| | More

Vocal Cord Dysfunction

Marianna Sockrider, MD, DrPH
Associate Professor
Pediatric Pulmonology
Baylor College of Medicine
Houston, Texas

Introduction

Vocal cord dysfunction (VCD) is a condition in which the vocal cords have paroxysmal closure during inspiration resulting in acute dyspnea and symptoms of acute airflow obstruction. VCD can mimic asthma but does not respond to pharmacotherapy. Some patients with asthma can also have VCD. Therapy for VCD is primarily behavioral with breathing exercises and stress reduction techniques.

The ATS has published an Patient Information Series fact sheet on VCD that is available on its Patient Education website.  It is available in English and Spanish.  This fact sheet remains high in the Google™ search listing and has been a useful resource for patients and public education.

 Last Update: September 2009

Search

The search for websites providing information on VCD was done with the use of a search engine (Google) with the search term specific phrase "vocal cord dysfunction" and English language only. This search yielded a total of 81,600 sites. The first 150 site listings were reviewed by this author, based on Google's hierarchy. There were duplicate listings and many of the sites were news releases or journal articles which were not reviewed in detail since they reported on individual studies rather than providing an overview. All sites had to list the authors or an organizational sponsor of the website. The criteria for an acceptable site included adequate content, level of depth of material, appropriateness and value of links and date of last update.  The reading level was calculated by copying the website text into Microsoft® Word and calculating the Flesch-Kincaid score. A search of websites for relevant professional societies did not identify any other content related to VCD (American Speech-Language-Hearing Association, American Society of Pediatric Otolaryngology,  American Academy of Otolaryngology, British Society of Pediatric Otorhinolaryngologists and American College of Chest Physicians).

The goal was to profile a maximum of ten sites that appropriately cover this topic with a primary focus on patient/family educational content.  Several sites that have resources for health professionals are also included. Given the large number of sites, this review is not exhaustive, but represents sites that are informative. Despite the large volume of website listings, there were few high-quality sites found. Because of this a few commercially sponsored sites were included that offer public education through access to health encyclopedias.

Best Websites

National Jewish Medical Research Center Patient Information: VCD

This webpage provides patient education on VCD from National Jewish Medical and Research Center.

  1. Authority: National Jewish Medical and Research Center and its speech-language pathologists maintain this site. Physicians at National Jewish first described VCD in 1983 as a condition that could be confused with asthma. Rating: 5

  2. Currency: Currency: The site has not been updated since July, 2006 with information approved by Marcy Hicks, MS, CCC-SLP. Rating: 3

  3. Accuracy: The information is accurate and appropriate for lay readers. Rating: 5

  4. Navigation & Readability: There is good use of headings making the website easy to search and navigation is excellent. The reading level is high. There are no graphics to support the text. The reading level is 10.8th grade by the Flesch-Kincaid score. Rating: 3

  5. Utility: The content areas are defined into six categories listed in the left-hand column: Triggers, Symptoms, Diagnosis, Associated Conditions, Treatment and Lifestyle Management. On the right side is a link to programs offered by National Jewish Health for VCD. The site encourages patients to seek treatment to control VCD rather than just live with its symptoms. No specific information regarding speech pathology techniques are provided. Rating: 4

Summary: Overall, this site is accurate and well-designed for lay education. The materials are up to date. The reading level could be lower. This is a very good site.****

Duke Health

N/A

  1. Authority: The website is produced by the Duke University Health System. There is no specific author listed for this webpage. Rating: 4

  2. Currency: The webpage was published Feb 27, 2008 and has not been updated since. Rating: 3

  3. Accuracy: The information provided on VCD is accurate. Rating: 4

  4. Navigation & Readability: This single webpage is found under "Care Guides for the Voice Care Center". From the hospital’s homepage, the user clicks on "Explore Patient Care Services" where one can browse a list of medical conditions. However, VCD is not specifically listed. Rather one has to click on "Voice Care Center" and then go to "Education and Resources" to get to the Care Guide. The reading level is 9th grade by the Flesch-Kincaid score. Rating: 2

  5. Utility: The webpage provides lay readers a brief overview of VCD, its symptoms, who gets VCD, its diagnosis and treatment. The text size can be adjusted on the site. There are no graphics. Rating: 4

Summary: This webpage provides good basic information on VCD for the lay reader, but it could be enhanced with graphics and a lower literacy level.***

Children's Hospital , St. Louis, Missouri

N/A

  1. Authority: The website is produced by the Children's Hospital, St. Louis, Missouri affiliated with the Washington University School of Medicine. There is no specific author listed for this webpage. Rating: 4

  2. Currency: The website is copyrighted 2009. It is not clear if that is the date of last update for this page. Rating: 3

  3. Accuracy: The information provided on VCD is accurate though limited. Rating: 4

  4. Navigation & Readability: This single webpage provided under specialty programs is embedded under medical services/therapy services. From the hospital's homepage, it is not clear how to find this site except by using the general search function. It is not found on the "Patients and Families" tab. The reading level is 7th grade by the Flesch-Kincaid score. Rating: 2

  5. Utility: The webpage provides lay readers a brief overview of VCD, its symptoms and its causes. There is a graphic showing normal opening and closing of the vocal cords. There is no specific information about treatment except that a speech pathologist and psychologist will likely play and important role. There is no description of how to make a diagnosis. Rating: 3

Summary: This web page provides basic information on symptoms and causes of VCD for the lay reader.***

University of Arizona Pediatric Patient Information - VCD

This website provides patient and parent information on VCD as part of pediatric patient information provided by the University of Arizona.

