Dysfunction Vocal Cord Icd 10
Jude Petkus
Vocal Cord Dysfunction (VCD) is a breathing and voice symptom that is caused by restriction of the airway when you inhale. This unintended closure of the vocal cords (folds) causes the gasping sound you sometimes hear when exercising heavily. Those with VCD can have this inhalatory stridor (gasping) even when resting. During normal breathing, the vocal folds open (ABduct) to allow air into the trachea and lungs. When you exhale, the vocal folds remain open as well. However, when you speak, sing, swallow, cough, or lift heavy things, the vocal folds close (ADduct) with varying degrees of force. While VCD has a higher prevalence in athletes and World Trade Center responders, it has been reported in all age groups including adolescents, children and even infants.
VCD is also known by other names such as paradoxical vocal fold motion, Munchausen stridor, hysterical stridor, functional laryngeal stridor, pseudoasthma, factitious asthma, emotional laryngeal wheezing, psychogenic upper airway obstruction, episodic laryngeal dyskinesia, episodic paroxysmal vocal fold closure. This variety of names highlights two important characteristics of VCD. First, there is usually no observable physical reason for the condition, and second, the difficulty with inhaling can cause emotional distress.
At the Grabscheid Voice and Swallowing Center of Mount Sinai, our voice and airway experts have more than 25 years of experience treating patients with this disorder. Our specialists have researched and published new methods of treating many of the causes of VCD.
People with VCD experience difficulty inhaling. This is often associated with a stridor (noise) when inhaling that comes from the throat and not the lungs themselves. VCD can be progressive, and may start with wheezing in response to certain triggers such as heavy exercise, cold air, irritating smells (frying oil, chemicals, cleaners, perfume, smoke, etc), shouting, singing or loud speaking, and even emotional stress. In extreme variants, these symptoms can result in the feeling of not being able to breath.
Vocal Cord Dysfunction is an acquired condition. It is a behavior of the muscles and nerves. Usually this results from the vocal cords over-protection of the airway. They are supposed to close when you are swallowing, or if irritants like dust or strong chemical smells enter the trachea. However, if this closure occurs often, or if the noxious stimulus is strong enough, this pattern may become more frequently used. Sometimes the pattern becomes so habituated that the patient will have noisy inhalations even when speaking.
People at increased risk for VCD include athletes, especially those who play outside during winter months, and swimmers (likely related to the chlorine exposure). Those whose jobs expose them to strong chemicals or dust and particulates can also develop VCD. Emotional trauma, physical or mental abuse can also be risk factors for developing VCD. And finally, World Trade Center 9/11 responders are at a higher risk for this condition.
VCD is a symptom and is easily determined by looking at the vocal folds with a scope while the stridor (inhalatory noise, gasping) is happening. What is more important and difficult is determining the cause of the closure of your vocal folds when inhaling. These diagnostics are made by clinicians who are experienced in listening to breathing patterns and voice, and can have you do tasks that may make the symptoms worse or better. Frequently patients with VCD will have seen a pulmonologist, and may be on inhaled steroids as many of the symptoms are similar to those of asthma or other restrictive airway conditions. While steroids can help to manage asthma, they will not work on VCD unless they are having a placebo effect.
Often patients are referred for a breathing or voice problem and the diagnosis of Vocal Cord Dysfunction may not be secured. Therefore, when you call the Grabscheid Voice and Swallow Center, your initial visit will likely be scheduled with our team of voice clinicians. You will see a laryngologist and a speech language pathologist on the same visit who will evaluate your breathing and voice production with a scope to see how the vocal folds are moving. They will discuss with you their impressions as a team and your treatment options.
If you elect for treatment, we will likely suggest that you attempt voice therapy first. If you have been receiving treatment elsewhere and wish to switch your care to our center, we can attempt to get insurance carrier approval for treatment on your initial visit.
Both asthma and vocal cord dysfunction can make breathing difficult. Signs and symptoms of either condition can include coughing, wheezing, throat tightness and hoarseness, but they're two separate disorders.
