# 212 Paradoxical Vocal Cord Dysfunction
When is respiratory distress not what it seems? "All that wheezes is not asthma."
There is always a risk in anchor fixation upon the first or most likely diagnostic choice. From basic nature and pattern recognition, to Occam's Razor or Law of Parsimony, or whether the hoofbeats are horses or zebras, we gravitate to the obvious.
Some are natural errors or a failure to look/exclude, e.g., aspirated foreign body treated as asthma and then subsequent pneumonia.
An excellent asthma mimic, which unfortunately has received pejoratives such as factitious; Munchausen's; psychogenic; is VCD, Paradoxical Vocal Cord Dysfunction, which can be due to hypersensitive inflammatory irritation, or co-exist with actual asthma. Some doctors have been angered that the distressed patient just intubated was "a faker" without respiratory failure.
Listening over the larynx may identify the inspiratory component and localize the source of the sound.
Vocal cords that abduct tightly during inspiration, but for a small posterior chink, create the stridor and transmitted wheeze that is heard in a Mueller Maneuver (essentially, a 'reverse Valsalva' Maneuver. Although Pulmonary Function Testing Loops are flattened and altered, and there is no response (with pure VCD) to Methacholine Challenge, a certain diagnosis can be done by visualizing the cords when symptomatic; most easily by a flexible endoscope via the nose.
Immediate treatment might include: explanation; calming measures; panting breaths to relax the cords; Heli-Ox; Ipratroprium; or topical lidocaine to the larynx. Follow-up should be with an ENT, Chest, Allergist, Speech Therapist, ± Psych. Prognosis is good as patients learn to control their symptoms. [Buddiga]
Buddiga, Praveen ,MD. Vocal Cord Dysfunction Treatment & Management. Medscape. Updated: Mar 30, 2016.
N. B. This is a web resource for health professionals.
O'Hollaren, Mark T., MD. Dyspnea Due to Vocal Cord Dysfunction and Other Laryngeal Sources. Medscape. August 26, 2002.
Sidofsky, Carol. Can't Breathe? Suspect Vocal Cord Dysfunction! Last updated 2017; website started 2001.
N. B. This is a website by a VCD patient, intended for the public, to raise awareness and to provide information and resources.
American Academy of Allergy, Asthma & Immunology. Vocal Cord Dysfunction (VCD) or Paradoxical Vocal Fold Movement (PVFM). ©2017.
N. B. This is a consumer page from a professional organization.
National Jewish Hospital. Vocal Cord Dysfunction (VCD). ©2017.
N. B. This is a consumer page from a leading respiratory center.
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