Vocal Cord Dysfunction (VCD): Why the Term Should Be Abandoned

Vocal cord dysfunction (VCD) has become a useless term in laryngology because it is defined differently by different clinicians. It has been used to mean:

• a voice disorder,
• a breathing disorder,
• a cough disorder, or
• laryngospasm,
• or some combination of the above.

As a result, “VCD” functions as a catch-all diagnosis, blurring together heterogeneous conditions that should instead be carefully distinguished.

If a clinician states, “This patient has VCD,” the natural reply would be: “Do you mean an abnormal voice? Breathing difficulty? Cough? Laryngospasm?” The phrase is about as unhelpful as saying, “The man traveled in a conveyance.” One must ask: “By plane? Car? Train? Motorcycle?”

Four Ways “VCD” Is Used

(abstracted from common online usage by artificial intelligence)

1. VCD as a Voice Disorder:

   Paradoxical vocal fold movement disrupts normal voicing, producing episodes of dysphonia, voice breaks, or inability to sustain phonation.

2. VCD as a Breathing Disorder:

   Vocal folds close inappropriately during respiration (usually on inspiration), causing episodic upper-airway obstruction with shortness of breath, throat tightness, and noisy inhalation (stridor).

3. VCD as a Cough Disorder:

   Paradoxical vocal fold closure and laryngeal hypersensitivity trigger cough in response to minimal stimuli such as talking, laughing, odors, temperature change of ambient air, touching a spot on the neck, etc.

4. VCD as Laryngospasm:

   Episodic, inappropriate adduction of the vocal folds during respiration, producing partial or near-complete airway obstruction — essentially laryngospasm called VCD instead.

In all four cases, paradoxical or inappropriate vocal fold motion is the proposed finding, but the phenomenology differs: voice change, impaired breathing, cough, or laryngospasm.

Sorting Out Mechanism vs. Use

Logic suggests that each expression of “VCD” could have either:

• a neurological/neuromuscular cause, or
• a behavioral / nonorganic cause (i.e., “software, not hardware”).

1. Voice disorder “VCD”

   • Neurological differential: laryngeal dystonia (spasmodic dysphonia), ALS, paresis/paralysis, myoclonus, etc.
   • Nonorganic: consciously or subconsciously manipulated voice production (malingering for external gain; somatization or factitious disorder for psychological benefit).
   • Distinction: usually straightforward via Part II of the Integrative Diagnostic Model — modeling, elicitation, trial therapy, and judging patient response.

2. Breathing disorder “VCD”

   • Neurological differential: respiratory dystonia, paresis/paralysis, neuromuscular disease.
   • Nonorganic: secondary gain–related breathing disturbances (seen in young athletes, for example).
   • Clues: inspiratory noise (not expiratory, as in asthma); may peculiarly have been treated as asthma, sometimes for years before correct diagnosis.

3. Cough disorder “VCD”

   • Neurologic diagnosis via syndrome match: sensory neuropathic cough is usually a prima facie diagnosis once pulmonary causes are ruled out.
   • Nonorganic cough — typically unimodal, perfunctory, predictable, distractible, with cognitive dissonance and peculiar serenity (“la belle indifférence”).

4. Laryngospasm “VCD”

   • Neurological diagnosis: a sensory hyperexcitability disorder, clearly recognizable long before “VCD” became a diagnosis in vogue. The clinical scenario is clear and the diagnosis should be simply … laryngospasm! An abrupt, terrifying triggering of the laryngeal closure reflux that lasts from a few seconds to (most commonly) about a minute, and rarely, 90 seconds.
   • Nonorganic? not yet documented as nonorganic; malingering unlikely.

Clinical Bottom Line

Neurogenic vs. psychogenic: With rapport and skilled elicitation of diverse vocal and breathing tasks, clinicians can nearly always separate the two.

Recommendation: The term “VCD” should be abandoned. It obscures rather than clarifies, groups disparate phenomena together, and fails the test of diagnostic precision.