Vocal cord dysfunction is the abnormal closing of the vocal cords when you breathe in or out. It's also called laryngeal dysfunction, paradoxical vocal cord movement disorder or paradoxical vocal fold motion. Like asthma, vocal cord dysfunction can be triggered by breathing in lung irritants, having an upper respiratory infection or exercising. However, unlike asthma, vocal cord dysfunction isn't an immune system reaction and doesn't involve the lower airways. Treatment for the two conditions also is different.
Because they have similar triggers and symptoms, it's common for vocal cord dysfunction to be misdiagnosed as asthma. This can lead to use of asthma medications that don't help and cause side effects. Some people have both vocal cord dysfunction and asthma, and require treatment for both conditions.
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In asthma, the airways (bronchial tubes) tighten, making breathing difficult. With VCD, the vocal cord muscles tighten, which also makes breathing difficult. Unlike asthma, VCD is not an allergic response starting in the immune system.
Diagnosis
Diagnosing VCD can be challenging. The history of breathing difficulties when taking in a breath, having a hoarse voice or experiencing voice changes may be very helpful to discuss with your allergist / immunologist. This may lead to further tests such as spirometry or laryngoscopy.
Spirometry is a breathing test that measures airflow. A laryngoscopy involves looking at the vocal cords through a camera attached to a flexible tube. Vocal cords should be open when taking in a breath. In some people with VCD, the vocal cords actually close instead of opening.
Vocal cord dysfunction involves inappropriate vocal cord motion that produces partial airway obstruction. Patients may present with respiratory distress that is often mistakenly diagnosed as asthma. Exercise, psychological conditions, airborne irritants, rhinosinusitis, gastroesophageal reflux disease, or use of certain medications may trigger vocal cord dysfunction. The differential diagnosis includes asthma, angioedema, vocal cord tumors, and vocal cord paralysis. Pulmonary function testing with a flow-volume loop and flexible laryngoscopy are valuable diagnostic tests for confirming vocal cord dysfunction. Treatment of acute episodes includes reassurance, breathing instruction, and use of a helium and oxygen mixture (heliox). Long-term management strategies include treatment for symptom triggers and speech therapy.
Vocal cord dysfunction is a syndrome in which inappropriate vocal cord motion produces partial airway obstruction, leading to subjective respiratory distress. When a person breathes normally, the vocal cords move away from the midline during inspiration and only slightly toward the midline during expiration.1 However, in patients with vocal cord dysfunction, the vocal cords move toward the midline during inspiration or expiration, which creates varying degrees of obstruction.2 Vocal cord dysfunction has numerous labels in the literature, including paradoxical vocal cord dysfunction,3 paradoxical vocal fold motion,4 and factitious asthma.5
Vocal cord dysfunction occurs more often in women than in men, and is common in persons 20 to 40 years of age.2,6,7 However, studies have identified vocal cord dysfunction in adolescents and in children as young as eight years.8
Patients with vocal cord dysfunction typically present with recurrent episodes of subjective respiratory distress that are associated with inspiratory stridor, cough, choking sensations, and throat tightness.3 The presence of wheezing can indicate an asthma exacerbation, but is commonly a mistaken description of the stridor characteristic of vocal cord dysfunction.9,10 In one study, 59 percent of patients with vocal cord dysfunction had been previously diagnosed with asthma.8 Most patients with vocal cord dysfunction have intermittent and relatively mild symptoms, although some patients may have prolonged and severe symptoms.
Laryngospasm, a subtype of vocal cord dysfunction, is a brief involuntary spasm of the vocal cords that often produces aphonia and acute respiratory distress. Laryngospasm is a common complication of anesthesia.11 Another variation of vocal cord dysfunction is spasmodic dysphonia, which causes hoarseness and strained vocalization when the abnormal vocal cord motion occurs during speech.12
The primary diagnosis to consider in patients with respiratory distress or wheezing is asthma. Vocal cord dysfunction is often misdiagnosed as asthma, and a considerable subset of patients with vocal cord dysfunction also have asthma, making the diagnosis more difficult.2,8 A careful patient history may help to differentiate between the two conditions. Unlike asthma, vocal cord dysfunction causes more difficulty with inspiration than expiration, and is commonly associated with a sensation of throat tightness or choking. However, further testing, including pulmonary function testing and laryngoscopy, is usually required to make the diagnosis.13 Additional conditions in the differential diagnosis of vocal cord dysfunction are listed in Table 1.
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