Vocal cord dysfunction.

What is this?  Feels like throat tightness, not lung/chest tightness.  Starts less than 5 minutes into exercise and recovers within 5-10 minutes from stopping exercise.  These patients do not benefit from beta-agonist (albuterol) challenge like those who have exercise-induced asthma do.  Predisposing factors: allergic symptoms, anxiety, reflux.  Most common patient is a type A teenage female.

How to evaluate?

• A laryngoscope during exercise.  Yep, this is just like it sounds…This is when the patient rides a bike hard or runs on a treadmill fast and then a scope is introduced into the mouth and down the throat to look at the vocal cords.  The vocal cords SHUT instead of open (!) in vocal cord dysfunction.  This is counterintuitive as during exercise, the athlete needs MORE air.  This makes it difficult for the athlete to inhale as much air as their body would like.

Treatment:

• Speech therapy!  This is really the mainstay of treatment to help the vocal cords from shutting when they should be open.,
• treat reflux as if stomach acid comes up the esophagus, the vocal cords may shut in response to this acidic insult to the cords,
• behavioral treatment to help decrease anxiety.