Vocal Cord Dysfunction (VCD)

Vocal Cord Dysfunction (VCD)

Paradoxical Vocal Fold Movement, Irritable Larynx Syndrome

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At Duke Voice Care, you'll find experts in diagnosing and treating vocal cord dysfunction who also understand the difficulties of living with this disorder. Our Durham and Raleigh clinic locations offer customized treatments and therapy to help you find relief.

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About Vocal Cord Dysfunction

Vocal cord dysfunction, also known as paradoxical vocal fold movement, is part of irritable larynx syndrome -- an upper airway disorder with a range of symptoms, all related to excess irritation of the delicate voice box. During a VCD attack, your vocal cords close involuntarily when they should be open as you inhale, and you may feel as if you are choking or suffocating. Sometimes, sounds may come from your throat when you have trouble inhaling. You may also have a chronic cough. Some people with irritable larynx syndrome don't have difficulty breathing but only have a chronic cough, which can be debilitating in its own right.

Diagnosing and Treating VCD
VCD is frequently misunderstood and misdiagnosed. Often, it's mistaken for asthma. Our voice specialists will use the latest diagnostic tests to identify whether you have vocal cord dysfunction. Our specially trained speech pathologists can help you understand the common triggers for VCD attacks and teach you exercises to help your throat relax, keep your vocal cords open when you inhale, and ease your symptoms.

If you have asthma as well, we coordinate your care with lung specialists at Duke Health who can help you manage your condition.

Our Locations
Duke Voice Care has locations in Durham and Raleigh. Find one near you.


Vocal Cord Dysfunction Therapy

There are specific exercises designed to relieve attacks of vocal cord dysfunction. You will learn relaxed-throat breathing (also called pursed-lip breathing) and lower abdominal breathing to avoid episodes of difficult breathing. These simple breathing techniques keep the upper airway and voice box relaxed and open for easy breathing. Your speech pathologist will also work with you to understand your VCD triggers and reduce your exposure to these triggers. If you are an athlete suffering from VCD, you will also learn how to use these breathing strategies in your sport.

Chronic Cough Therapy

Your speech pathologist will teach you how to use good vocal hygiene to help your throat recover from the constant irritation caused by chronic cough. You will also learn breathing strategies that will help you break the cycle of chronic cough.

Voice Therapy

For many with irritable larynx syndrome, throat strain can be a result but also a cause of irritation -- part of a vicious cycle. In order to break the cycle of chronic throat irritation, you need to learn how to speak without strain. A speech pathologist will guide you through vocal exercises to improve breathing, reduce throat strain, and find your optimal pitch and volume for strong, healthy speaking. We'll customize your treatment to help you get your voice back and meet your daily voice needs.

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Our team will take a detailed history of your breathing symptoms to note the patterns that suggest vocal cord dysfunction and identify any triggers for these attacks. Your laryngologist will also evaluate whether any medical conditions, surgeries, or recent illnesses could have caused changes in your voice or breathing. We will perform a head and neck examination and a visual examination of your voice box. The following tests may also be necessary.


This detailed visual exam helps us evaluate how your vocal cords vibrate while you speak or sing. A tiny camera attached to a small tube called an endoscope is inserted through your nose and allows us to see your vocal cords and larynx (voice box). A flashing strobe light simulates slow-motion video images of your vocal cords. The exam takes only about a minute, and your nose may be sprayed with topical anesthetic for your comfort.

Your team will look for lesions, stiffness, paralysis, irregular movements, throat strain, or incomplete closure of the vocal cords. If VCD is suspected, your team will evaluate the movement of your vocal cords during breathing. Actual episodes of VCD are rarely seen on these exams, but your larynx will be evaluated to make sure that all the structures are normal.

After the exam, your team will review the images with you to discuss your diagnosis and treatment plan.

Laryngovideostroboscopy can be essential to reaching an accurate diagnosis and determining the best treatment for voice box problems.

Asthma Evaluation

We may refer you to a lung disease specialist who will determine whether you have asthma and provide treatment as needed.

Duke University Hospital is nationally ranked in 10 adult specialties
Consistently Ranked Among the Nation’s Best Hospitals
In addition, Duke University Hospital is proud to be named the best hospital in North Carolina, and nationally ranked in 10 adult and 9 pediatric specialties by U.S. News & World Report for 2019–2020.

Why Choose Duke

A Team of Experts
At Duke, one of the few comprehensive voice centers in the Southeast, your care team will include laryngologists -- ear, nose, and throat (ENT) doctors with advanced training in voice and throat disorders -- and speech pathologists specially trained to evaluate and treat patients with voice problems and laryngeal disorders. Your team has years of experience treating vocal cord dysfunction.

Coordinated Care
We work with specialists in allergy, asthma, and digestive disorders throughout Duke Health to ensure you receive coordinated care for all of the underlying causes of your vocal cord dysfunction.

Sport-Specific Care for Athletes
If you are an athlete with VCD, we'll coordinate with your coach as appropriate to provide education about your disorder and promote the use of best breathing strategies for you in your sport.

Research in the Latest Treatment Advances
Our ongoing research ensures you receive the best care.

Reviewed: 02/20/2018