Vocal Cord Dysfunction (VCD)

Paradoxical Vocal Fold Movement (PVFM)

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Our voice specialists use the latest diagnostic tests along with their years of experience to determine whether you have vocal cord dysfunction (VCD), also known as paradoxical vocal fold movement (PVFM). Specially trained speech-language pathologists help you understand the common triggers for VCD episodes and teach you breathing exercises to help relax the throat and ease your symptoms.

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About Vocal Cord Dysfunction

VCD, a type of irritable larynx syndrome, is an upper airway disorder related to irritation of the voice box. Normal breathing requires the vocal cords to remain open so air can pass in and out of the lungs. During a VCD episode, the vocal cords start to close involuntarily during inhalation. Since your airway is narrowed, you may feel like you can’t inhale. Sometimes, sounds may come from your throat during an episode. VCD is frequently misunderstood, misdiagnosed, and mistaken for asthma or a severe allergic reaction because of similar symptoms.

Our Locations

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


Speech Therapy for Vocal Cord Dysfunction

Speech therapy is the primary treatment for VCD. Specially trained speech-language pathologists teach you exercises designed to relieve episodes of VCD. You will learn relaxed-throat breathing and lower-abdominal breathing strategies to manage episodes of breathing difficulty. These simple techniques keep the upper airway and voice box relaxed and open for easier breathing. Your speech-language pathologist will also work with you to understand your VCD triggers and control your response to these triggers. If you are an athlete with VCD, we'll coordinate with your coaches as appropriate to provide education about the condition and promote breathing strategies for you in your sport(s).

Voice Therapy

For many, VCD can cause throat strain during and after episodes. If this occurs, the voice itself can become strained or hoarse. A speech-language pathologist will guide you through vocal exercises to improve breathing, reduce throat strain, and find your optimal pitch and volume for strong, healthy speaking. Improving your voice will not only help you speak more easily and clearly, but it can reduce your throat irritation and shortness of breath.

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Our team will take a detailed history of your breathing symptoms to note the patterns that suggest VCD and identify any triggers for these episodes. Your laryngologist -- an ear, nose, and throat (ENT) doctor with advanced training in voice and throat disorders -- 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.


This detailed visual examination of your voice box helps us evaluate how your vocal cords open, close, and vibrate while you breathe and speak or sing. A tiny camera attached to a small tube called an endoscope is inserted through your nose and into your throat, which 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 about two minutes, and your nose can be sprayed with topical anesthetic for 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 voice box 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. Videolaryngostroboscopy is essential to reaching an accurate diagnosis and determining the best treatment for VCD and other voice box problems.

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 10 pediatric specialties by U.S. News & World Report for 2024–2025.

Why Choose Duke

Team of Experts
At Duke, one of the few comprehensive voice centers in the Southeast, your care team will include laryngologists and speech-language pathologists specially trained to evaluate and treat patients with voice problems and laryngeal disorders. Our team has years of experience treating VCD.

Team Care Approach
If you have other medical conditions that may contribute to your voice issues -- such as allergies, asthma, or acid reflux -- we will work with your other providers throughout Duke Health to ensure you receive the best care from an integrated team.

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 breathing strategies for you in your sport.

This page was medically reviewed on 03/08/2023 by