ConditionLungs & breathing
Vocal Cord Dysfunction (Inducible Laryngeal Obstruction)
Vocal cord dysfunction (VCD), now often called inducible laryngeal obstruction (ILO), is a condition in which the vocal cords close or narrow when they should open during breathing, especially breathing in. It causes sudden throat tightness, difficulty getting air in, noisy breathing (stridor) and coughing. Attacks are often triggered by exercise, irritants, strong smells, reflux or stress, and are frequently mistaken for asthma. Asthma inhalers do not help, but speech therapy breathing techniques usually do.
Also called: Inducible laryngeal obstruction, paradoxical vocal fold motion, exercise-induced laryngeal obstruction, VCD
At a glance
- What it is
- Inappropriate closing of the vocal cords during breathing in, narrowing the airway.
- Triggers
- Exercise, smoke, fumes, perfumes, cold air, reflux, postnasal drip, stress, upper respiratory infections.
- Symptoms
- Throat tightness, difficulty breathing in, noisy inspiratory breathing, cough, voice change. Attacks start and stop suddenly.
- Diagnosis
- Laryngoscopy during symptoms or a provocation test. Spirometry may show a flattened inspiratory loop.
- Treatment
- Speech-language therapy breathing techniques, treating reflux, allergies and asthma, and psychological support.
When to get help
Call 911 or go to the ER
- Severe difficulty breathing, blue or gray lips, fainting or inability to speak: call 911 or your local emergency number
- Throat tightness with hives, facial or lip swelling, or after a food, sting or medicine (possible anaphylaxis): use epinephrine if prescribed
- A first episode of noisy breathing or throat closing, until the cause is known
See a doctor within a day or two
- Episodes that are becoming more frequent or severe
- Breathing symptoms that do not respond to your asthma inhaler
Book a routine appointment
- Repeated episodes of throat tightness or noisy breathing with exercise, smells or stress
- Asthma that is not improving despite treatment
- A child or teen athlete with breathing difficulty during exercise
What happens during an attack
Normally, the vocal cords open wide when you breathe in and narrow slightly when you breathe out. In VCD, they close or narrow during inhalation, partly blocking the airway. Air moving through the narrowed opening makes a high-pitched noise (stridor) heard on breathing in, felt in the throat or neck. The larynx is thought to be hypersensitive, reacting to triggers with a protective closing reflex.
VCD vs asthma
| Feature | Vocal cord dysfunction | Asthma |
|---|---|---|
| Hard part of breathing | Breathing in | Breathing out |
| Location of tightness | Throat or neck | Chest |
| Sound | Inspiratory stridor | Expiratory wheeze |
| Onset and end | Sudden start and stop | Builds and eases over longer |
| Response to inhaler | Little or none | Usually improves |
| Oxygen level | Usually normal | Can fall in severe attacks |
Many people have both conditions, which makes diagnosis harder. Misdiagnosed VCD can lead to unnecessary high-dose steroids and emergency visits.
Triggers and risk factors
- exercise: especially in young athletes, often during intense competition
- irritants: smoke, fumes, cleaning products, perfumes, cold or dry air
- GERD and laryngopharyngeal reflux
- postnasal drip from allergic rhinitis or sinusitis
- respiratory infections
- anxiety and stress, which can trigger or worsen episodes but are not the only cause
- more common in women and adolescents
Symptoms
- sudden throat tightness or a choking feeling
- difficulty getting air in
- noisy, high-pitched breathing on inhaling
- cough, throat clearing
- hoarseness or voice change
- chest tightness, though usually less than in asthma
- dizziness or tingling from overbreathing during episodes
- anxiety during episodes, which can worsen the cycle
Episodes usually last seconds to minutes and resolve completely in between.
Diagnosis
- flexible laryngoscopy: a thin camera through the nose shows the vocal cords closing during inhalation. Best done during symptoms or after a trigger (such as exercise or an irritant) in a provocation test
- continuous laryngoscopy during exercise (CLE) for exercise-induced cases
- spirometry with flow-volume loops: may show a flattened inspiratory loop
- tests for asthma to determine whether both are present
- evaluation for reflux, allergies and other causes, such as vocal cord paralysis
Treatment
Speech-language therapy
The cornerstone of treatment. A speech-language pathologist teaches "rescue breathing" techniques that open the vocal cords, such as:
- breathing in through the nose
- pursed-lip or "sniff" breathing
- relaxed throat breathing, with the tongue resting low
- breathing out through a narrow straw or with an "s" sound
Most people improve within a few sessions with regular practice.
Treat contributing conditions
- reflux: lifestyle changes and acid-suppressing medicine if appropriate
- allergic rhinitis and postnasal drip: nasal steroids, antihistamines
- asthma: optimize treatment if both are present
- avoid known irritants
Psychological support
Anxiety management, CBT or relaxation training help when stress is a trigger.
Other options
- inspiratory muscle training for athletes
- surgery (supraglottoplasty) only for specific structural forms in some athletes
Outlook
VCD is not usually dangerous, despite how frightening it feels, because the airway rarely closes completely and oxygen levels typically stay normal. Most people achieve good control with breathing techniques and treatment of triggers.
Frequently asked questions
What is vocal cord dysfunction?
It is a condition in which the vocal cords close or narrow when you breathe in, partly blocking the airway. It causes throat tightness, noisy breathing and coughing, and is often mistaken for asthma.
How is vocal cord dysfunction different from asthma?
VCD makes breathing in difficult and causes tightness in the throat, with a high-pitched noise on inhaling. Asthma makes breathing out harder, causes chest tightness and wheeze, and improves with inhalers. Some people have both.
What triggers vocal cord dysfunction?
Common triggers are exercise, smoke, fumes, strong smells, cold air, reflux, postnasal drip, respiratory infections and stress. Identifying and managing triggers is part of treatment.
How is vocal cord dysfunction treated?
Speech-language therapy that teaches breathing techniques to relax and open the vocal cords is the main treatment. Treating reflux, allergies and asthma, and managing stress, also help.
Is vocal cord dysfunction dangerous?
Episodes are frightening but usually not dangerous, as oxygen levels typically stay normal and symptoms resolve quickly. However, a first episode, or one with swelling or hives, should be treated as an emergency until other causes are excluded.
Sources
This guide was written from current patient and clinical guidance, including:
- European Respiratory Society/ELS/ACCP: Official task force statement on inducible laryngeal obstruction
- American Academy of Allergy, Asthma & Immunology (AAAAI): Vocal cord dysfunction
- American Thoracic Society: Patient information: Vocal cord dysfunction
- National Jewish Health: Vocal cord dysfunction
- American Speech-Language-Hearing Association (ASHA): Paradoxical vocal fold movement