Vocal cord dysfunction: an update

To review the clinical manifestations of vocal cord dysfunction (VCD) and to discuss new developments in the diagnosis and treatment.

PubMed searches were performed for articles published regarding presentation, pathogenesis, diagnosis, and treatment options of VCD using the keywords vocal cord dysfunction, pathogenesis, clinical features, diagnosis, and management.

Articles were selected based on their relevance to the topic of this review. The newest developments in VCD were defined by articles published in the past 8 years.

The exact cause and pathogenesis remain unclear, although laryngeal hyperresponsiveness likely plays a role in a subset of patients. Certain findings on spirometry are often interpreted to suggest VCD, but recent studies have had varying results on how useful these are in the diagnosis of VCD. Diagnosis is made by direct visualization of the adduction of the vocal cords via rhinolaryngoscopy, but the method used to provoke symptoms and adduction varies. Other noninvasive tests have been evaluated as well.

The early recognition and treatment of VCD are imperative to prevent the misdiagnosis and mismanagement of asthma. In addition, VCD and asthma can occur together. The origin and pathogenesis of VCD need to be better defined. More studies comparing the provocation methods during laryngoscopy may be helpful in further standardizing a diagnostic test. Further research is needed to determine whether other noninvasive tests are as effective in diagnosing VCD as laryngoscopy.