A case of vocal cord dysfunction in the emergency department


Submitted: 27 March 2022
Accepted: 18 May 2022
Published: 27 June 2022
Abstract Views: 854
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Authors

  • Erika Poggiali Emergency Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy.
  • Giuseppe Di Trapani Otorhinolaryngology Unit, “Guglielmo da Saliceto” Hospital, Piacenza, Italy.
  • Antonio Agosti Emergency Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy.
  • Celestino Caiazza Emergency Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy.
  • Alessandra Manicardi Intensive Care Unit, Emergency Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy.
  • Chiara Zanzani Intensive Care Unit, Emergency Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy.
  • Stefano Vollaro Neurology Unit, “Guglielmo da Saliceto” Hospital, Piacenza, Italy.
  • Andrea Vercelli Emergency Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy.

We describe the case of a 78-year-old woman admitted to our emergency department for an acute onset of severe dyspnoea with inspiratory wheezing-like sounds. She denied fever, cough, voice change and pain. She referred a similar but less severe episode occurred spontaneously one year before, with complete resolution in few minutes without sequelae. On examination upper airway obstruction was firstly excluded. She was initially treated as having asthma, without response. Parenteral high dose corticosteroids and antihistamines provided no benefit. Point-of-care-ultrasound resulted normal. Flexible laryngoscopy during the episode showed paradoxical vocal cord movement with adduction during both inspiration and expiration. This demonstrated that her dyspnoea was from Vocal Cord Dysfunction (VCD). VCD completely solved after administration of intravenous benzodiazepines.


Dunglison R. Practice of Medicine; or a treatise on special pathology and therapeutics. Phladelphia, Lea & Blanchard, 1842. DOI: https://doi.org/10.1097/00000441-184204000-00009

Patterson R, Schatz M, Horton M. Munchausen’s stridor: non-organic laryngeal obstruction. Clin Allergy 1974;4:307–310. DOI: https://doi.org/10.1111/j.1365-2222.1974.tb01390.x

Weinberger M, Doshi D. Vocal cord dysfunction: a functional cause of respiratory distress. Breathe (Sheff) 2017;13:15-21. DOI: https://doi.org/10.1183/20734735.019316

Dunn NM, Katial RK, Hoyte FCL. Vocal cord dysfunction: a review. Asthma Res Pract 2015;1:9. DOI: https://doi.org/10.1186/s40733-015-0009-z

Morrison M, Rammage L, Emami AJ. The irritable larynx syndrome. J Voice 1999;13:447–55. DOI: https://doi.org/10.1016/S0892-1997(99)80049-6

Andrianopoulos MV, Gallivan GJ, Gallivan KH. PVCM, PVCD, EPL, and irritable larynx syndrome: what are we talking about and how do we treat it? J Voice 2000;14:607–18. DOI: https://doi.org/10.1016/S0892-1997(00)80016-8

Rundell KW, Spiering BA. Inspiratory stridor in elite athletes. Chest 2003;123:468–74. DOI: https://doi.org/10.1378/chest.123.2.468

Goldstein R, Bright J, Jones SM, et al. Severe vocal cord dysfunction resistant to all current therapeutic interventions. Respir Med 2007;1:857–8. DOI: https://doi.org/10.1016/j.rmed.2006.08.009

Newman KB, Mason UG 3rd, Schmaling KB. Clinical features of vocal cord dysfunction. Am J Respir Crit Care Med 1995;152:1382–6. DOI: https://doi.org/10.1164/ajrccm.152.4.7551399

Christopher KL, Wood RP 2nd, Eckert RC, et al. Vocal-cord dysfunction presenting as asthma. N Engl J Med 1983;308:1566–70. DOI: https://doi.org/10.1056/NEJM198306303082605

Greenlee JDW, Donovan KA, Hasan DM, et al. Chiari I malformation in the very young child: the spectrum of presentations and experience in 31 children under age 6 years. Pediatrics 2002;110:1212–9. DOI: https://doi.org/10.1542/peds.110.6.1212

Hilland M, Røksund OD, Sandvik L, et al. Congenital laryngomalacia is related to exercise induced laryngeal obstruction in adolescence. Arch Dis Child 2016;101:443–8. DOI: https://doi.org/10.1136/archdischild-2015-308450

Morris MJ, Christopher KL. Diagnostic criteria for the classification of vocal cord dysfunction. Chest 2010;138:1213–23. DOI: https://doi.org/10.1378/chest.09-2944

Murry T, Tabaee A, Aviv JE. Respiratory retraining of refractory cough and laryngopharyngeal reflux in patients with paradoxical vocal fold movement disorder. Laryngoscope 2004;114:1341–5. DOI: https://doi.org/10.1097/00005537-200408000-00005

Fritz GK, Fritsch S, Hagino O. Somatoform disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1997;36:1329–38. DOI: https://doi.org/10.1097/00004583-199710000-00014

Selner JC, Staudenmayer H, Koepke JW, et al. Vocal cord dysfunction: the importance of psychologic factors and provocation challenge testing. J Allergy Clin Immunol 1987;79:726–33. DOI: https://doi.org/10.1016/0091-6749(87)90203-X

Powell DM, Karanfilov BI, Beechler KB, et al. Paradoxical vocal cord dysfunction in juveniles. Arch Otolaryngol Head Neck Surg 2000;126:29–34. DOI: https://doi.org/10.1001/archotol.126.1.29

Miller S. Voice therapy for vocal fold paralysis. Otolaryngol Clin North Am 2004;37:105–19. DOI: https://doi.org/10.1016/S0030-6665(03)00163-4

Earles J, Kerr B, Kellar M. Psychophysiologic treatment of vocal cord dysfunction. Ann Allergy Asthma Immunol 2003;90:669–71. DOI: https://doi.org/10.1016/S1081-1206(10)61874-1

Anbar RD, Hehir DA. Hypnosis as a diagnostic modality for vocal cord dysfunction. Pediatrics 2000;106:e81. DOI: https://doi.org/10.1542/peds.106.6.e81

Morris MJ, Allan PF, Perkins PJ. Vocal cord dysfunction: etiologies and treatment. Clin Pulm Med 2006;13:73–86. DOI: https://doi.org/10.1097/01.cpm.0000203745.50250.3b

Slinger C, Slinger R, Vyas A, et al. Heliox for inducible laryngeal obstruction (vocal cord dysfunction): A systematic literature review. Laryngoscope Investig Otolaryngol 2019;4:255-8. DOI: https://doi.org/10.1002/lio2.229

Fowler SJ, Thurston A, Chesworth B, et al. The VCDQ - a questionnaire for symptom monitoring in vocal cord dysfunction. Clin Exp Allergy 2015;45:1406-11. DOI: https://doi.org/10.1111/cea.12550

Mahoney J, Hew M, Vertigan A, Oates J. Treatment effectiveness for vocal cord dysfunction in adults and adolescents: A systematic review. Clin Exp Allergy 2022;52:387-404. DOI: https://doi.org/10.1111/cea.14036

George S, Suresh S. Vocal cord dysfunction: Analysis of 27 cases and updated review of pathophysiology & management. Int Arch Otorhinolaryngol 2019;23:125-30. DOI: https://doi.org/10.1055/s-0038-1661358

Poggiali, E., Di Trapani, G., Agosti, A., Caiazza, C., Manicardi, A., Zanzani, C., Vollaro, S., & Vercelli, A. (2022). A case of vocal cord dysfunction in the emergency department. Emergency Care Journal, 18(2). https://doi.org/10.4081/ecj.2022.10483

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