  1. Authority: This site is produced by the Arizona Respiratory Center at the University of Arizona College of Medicine. There are links to information regarding the Center and its staff but specific authors for the webpage content are not identified. Rating: 4

  2. Currency: The site was copyrighted by the Arizona Board of Regents in 2005. Last update January 25, 2008. Rating: 5

  3. Accuracy: The information provided is accurate. Rating: 4

  4. Navigation & Readability: The text is written in first person addressing the patient directly. The reading level is 10th grade by the Flesch-Kincaid score. There are no graphics to support the text. There is good use of headings. The website is easily searched and navigation is very good. Rating: 3

  5. Utility: This site provides a short overview with links to additional online resources. The information covers the basics of presentation, diagnosis and treatment. Rating: 3

Summary: Overall, this site is an accurate but brief description of VCD for lay education.***

Healthline® Connect to Better Health

This website provides a description of VCD as part of a set of online health encyclopedias for public education.

  1. Authority: This site is produced by Healthline Media Network. Healthline was founded in 1999 as YourDoctor.com and was relaunched as Healthline Networks in 2005. This content is licensed from GALE CEngage Learning and is extracted from the Gale Encyclopedia of Children's Health. The authors are listed as Tish Davidson A.M. and Thomson Gale. No other information is provided about the authors. Rating: 3

  2. Currency: The site's most recent update was April 4, 2006. Rating: 3

  3. Accuracy: The information provided is accurate. Rating: 4

  4. Navigation & Readability: The text font is small and the reading level is high. The content is divided into five webpages and the headings are given on the left column so one can navigate to a specific section or click page-by-page. Included are sections that have not been in other sites such as parental concerns and alternative treatment (biofeedback). There are hotlinks for words throughout the text that allows the reader to go to definitions for terms such as stridor and laryngoscopy. There is also a limited key-term glossary included in the text. There are no graphics to support the text. There are advertisements across the top and margins that are somewhat distracting. The reading level is 11.7th grade by the Flesch-Kincaid score. Rating: 3

  5. Utility: This site contains a thorough overview with information from presentation to treatment of VCD. Rating: 4

Summary: Overall, this site is accurate and appropriate for lay education. While the reading level is high, there are links to definitions and many medical terms are included.***

Allergy and Asthma Network: Mothers of Asthmatics

N/A

  1. Authority: This site is produced by the Allergy and Asthma Network and Mothers of Asthmatics. The author of this article is Laurie Ross. It was first published in the organization’s lay publication Allergy & Asthma Today, Volume 6, Issue 1 in February, 2009. She conducted interviews with Susan Brugman, MD, Pediatric Pulmonologist, National Jewish Medical and Research Center, Sunil Kapoor, MD, Pediatric Pulmonologist, the Pediatric Lung Center in Fairfax, Virginia, Michael Mellon, MD, pediatric allergist, the Southern California Permanente Medical Group in San Diego, CA and Susan Miller, PhD, CCC-SLP, certified speech-language pathologist at Georgetown University Hospital. Rating: 4

  2. Currency: The webpage was posted on February 19, 2009. Rating: 5

  3. Accuracy: The information provided is accurate. Rating: 4

  4. Navigation & Readability: The article begins with a pediatric case example and discusses her work up and management. The article covers information regarding the diagnosis, common symptoms, triggers, comparison to and treatment. There are no graphics to support the text. Rating: 3

  5. Utility: This site provides a short article with basic information. Rating: 3

Summary: Overall, this article is accurate and up-to-date for lay education. It is good article.***

Yahoo! Healthwise Public Education Asthma and Vocal Cord Dysfunction

This website provides a short description of VCD and asthma as part of an online health encyclopedia for public education.

