- Vocal cord dysfunction (VCD) is a common condition characterized by the throat inexplicably closing during rigorous exercise.
- