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CAN'T BREATHE? SUSPECT VOCAL CORD DYSFUNCTION!

What exactly is Vocal Cord Dysfunction (VCD)? How is VCD different from laryngospasm?

 
Normally, "when you breathe in, or inhale, the vocal cords open, [abduct/move away from eachother] allowing air to flow into your windpipe (trachea) and allowing air to reach your lungs. However, with Vocal Cord Dysfunction, the vocal cords close together [adduct/move toward eachother], or constrict, when you inhale. This leaves only a small opening for air to flow into your windpipe." (Ref. 1, on web-page 9), See Fig. 1 (Ref. 3, on web-page 9) 

During an attack (spasm) of VCD, the abnormal, 'paradoxical' vocal cord motion ('PVCM') CAN BE SEEN AND EVEN PHOTOGRAPHED by an experienced doctor or experienced SLP (Speech & Language Pathologist),using "a procedure called a LARYNGOSCOPY " (Ref. 1)."which is the MOST IMPORTANT TEST IN MAKING THE DIAGNOSIS OF VCD." (Ref.1). A laryngoscope is a narrow flexible tube with a tiny camera and light attached, that is gently passed through a nostril and down to the throat, above the vocal cords, after a local anesthetic is sprayed in the nose and throat to completely prevent gagging during the procedure. Some doctors prefer not to use a local anesthetic, when possible (for those patients who don't have a very active gag reflex).

In Figure 1 (Ref. 3), notice the abnormally small diamond- shaped opening (some say triangle-shaped opening) between the rear (posterior) ends of the vocal cords. This small opening is called a "chink".

In the 1980's, VCD was defined as follows: "The adduction of vocal cords with an open glottic [between the vocal cords] chink [small space/opening] in a patient experiencing dyspnea [difficulty breathing] unequivocally establishes the diagnosis of VCD." (Ref. 5). "In VCD the vocal cords adduct anteriorly [toward the front of the body] from the vocal process, and the posterior glottic chink remains open. The adduction occurs during inspiration [breathing in/inhaling] or in both the inspiratory and expiratory [breathing out/exhaling] phases." (Ref. 5) 

However, Dr. Susan Brugman, MD (Pediatric Pulmonologist at Nat'l Jewish) wrote that "...VCD patients may present with variations of the classic picture of anterior vocal cord adduction with posterior chinking", such as complete closure of the space between the vocal cords, that is, no "chink" [no opening/space at all, between vocal cords], especially in pre-teen-age children [and also in adults].

NEW INFORMATION (2003 VCD Conference, Dr. Susan Brugman, MD): At Nat'l Jewish Medical & Research Center, in Denver, Colorado, 70% of VCD patients had complete vocal cord closure, during attacks, with no "chinking", and 13% of VCD patients had the posterior chink, during VCD attacks.

There can be many more possible variations of how individual VCD patients' vocal cords move and appear, during VCD attacks. This includes how fast or how slowly the vocal cords close up. (See Ref. 10 on web-page 9 of this website, and, see web-page 2). One VCD patient seen at Nat'l Jewish, had vocal cords close up so tightly, during VCD attacks, that the vocal cords actually overlapped! (personal communication with the patient, 2003). 

Sometimes VCD patients do not have a VCD attack, while being laryngoscoped. But, such patients still do have VCD. So, they may not be able to be diagnosed until later on, when a VCD attack happens (or is induced, for the purpose of diagnosis) during a follow-up laryngoscopy.

Some SLP's (Speech & Language Pathologists) say they have seen certain  abnormalities of vocal cord vibrations, when they did video-stroboscopic laryngoscopies on VCD patients, BETWEEN VCD attacks. A regular laryngoscopy would have shown a so-called "normal" result, between VCD attacks. 
 

A
Anterior (front of body)

B
Anterior (front)

Posterior (rear/back of body)

Posterior (back)

Fig. 1. Artist's drawing demonstrating the appearance of the vocal cords during (A) inspiration in a normal patient and (B) during inspiration in a patient with VCD. Note the paradoxical narrowing of the vocal cords (B) with the characteristic diamond-shaped posterior chink (identified by the dashed circle). Reprinted by permission of Mayo Foundation. (Fig. 1 comes from Reference 3: see webpage 9, at http://cantbreathesuspectvcd.com/page9.html ).
Laryngospasm (closing up spasm of one or more parts of the larynx/voice box, such as vocal cords) may or may not be different from VCD. (Ref. 5,6--on webpage 9) Laryngospasm completely closes off the air supply, leaving no opening at all between the vocal cords. Immediate emergency help is needed to save life. Some speakers at the 2003 Nat'l Jewish VCD Conference defined laryngospasm as "persistent [long lasting] VCD". But, there were some differing opinions at this VCD conference, about how to define and compare VCD and laryngospasm. See web-Page 3 and References (web-Page 9), for more info and controversey about this.

Also, some people have "mid inspiratory [in the middle of inhaling] prolapse [collapse, drawing inward and downward] of peri-glottic [near the vocal cords] structures, into the glottic airway [vocal cord area]". This can happen at the same time that vocal cords close up in a VCD attack, OR, this can happen WITHOUT vocal cords closing up at all. This "Upper Airway Dysfunction" (UAD) is very similar to VCD, and is treated the same way that VCD is treated, and usually does NOT need surgery. Some types of UAD can be seen during a laryngoscopy.See more about "laryngochalasia" in link (N), on links webpage. See http://cantbreathesuspectvcd.com/links.html

Confusingly, Vocal Cord Dysfunction (VCD) has been called     "Episodic Laryngeal Dyskinesia (ELD), Paradoxical Vocal Cord Motion (PVCM), Non-organic upper airway obstruction, Laryngeal asthma, Emotional laryngeal wheezing, Psychogenic upper airway obstruction, Munchausen stridor" (Ref. 4), "factitious asthma, psychogenic stridor, functional upper airway obstruction, paradoxical vocal cord adduction, hysterical stridor" (Ref. 3), etc. Many of these terms are outdated and imply that it is all in one's head. But VCD (Vocal Cord Dysfunction) is not imaginary -- it is real.

Also, VCD has also been called: Steriod Resistant Asthma, Pseudo Asthma,  Adult Spasmodic Croup,  Inappropriate Adduction (IA), Paradoxical Vocal Fold Adduction (PVFA), Laryngeal Muscle Tension Disorder , Muscle Tension Dysphonia (MTD) that affects breathing, Laryngeal Dystonia (LD), Laryngeal Spasm, Episodic Paroxysmal Laryngospasm (EPL), Respiratory (breathing) type of Adductor Spasmodic Dysphonia, Irritable Larynx Syndrome (ILS), Upper Airway Dysfunction--some say "disorder" (UAD), and ..."Very Confusing Disorder" (Dr. Susan Brugman, MD, at 2001 & 2003 VCD Conferences), etc.  (Ref.21,22 on page 9; also, links "D", "E", "O" & "P" on "links" page, and many other sources.)

Dr. Brugman, MD (Pediatric pulmonologist/lung doc at National Jewish Medical & Research Center), said (at Nat'l Jewish's 2003 VCD Conference) that VCD has been found to exist, not only in humans, but also in racehorses! (according to N.J. Kannegieter and ML Dore, University of Sydney, New South Wales, Australia).

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email | links page | home page: intoduction & OUTLINE | [1: definitions][2: signs & symptoms][3: recognition & diagnosis][4 treatments][5: underlying causes][6: cure & prevention][7: experts on VCD][8: VCD Conferences][9: References][10: VCD support, & Appendix A: some SINUS TIPS; Appendix B: some GASTRIC REFLUX TIPS (without acid blockers); Appendix C: some TIPS for INFANT GERD & COLIC; Appendix D: some ERGONOMICS TIPS; Appendix E: some TIPS for GLUTEN-FREE EATING; Appendix F: some TIPS for keeping a TOTAL DIARY/JOURNAL ]