Vocal Cord Dysfunction

  • Miles M. WeinbergerEmail author
  • Devang R. Doshi
Part of the Respiratory Medicine book series (RM)


Initially described as hysteria and then Munchausen’s stridor, we now recognize vocal cord dysfunction as a functional group of disorders. Exercise and spontaneously occurring phenotypes exist that benefit from different treatments. The former appears to respond to pharmacological pretreatment with an anticholinergic aerosol and the latter may require vocal cord training to learn to relieve the symptoms. The differential diagnosis includes consideration of neurological and anatomical abnormalities. Recognition and effective treatment is important to permit the individual to be involved in activities important to them and to avoid unnecessary and ineffective medical care.


Functional disorder Stridor Vocal cord dysfunction Vocal cords 

Supplementary material

Video 6.1: Flexible laryngoscopy demonstrating paradoxical vocal cord movement.mpg (MPG 9.59 MB)

Video 6.2: Flexible laryngoscopy demonstrating nearly continuous adduction of the vocal cords.mpg (MPG 7.49 MB)


  1. 1.
    Patterson R, Schatz M, Horton M. Munchausen’s stridor: non-organic laryngeal obstruction. Clin Allergy. 1974;4:307–10.PubMedCrossRefGoogle Scholar
  2. 2.
    Rogers JH, Stell PM. Paradoxical movement of the vocal cords as a cause of stridor. J Laryngol Otol. 1978;92:157–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Christopher KL, Wood 2nd RP, Eckert RC, Blager FB, Raney RA, Souhrada JF. Vocal-cord dysfunction presenting as asthma. N Engl J Med. 1983;308:1566–70.PubMedCrossRefGoogle Scholar
  4. 4.
    Newman KB, Mason 3rd UG, Schmaling KB. Clinical features of vocal cord dysfunction. Am J Respir Crit Care Med. 1995;152:1382–6.PubMedGoogle Scholar
  5. 5.
    McFadden Jr ER, Zawadski DK. Vocal cord dysfunction masquerading as exercise-induced asthma. A physiologic cause for “choking” during athletic activities. Am J Respir Crit Care Med. 1996;153:942–7.PubMedGoogle Scholar
  6. 6.
    Thomas PS, Geddes DM, Barnes PJ. Pseudo-steroid resistant asthma. Thorax. 1999;54: 352–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Doshi D, Weinberger M. Long-term outcome of vocal cord dysfunction. Ann Allergy Asthma Immunol. 2006;96:794–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Abu-Hasan M, Tannous B, Weinberger M. Exercise-induced dyspnea in children and adolescents: if not asthma then what? Ann Allergy Asthma Immunol. 2005;94:366–71.PubMedCrossRefGoogle Scholar
  9. 9.
    Wood RP, Milgrom H. Vocal cord dysfunction. J Allergy Clin Immunol. 1996;98:481–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Goldstein R, Bright J, Jones SM, Niven RM. Severe vocal cord dysfunction resistant to all current therapeutic interventions. Respir Med. 2007;1–1:857–8.CrossRefGoogle Scholar
  11. 11.
    Hayes JP, Nolan MT, Brennan N, FitzGerald MX. Three cases of paradoxical vocal cord adduction followed up over a 10-year period. Chest. 1993;104:678–80.PubMedCrossRefGoogle Scholar
  12. 12.
    Freedman MR, Rosenberg SJ, Schmaling KB. Childhood sexual abuse in patients with paradoxical vocal cord dysfunction. J Nerv Ment Dis. 1991;179:295–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Weinberger M, Abu-Hasan M. Pseudo-asthma: when cough, wheezing, and dyspnea are not asthma. Pediatrics. 2007;120(4):855–64.PubMedCrossRefGoogle Scholar
  14. 14.
    Rundell KW, Spiering BA. Inspiratory stridor in elite athletes. Chest. 2003;123:468–74.PubMedCrossRefGoogle Scholar
  15. 15.
    Smith RJ, Bauman NM, Bent JP, Kramer M, Smits WL, Ahrens RC. Exercise-induced laryngomalacia. Ann Oto Rhinol Laryngol. 1995;104:537–41.Google Scholar
  16. 16.
    Bent JP, Miller DA, Kim JW, Bauman NM, Wilson JS, Smith RJ. Pediatric exercise-induced laryngomalacia. Ann Oto Rhinol Laryngol. 1996;105:169–1675.Google Scholar
  17. 17.
