Vocal Cord Dysfunction (VCD)

Inducible laryngeal obstruction is an upper airway disorder related to irritation of the voice box. Normal breathing requires the vocal cords to remain open so air can pass in and out of the lungs. During an ILO episode, the vocal cords start to close involuntarily during inhalation. This narrows your airway, making it difficult to inhale. When these symptoms are triggered by exercise, it is called exercise-induced laryngeal obstruction (EILO).

Sometimes, high-pitched sounds may come from your throat during an episode. ILO and EILO are frequently misunderstood, misdiagnosed, and mistaken for asthma or a severe allergic reaction because of similar symptoms.

Our team will take a detailed history of your breathing symptoms to note the patterns that suggest ILO and identify any triggers for these episodes. Your laryngologist -- an ear, nose, and throat (ENT) doctor with advanced training in voice and throat disorders -- will also evaluate whether any medical conditions, surgeries, or recent illnesses could have caused changes in your voice or breathing. We will perform a head and neck examination and a visual examination of your voice box.

Videolaryngostroboscopy
Videolaryngostroboscopy is the gold standard for vocal cord and voice box evaluation. This detailed visual exam enables your provider to observe how your vocal cords vibrate while you speak and to look for lesions, stiffness, paralysis, irregular movements, throat strain, incomplete closure of the vocal cords, or other physical contributors to your voice problem. This test is typically only available at advanced ear, nose, and throat (ENT) clinics, like those at Duke.

A tiny camera attached to a small tube called an endoscope is inserted through your nose, allowing your provider to see your vocal cords and larynx (voice box). The camera records while a flashing strobe light simulates slow motion video capture of your vocal cords moving. Compared to a still photo, this video allows your provider to see subtle changes in how your voice box and throat function when you make different sounds. It takes only about a minute, and your nose may be sprayed with topical anesthetic to numb and open the nasal passages to make it more comfortable for you

If ILO is suspected, your team will evaluate the movement of your vocal cords during breathing. Even if an ILO episode is not captured during this exam, a thorough evaluation of your voice box ensures that all structures are normal. After the exam, your team will review the images with you to discuss your diagnosis and treatment plan. 
 

Team of Experts
At Duke, one of the few comprehensive voice centers in the Southeast, your care team will include laryngologists and speech-language pathologists specially trained to evaluate and treat patients with voice problems and laryngeal disorders. Our team has years of experience treating ILO and EILO.

Team Care Approach
If you have other medical conditions that may contribute to your voice issues -- such as allergies, asthma, or acid reflux -- we will work with your other providers throughout Duke Health to ensure you receive the best care from an integrated team.

Care for Athletes
If you are an athlete with exercise-induced laryngeal obstruction (EILO), we can coordinate with your coach to provide education about your condition and share breathing strategies for you to use.