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March 01, 2011

Olympic Athlete Hopeful With Vocal Cord Dysfunction

There was a recent article about Hannah Lupton, a heptathlete, who suffers from vocal cord dysfunction. This disorder is basically when the vocal cords come together during inhalation when it should be apart resulting in shortness of breath localized to the throat area.

Normally, during breathing, the vocal cords are apart as shown in the picture. When talking or swallowing, the vocal cords come together (TVC is True Vocal Cord).


Laryngospasm, which is the most severe form of vocal cord dysfunction, is when the vocal cords come together completely preventing any air from moving into the lungs resulting in a high pitched squeal when trying to breath. People may even faint due to lack of oxygen when this happens.

The vocal cord exercises as described in the news article may encompass these strategies among others:

METHOD 1: Breathing Technique
There are 3 steps to this particular method.
  1. As soon as one feels an attack coming, SLOWLY breath in through the NOSE. DO NOT BREATH IN THROUGH THE MOUTH! Sometimes deliberately holding breath for 5 seconds prior to nasal inhalation helps.
  2. More quickly exhale out the mouth with pursed lips.
  3. Continue slow nasal inhalation, and quick mouth exhalation with pursed lips until the episode passes.
Why does this work? For some reason, nasal breathing reinforces the brain to keep the vocal cords apart when inhaling. Quick inhalation through the mouth seems to do the opposite and encourage the vocal cords to close which exacerbates the problem. Also, quick inhalation reinforces the Bernoulli Principle that as a fluid (air in this case) passes through a pipe that suddenly narrows (the vocal cords), the pressure actually decreases which encourages further narrowing (or vocal cord closure). Therefore, SLOW breathing helps keep the vocal cords apart! You can test this principle yourself by sucking air on a narrow short straw slowly and than quickly. You will find that the straw will tend to collapse when sucking in quickly.

METHOD 2: Straw Breathing

This method essentially forces a person to decrease the speed of breathing allowing for vocal cord relaxation. In essence, cut a regular drinking straw to half its length. When an attack occurs, place the straw in your mouth and make a tight seal. Breath thru the straw (via mouth) until attack passes.

Patients with recurrent laryngospasm attacks typically keep a straw in their pocket/purse to have immediately on hand.

METHOD 3: Pressure Point

Another manuever that may work is firm pressure in the "laryngospasm notch." Basically, with an attack, quickly with your (or somebody else's) index fingers, press very firmly just behind both your earlobes where there is a notch between the bone of your mastoid process and ear. Press deep and forward towards the nose. It should hurt. If it doesn't hurt, you are not pressing hard enough. The attack should resolve within 10 seconds. Here is an article describing this method.

METHOD 4: CPAP

This particular method applies only if laryngospasm attacks occur mainly at night while sleeping. Essentially, one uses a CPAP machine which blows air into your lungs while you sleep. This treatment helps by preventing the body from believing it is "drowning" which would result in vocal cord adduction. By having a persistent positive airflow from the CPAP device, it also reinforces to the brain to keep the vocal cords apart. At worst case, if an attack occurs, the CPAP machine helps push air into your lungs past the vocal cords. Indeed... if you ask any anesthesiologist what they do when a laryngospasm attack occurs during intubation, they'll say apply strong positive pressure by mask (along with other things of course).

Make sure you use heated humidification. Please be aware that the air pressure being applied MAY actually cause laryngospasm due to direct vocal cord irritation of the forced air. Unfortunately, there's no way to predict someone who will respond vs someone who will do worse with this treatment method.

Other Treatments

Oftentimes, the above strategies help enough that a patient finds these attacks occur less frequently with decreasing severity over time until they altogether stop. Rarely, a benzodiazepine medication will be prescribed for these attacks to help with the anxiety aspect until the strategy is internalized. Working with speech pathology has also been found to be helpful. In certain situations, laryngeal sensory neuropathy (LSN) may be contributing to VCD and treatment geared towards LSN improves VCD. Of course, treatment of the trigger whether it be allergy, asthma, or reflux is important.

In rare cases, I will consider injecting BOTOX into the vocal cords which will physically prevent the vocal cords from coming together and as such, prevent the difficulty in breathing should an attack occur. In some people, it decreases not only the severity, but also the frequency of attacks. The way BOTOX is injected into the vocal cords is shown below in the video. Please note that the vast majority of patients upon whom I perform vocal cord BOTOX injections are those suffering from spasmodic dysphonia.



Read the news article here.

Read more about vocal cord dysfunction here.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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