A case of vocal cord dysfunction

Abstract

Vocal cord dysfunction VCD is characterized by a paradoxical vocal cord movement in which vocal cord adduction on inspiration results in inspiratory stridor around the larynx. Laryngoscopy performed by an otolaryngologist is essential in diagnosis. However, there have been few reports by otorhinolaryngologists regarding VCD. Here we report our experience with a case of VCD, augmented by discussion from related literature. A 24-year-old woman presented with cough two weeks after having come for consultation at the respiratory medicine department. She had been prescribed an antitussive drug, but her symptoms had not improved. She visited the emergency room with a chief complaint of sudden dyspnea with stridor. There were no abnormal findings in a blood test and neck chest CT, and she was referred to undergo a detailed examination the following day. Laryngoscopy revealed vocal cord adduction movement on inspiration. VCD was diagnosed based on the laryngoscopy and clinical findings. We provided treatment by explaining her clinical condition using visual feedback and by larynx relaxation, and the paradoxical vocal cord movement and all other symptoms completely resolved after one month. At the time of writing, the patient remains in complete remission. The physician's failure to recognize VCD can result in misdiagnosis of asthma and incorrect treatment. It is essential that physicians consider VCD in the diagnosis of cases presenting with stridor and dyspnea.