SELECTED ARTICLES FROM THE RECENT LITERATURE 2003

12/2/03

Vocal cord dysfunction in children

Summary
Vocal cord dysfunction (VCD) is a non-organic disorder of the larynx involving unintentional paradoxical adduction of the vocal cords during breathing. As reviewed by Tilles, VCD episodes in children and adolescents are most commonly triggered by exercise. Therefore, such VCD cases are typically confused with exercise-induced asthma. In these younger patients, VCD has been associated with gastro-esophageal reflux and psychiatric illness. Asthma and VCD may co-exist in the same child. Therefore, one should suspect VCD in cases of childhood asthma that are "atypical", not responding to adequate anti-asthma therapy. A definitive diagnosis of VCD requires direct visualization of the vocal cords during symptomatic episodes.

Reference
Current Allergy and Asthma Reports 2003; 3:467-72

Editor's Comments
I believe that diagnosing VCD is often very difficult, frequently when VCD mimics asthma. It must be particularly difficult in children. A flattened inspiratory curve in a flow volume loop obtained during spirometry raises the diagnostic possibility of VCD but direct visualization of the vocal cords is needed for definitive diagnosis. This is logistically difficult since VCD often occurs episodically in an unpredictable manner.

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