabotulinumtoxinA, often known as Botox, may be helpful for the voice disorder and for treating the breathing difficulty in some cases, although the evidence is limited.

FAQs

  1. What are the common triggers for vocal cord dysfunction?
  2. How is vocal cord dysfunction diagnosed and treated?
  3. Can OnabotulinumtoxinA injections be used for treating dyspnea in cases of vocal cord dysfunction?

Doctor’s Tip

One helpful tip a doctor might tell a patient about vocal cord surgery is to follow all post-operative care instructions carefully, including voice rest and avoiding activities that strain the vocal cords. It is important to allow the vocal cords time to heal properly in order to achieve the best possible outcome from the surgery. Additionally, attending follow-up appointments with the surgeon and speech therapist is crucial for monitoring progress and ensuring the best recovery.

Suitable For

Patients who are typically recommended vocal cord surgery include those with severe cases of vocal cord dysfunction that do not improve with conservative treatments such as breathing maneuvers and vocal cord relaxation techniques. Surgery may also be recommended for patients with vocal cord paralysis or other structural abnormalities of the vocal cords that are causing significant symptoms. It is important for patients to undergo a thorough evaluation by a laryngologist or otolaryngologist to determine if surgery is the appropriate treatment option for their specific condition.

Timeline

  • Before vocal cord surgery, a patient may experience symptoms of vocal cord dysfunction such as inspiratory stridor or wheezing, sudden, severe dyspnea, throat or chest tightness, and anxiety.
  • The patient may undergo tests such as nasolaryngoscopy and pulmonary function testing to diagnose vocal cord dysfunction and rule out other possible causes of their symptoms.
  • Common triggers for vocal cord dysfunction, such as exercise, asthma, GERD, and irritants, should be identified and managed prior to surgery.
  • Therapeutic breathing maneuvers and vocal cord relaxation techniques may be recommended as first-line therapy for managing symptoms before surgery.
  • After vocal cord surgery, the patient may experience improvements in their symptoms, such as reduced dyspnea and improved vocal function.
  • Post-operative care may include voice therapy, medications, and follow-up appointments to monitor the patient’s progress and ensure proper healing.

What to Ask Your Doctor

  1. What is the underlying cause of my vocal cord dysfunction?
  2. What are the potential risks and complications of vocal cord surgery?
  3. What is the success rate of vocal cord surgery in treating vocal cord dysfunction?
  4. What is the recovery process like after vocal cord surgery?
  5. Are there any alternative treatments or therapies for vocal cord dysfunction that I should consider before opting for surgery?
  6. How long will it take for me to see improvement in my symptoms after vocal cord surgery?
  7. Will I need speech therapy or vocal coaching after vocal cord surgery?
  8. How often will I need to follow up with you after vocal cord surgery?
  9. Are there any lifestyle changes or modifications I should make to prevent recurrence of vocal cord dysfunction after surgery?
  10. Can you provide me with information on support groups or resources for individuals with vocal cord dysfunction?

Reference

Authors: Malaty J, Wu V. Journal: Am Fam Physician. 2021 Nov 1;104(5):471-475. PMID: 34783512