Vocal cord dysfunction,☆☆,

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CLINICAL EXPERIENCE

Newman et al.4 recently reviewed clinical experience at the National Jewish Center for Immunology and Respiratory Medicine from 1984 through 1991. Ninety-five patients met the criteria for the diagnosis of VCD. Among them, 42 had VCD alone, and 53 had VCD associated with asthma. In the course of their disease, 28% of the patients with VCD had been intubated.4 Patients with uncomplicated VCD had been misdiagnosed as having asthma for an average of 4.8 years. Their prescribed medications were

DIAGNOSIS

Definitive criteria are needed to differentiate between asthma and VCD and to identify those patients who have either or both. The diagnosis of VCD is best established by flexible fiberoptic rhinolaryngoscopy of a patient experiencing either spontaneous or induced symptoms.11, 12, 13 The examination can be videotaped or photographed for the medical record (Fig. 1). Complications are rare, and discomfort is minimal.11, 12, 13 In VCD the vocal cords adduct anteriorly from the vocal process, and

TREATMENT

In our experience, the most successful treatment of VCD is derived from breathing exercises used for hyperfunctional voice disorders to decrease laryngeal muscle tone.7, 24 These techniques can be taught by a speech therapist in one or two half-hour sessions and are readily accepted by most patients who are eager to exert control over their symptoms. In some extreme cases hypnosis, biofeedback, and psychotherapy have been used successfully.7, 25 An approach reserved for acute attacks is the

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    From the Divisions of aOtolaryngology and b Allergy and Immunology and the Departments of a,bPediatrics and a,bMedicine, National Jewish Center for Immunology and Respiratory Medicine and the University of Colorado Health Sciences Center, Denver.

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    Reprint requests: Henry Milgrom, MD, National Jewish Center for Immunology and Respiratory Medicine, 1400 Jackson St., Denver, CO 80206.

    0091-6749/96 $5.00 + 0 1/1/72536

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