The Birds and the Bees and VCD?


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Misdiagnosed

Breathing problems can accompany a multitude of conditions including asthma, laryngeal malformations, coughing, narrowing of the windpipe, stress, anxiety, intense exercise, certain smells or illness. Many times a condition that presents like asthma goes misdiagnosed for far too long, with inhalers that don’t work. When the inhalers do not improve, it is often misdiagnosed again as stress and anxiety and treated with medications. BUT, the patients continue to suffer…

What is VCD?

Paradoxical Vocal Fold Motion, or Vocal Cord Dysfunction (VCD), is a disorder of the vocal cords that causes episodes where patients can’t get air in, or out, or both. Behavioral management is highly effective in these patients when received from speech-language pathologists (Vertigan & Gibson 2016). Patients with VCD may often also be athletes, have a type-a personality and can also have asthma that triggers the episodes of VCD. One big difference in other respiratory conditions and VCD is that VCD will not happen during sleep AND if a patient loses consciousness after an episode, they will begin to breathe normally again.

Hina Talib, MD, who specializes in treating teens and adolescents says the prevalence of VCD in children and adolescents admitted to hospital for bronchial asthma may be as high as 14 % and in as many as 5% of Olympic athletes (Kenn & Hess 2008) She also states that it can be seen in all ages, and that in children it can emerge around 14 or 15. In children under 18, 85% diagnosed with VCD are girls.

How Does Speech Pathology Help?

Speech-language pathologists (SLPs) an help by completing videostroboscopy to visualize the larynx. This can be done with a rigid or flexible scope. This benefits the patient a great deal because they can begin to better understand the larynx and its inner-workings, for a better treatment outcome. SLPs can help by: 1) teaching patients how to open and close their vocal cords, 2) teaching rescue breathing techniques to help keep the vocal cords open during an episode 3) reducing severity and frequency of the episodes in hopes that we can get rid of them completely.

 


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Vertigan and Gibson describe in their 2016 book that this is how we see VCD symptoms now. It is only when we see the whole picture, that we can know what we are dealing with.



Clip art drawn by Daniel @thestudyingspeechie on Instagram

Clip art drawn by Daniel @thestudyingspeechie on Instagram

Techniques Instead of Drugs?

Tod Olin and colleagues have truly given us a great addition to the abdominal open throat breathing that we were using to treat VCD in the past. In their 2017 article, Sarah Graham, Emily Deardorff and Kristina Johnston help Tod Olin describe a case study using these novel techniques. Then in 2018, the team describes the case series to better describe how to implement these breathing techniques in patients suffering from VCD. The EILOBI or Exercise Induced Laryngeal Obstruction Biphasic Inspiratory techniques are unique. The inhale is broken down into 2 parts with a restriction followed by an opening with 3 different variants: the tooth, the lip and the tongue variants.

A Group Effort

It is extremely important that if you suspect you or someone you know has VCD, you get checked out by a team of professionals. A certified allergist and clinical immunologist like Dr. Manisha Relan can help rule out other issues and determine if allergies make your VCD worse. An ENT can also visualize the larynx and identify if reflux is making it worse. Since this disorder affects teens and adolescents, a physician like Dr. Hina Talib who specializes in treating VCD and anxiety can be very helpful. Collaboration is key because if we do not see the whole picture, the patient keeps getting treated for something that is not the true cause of the breathing difficulties, leading to frustration and time wasted.

 

 

Resources for SLPs Treating VCD

Speech Pathology Management of Chronic Refractory Cough by Anne Vergitan and Peter Gibson has an EXCELLENT portion dedicated to how we treat VCD. I also spent a lot of time crafting handouts that I use in my clinic to help treat Vocal Cord Dysfunction from evaluation to the therapy room. These handouts are available HERE or on TPT. For younger clients suffering from VCD, I created the game packet called Breathe Easy which is also available either HERE or on TPT. Even in Spanish too.

Ultimately, if you are unsure of how to treat VCD, please refer to a speech-language pathologist trained and experienced in helping this population.

Wanna learn more about VCD? Click Here for a great article by K.Kenn and R. Balkissoon from the European Respiratory Journal in 2011.

Here is a great website for parents too.

Sources:

Johnston KL, Bradford H, Hodges H, Moore CM, Nauman E, Olin JT. (2018) The Olin EILOBI Breathing Techniques: Description and Initial Case Series of Novel Respiratory Retraining Strategies for Athletes with Exercise Induced Laryngeal Obstruction. Journal of Voice Nov;32(6):698-704. doi: 10.1016/j.jvoice.2017.08.020

Klaus Kenn & Markus Hess Vocal Cord Dysfunction: An Important Differential Diagnosis of Bronchial Asthma. Dtsch Arztebl Int 2008 Oct;105(41):699-704

Graham S, Dardorff E, Johnston K, Olin JT. (2017) The Fortuitous Discovery of the Olin EILOBI Breathing Techniques: A Case Study. Journal of Voice.

Vertigan, A & Gibson, P. Speech Pathology Management of Chronic Refractory Cough and Related Disorders, Compton Publishing 2016

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on voice science nationally. She is part of the Professional Development Committee for ASHA Special Interest Group 3, Voice and Upper Airway Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at  www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.

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