    Björnsdóttir US, Gudmundsson K, Hjartarson H, Bröndbo K, Magnússon B, Juliusson S. Exercise-induced laryngochalasia: an imitator of exercise-induced bronchospasm. Ann Allergy Asthma Immunol. 2000;85:387–91.PubMedCrossRefGoogle Scholar
  18. 18.
    Manell DL, Arjmand EM. Laryngomalacia induced by exercise in a pediatric patient. Int J Ped Otorhinolaryngol. 2003;67:999–1003.CrossRefGoogle Scholar
  19. 19.
    Christensen P, Thomsen SF, Rasmussen N, Backer V. Exercise-induced laryngeal obstructions objectively assessed using EILOMEA. Eur Arch Otorhinolaryngol. 2010;267:401–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Greenlee JDW, Donovan KA, Hasan DM, Menezes AH. Chiari I malformation in the very young child: the spectrum of presentations and experience in 31 children under age 6 years. Pediatrics. 2002;110:1212–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Morris MJ, Christopher KL. Diagnostic criteria for the classification of vocal cord dysfunction. Chest. 2010;138:1213–23.PubMedCrossRefGoogle Scholar
  22. 22.
    Kim C-M, Kim B-S, Cho K-J, Hong S-J. Laryngotracheal involvement of relapsing polychondritis in a Korean girl. Pediatr Pulmonol. 2003;35:314–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Vassilyadi M, Strawsburg RH. Delayed onset of vocal cord paralysis after explantation of a vagus nerve stimulator in a child. Childs Nerv Syst. 2003;19:261–3.PubMedGoogle Scholar
  24. 24.
    Zalvan C, Sulica L, Wolf S, Cohen J, Gonzalez-Yanes O, Blitzer A. Laryngopharyngeal ­dysfunction from the implant vagal nerve stimulator. Laryngoscope. 2003;113:221–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Ayres JG, Gabbott PLA. Vocal cord dysfunction and laryngeal hyperresponsiveness: a function of altered autonomic balance? Thorax. 2002;57:284–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Fritz GK, Fritsch S, Hagino O. Somatoform disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1997;36:1329–38.PubMedCrossRefGoogle Scholar
  27. 27.
    Selner JC, Staudenmayer H, Koepke JW, Harvey R, Christopher K. Vocal cord dysfunction: the importance of psychologic factors and provocation challenge testing. J Allergy Clin Immunol. 1987;79:726–33.PubMedCrossRefGoogle Scholar
  28. 28.
    Gavin LA, Wamboldt M, Brugman S, Roesler TA, Wamboldt F. Psychological and family characteristics of adolescents with vocal cord dysfunction. J Asthma. 1998;35:409–17.PubMedCrossRefGoogle Scholar
  29. 29.
    Leo RJ, Konakanchi R. Psychogenic respiratory distress: a case of paradoxical vocal cord dysfunction and literature review. Prim Care Companion J Clin Psychiatry. 1999;1:39–46.PubMedCrossRefGoogle Scholar
  30. 30.
    Powell DM, Karanfilov BI, Beechler KB, Treole K, Trudeau MD, Forrest LA. Paradoxical vocal cord dysfunction in juveniles. Arch Otolaryngol Head Neck Surg. 2000;126:29–34.PubMedGoogle Scholar
  31. 31.
    Sullivan MD, Heywood BM, Beukelman DR. A treatment for vocal cord dysfunction in female athletes: an outcome study. Laryngoscope. 2001;111:1751–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Earles J, Kerr B, Kellar M. Psychophysiologic treatment of vocal cord dysfunction. Ann Allergy Asthma Immunol. 2003;90:669–71.PubMedCrossRefGoogle Scholar
  33. 33.
    Miller S. Voice therapy for vocal fold paralysis. Otolaryngol Clin North Am. 2004;37: 105–19.PubMedCrossRefGoogle Scholar
  34. 34.
    Sandage M, Zelazny S. Paradoxical vocal fold motion in children and adolescents. Lang Speech Hear Serv Sch. 2004;35:353–62.PubMedCrossRefGoogle Scholar
  35. 35.
    Anbar RD, Hehir DA. Hypnosis as a diagnostic modality for vocal cord dysfunction. Pediatrics. 2000;106:e81.PubMedCrossRefGoogle Scholar
  36. 36.
    Murry T, Tabaee A, Aviv JE. Respiratory retraining of refractory cough and laryngopharyngeal reflux in patients with paradoxical vocal fold movement disorder. Laryngoscope. 2004;114:1341–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of Iowa HospitalIowa CityUSA
  2. 2.William Beaumont School of MedicineOakland UniversityBloomfieldUSA

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