Vocal cord dysfunction
As vocal cord dysfunction ( VCD ) of English vocal cord , vocal cord ' and dysfunction , malfunction', is a dysfunction of the vocal cords designated, these pose suddenly closely in and can even close for a short time. This process leads to an attack-like shortness of breath . This is often preceded by a coughing fit .
A VCD also occurs in combination with bronchial asthma , which makes it even more difficult to detect the disease. Research suggests that 5% of suspected asthmatics have a VCD. In addition, 20 to 40% of difficult to untreatable asthmatics suffer from a VCD accompanying their asthma.
The (English) term vocal cord dysfunction appeared in the pulmonary literature in the last two decades of the 20th century as a differential diagnosis relevant clinical picture in therapy-resistant asthma. The same clinical picture is also referred to there as paroxysmal (or paradoxical ) vocal cord movement / motion (PVCM), paroxysmal (or paradoxical ) vocal cord dysfunction (PVCD), episodic paroxysmal laryngospasm (EPL) and irritable larynx syndrome (ILS).
In ear, nose and throat medicine , these clinical pictures have been described under more or less different names - depending on the severity of the symptoms and the triggering cause - since the 19th century. In particular, the clinical picture described as “inspiratory glottis spasm” is probably to be equated with vocal cord dysfunction . Particularly blatant cases in which shortness of breath leads to unconsciousness are called ictus laryngis (larynx stroke, loss of larynx).
Johann Schnitzler describes the inspiratory glottic spasm in 1895: “While in phonic glottic spasm the coordination disorder manifests itself in the fact that the degree of motor innervation is much more intense than the degree of intended innervation, so there is only a gradual difference, we have it to do inspiratory glottic spasm with a disturbance of coordination of a qualitative nature, in that instead of abduction of the vocal cords they are brought closer together during inspiration. Phonation proceeds normally; inspiration is connected with dyspnoea, since the adductors are also more strongly innervated during inspiration. The dyspnea and stridor disappear in sleep. "
Trigger from VCD
The triggers in VCD can be similar to those in bronchial asthma , which often manifests itself as attack-like shortness of breath.
- Stress, mental stress
- physical strain
- cold or warm air
- Fragrances, cigarette smoke , perfumes
- allergenic influences
- irritating foods such as B. Vinegar
- Gastric acid reflux
Signs of VCD
The following signs confirm the suspicion of VCD:
- Sudden onset of severe, sometimes life-threatening shortness of breath
- Difficulty breathing often after coughing fits
- spontaneous relief of shortness of breath
- Itchy throat, feeling of lump, tightness in the throat, frequent clearing of throat , hoarseness
- Conspicuously good lung function findings
- Asthma medication helps little or no help at all
VCD is a pathological reaction of the larynx. Anatomical changes are also described. The causes can be physical and / or psychological. The pathogenesis is currently not clear. A VCD can be interpreted as a paradoxical protective reflex. If there is a shortness of breath due to a VCD, several factors can usually be identified:
- Organic reasons: the backflow of gastric fluid ( reflux ) or a chronic sinus infection ( sinusitis ). The backflow of acid from the stomach or the secretion from the sinus leads to irritation of the larynx.
- Neurological causes: a hypersensitive area of the larynx or a pathological change in the cerebral cortex.
- Psychological causes: Emotional stress triggered by loss, drastic change, verbal and physical injuries and high performance and aspiration thinking as well as gain from illness .
The body or the vocal folds react to this tension, especially in phases of life in which the stress factors increase. On the other hand, the fact that you suffer from paroxysmal, unclear shortness of breath makes you very stressful. That is why it is often not possible to determine whether the body reacts to emotional sensitivities or the psyche to the soma.
The breathlessness attacks can occur at irregular intervals for no apparent reason.
The diagnosis is often problematic because the attacks occur unexpectedly and it is then only rarely possible to perform a laryngoscopy . There are VCD forms that do not lead to pronounced shortness of breath due to spasmodic glottic closure, but seem to occur more frequently during the day. In such cases, it is easier to detect a paradoxical vocal fold movement with a flexible laryngoscopy: on inspiration there is an adduction movement, such as phonation , and on expiration, the glottis dilates. Usually an inspiratory breathing sound can be heard.
With careful medical diagnostics, fear of an attack should be reduced at the same time. The feeling of threat is far greater than the real threat because the typical VCD seizure will stop on its own. If the VCD is an expression for the fact that the person has a psychological problem (somatization) , he must work on it himself or with competent help. If the reasons are narrowed down or identified, an individual therapy concept can be drawn up. In some cases, proton pump inhibitors can help well.
Through sports and exercise faith in your own body and your own performance can be regained. The processing of emotional problems and learning and applying relaxation techniques help to improve the vocal cord dysfunction. Correct breathing and voice therapy and its implementation in everyday life play a major role.
For many of those affected, however, the therapy is difficult because a somatic cause cannot be found, concomitant diseases make it more difficult and the patient, despite help, is unable to deal with the psychological factors.
- Klaus Kenn: Differential diagnoses of therapy-resistant bronchial asthma . In: Internal Medicine Practice . Hans Marseille Verlag, Munich 2001, DNB 011209097 , p. 253-265 .
- Klaus Kenn, Markus M. Hess: Vocal cord dysfunction: an important differential diagnosis for bronchial asthma . In: Deutsches Ärzteblatt . tape 105 , no. 41 , 2008, p. 699–704 ( aerzteblatt.de [accessed on November 11, 2013]).
- Klaus Kenn, Ron Balkissoon: Vocal Cord Dysfunction - what do we know . In: European Respiratory Journal . tape 37 , 2011, p. 194-200 , doi : 10.1183 / 09031936.00192809 .
- MV Andrianopoulos, GJ Gallivan, KH Gallivan: PVCM, PVCD, EPL, and irritable larynx syndrome: what are we talking about and how do we treat it? In: J Voice. 2000 Dec; 14 (4), pp. 607-618. PMID 11130117
- Joh. Schnitzler: Clinical Atlas of Laryngology. W. Braumüller, Vienna / Leipzig 1895.
- K. Low: Abnormal Vocal Cord Function. In: Am J Respir Crit Care Med. 2011; 184, pp. 50-56.