  1. Authority: This site is produced by Healthwise on Yahoo! Health site under its section on Asthma. The author is Maria G. Essig, MS, ELS and medical reviewers are listed. Rating: 4

  2. Currency: The webpage was last updated on May 15, 2007. Rating: 3

  3. Accuracy: The information provided is accurate. Rating: 4

  4. Navigation & Readability: The content is presented as a single webpage. The focus is on features that distinguish VCD from asthma. There are a few hotlinks for words throughout the text that allows the reader to go to other webpages for information on terms such as spirometry and gastroesophageal reflux. There are advertisements along the right margin that are somewhat distracting. The reading level is 7.9th grade by the Flesch-Kincaid score. Rating: 3

  5. Utility: This site contains a short overview focused primarily on distinguishing VCD from asthma. Rating: 3

Summary: Overall, this site is accurate and appropriate for lay education. It would have been helpful to describe more about treatment.***

Aspirus Wausau Hospital Patient Education - VCD

N/A

  1. Authority: This is a fact sheet produced by Aspirus Wausau Hospital, a nonprofit, community-directed health system based in Wausau, Wisconsin. There is no specific author listed for this webpage. The webpage is part of the Dr. Joseph F. Smith Medical Library, a research and health care resource center for health care professionals, patients, families and community members. Rating: 3

  2. Currency: The material is dated September 15, 2008. Rating: 4

  3. Accuracy: The information provided on VCD is accurate though limited. Rating: 4

  4. Navigation & Readability: The link on the Google search goes directly to the handout. It is not clear how to go from the library homepage to the handout, and there was no search function that was able to find the handout. The reading level is 5th grade by the Flesch-Kincaid score. Rating: 3

  5. Utility: This is a fact sheet that outlines breathing techniques used with VCD including the use of abdominal breathing technique. The content is written in the third person, so it is not clear if it is for the lay reader or the health professional. It mentions breathing inhalation techniques and suggests that relaxation techniques can also be added. It does provide more detail than most sites about breathing techniques. There are statements such as reassuring the patient that nothing is wrong that are somewhat misleading. No graphics are provided. Rating: 3

Summary: This webpage provides basic information on symptoms and causes of VCD for the lay reader.***

Asthma and Allergy Foundation of America (AAFA), Texas Chapter

N/A

  1. Authority: This is an article published in the free newsletter, Air It Out Electronic Version, published by the Asthma & Allergy Foundation of America, Texas Chapter. No author is identified. Rating: 3

  2. Currency: The material is dated March, 2008 and is published in Volume 15 Issue 3 #2. Rating: 4

  3. Accuracy: The information provided on VCD is accurate though limited. Rating: 4

  4. Navigation & Readability: The link on the Google search goes directly to the article. From the homepage, one can click on the tab for newsletters and scroll down the titles until this article is found. There does not appear to be a search function on the site. Rating: 3

  5. Utility: This is a newsletter article that defines VCD and briefly describes its symptoms compared with exercise-induced asthma. In addition, its diagnosis outlines breathing techniques used with VCD including the use of abdominal breathing technique. It mentions training from a speech pathologist on voice and breathing inhalation techniques and suggests that relaxation techniques can also be added. Rating: 3

Summary: This electronic news article provides basic information on symptoms and management of VCD for the lay reader.***

Other Important Sites

  • University of Delaware
    http://www.udel.edu/shs/staff/manuals/technical/VCD.ppt

    This website contains a 63-slide This website contains a 63 slide PowerPoint presentation on exercise-induced paroxysmal vocal cord dysfunction. The presentation was made by Dale Gregore, MS, CCC-SLP, speech pathologist and Clinical Rehabilitation Specialist at the University of Delaware. There are a number of useful images on the slides and content for health professionals. Case examples are included. However, speaker's notes are not provided. No presentation date is provided.

  • University of Texas Medical Branch Grand Rounds - Vocal Cord Dysfunction
    http://www.utmb.edu/otoref/grnds/Vocal-Cord-2001-07/VCD-2.htm

    This website provides a summary of a grand rounds presentation made at the University of Texas Medical Branch in Galveston, Texas. The target audience is health care professionals. The authors are Senior Medical Student Todd M. Weiss and faculty Francis B. Quinn, Jr., M.D.,FACS, MS (ICS), PE Professor of Otolaryngology and Pathology. The text is from a presentation done in July 18, 2001 and no attempt has been made to update it. This is a very thorough review including an extensive reference list, differential diagnosis and graphics.

  • University of Connecticut Otolaryngology Resident Medical Education VCD
    http://penguin.uchc.edu/~otomain/residency-PPTpresentations.htm

    This website provides a copy of a faculty PowerPoint presentation on VCD given at the University of Connecticut in 2002. The presentation was given by Starr Cookman MA, CCC-SLP, who is a faculty speech pathologist. The content is accurate. There are 49 slides in total that are generally well written and clear. However, some would require speaker's notes to know more fully what point is being made. There is no opening outline slide. There is reference to videotape clips, but those are not available on the website. There are very good images of vocal cords illustrating abnormalities which are not found in other sites reviewed. There are evaluation questions and a case study but no speaker's notes to accompany the slides are provided.

Disclaimer

The author has no personal or financial interest in any of the websites discussed above. The author has no personal or financial interest in any of the websites discussed above.