Airway Dysfunction
Vocal Cord Dysfunction
Vocal Cord Dysfunction
Although vocal cord dysfunction (also known as paradoxical vocal fold movement) is not a primary vocal complaint, the disorder is marked by inappropriate closure (adduction) of the vocal folds during inspiration. This results in inhalatory stridor, which can be confused with upper respiratory disorders such as asthma. Patients will perceive episodic shortness of breath, often during periods of exercise. Although the episodes are typically self-limiting, they have the potential to create airway distress and are often perceived as frightening by patients. In severe cases, the disorder may result in chronic dyspnea, requiring a tracheostomy. The etiology for vocal cord dysfunction is unknown, but a large percentage of patients with these symptoms have other respiratory diagnoses, including asthma, allergies, or frequent upper respiratory infections. Other etiologies associated with this disorder include esophageal reflux, panic/anxiety disorders, and neuromuscular dyskinesia. Recent evidence suggests that some latent differences in laryngeal movements are detectable in persons with vocal cord dysfunction even during asymptomatic periods (94). Treatment for vocal cord dysfunction is frequently successful, using behavioral techniques to interrupt the cycle of adductor inhalatory motion, and to restore the normal respiratory pattern with vocal fold opening (abduction). Depending upon the patient profile, this behavioral treatment approach must be augmented with anti-reflux medication and psychological intervention, as warranted.
Tracheal Stenosis
Constriction or narrowing of the windpipe (trachea), which is located just below the vocal folds is referred to as tracheal stenosis. People with tracheal stenosis may experience shortness of breath, wheezing, stridor, cough, and recurrent pneumonitis. There are multiple causes of stenosis including congenital, neoplastic, infectious and inflammatory. The most common etiology is trauma caused by intubation. Diagnosis of this problem may include direct laryngoscopy, videostroboscopy, bronchoscopy, CT scan, MRI, and/or traditional X-ray. There is no behavioral treatment for tracheal stenosis, and when constriction is severe, tracheal dilation, laser surgical intervention, or tracheal resection is indicated.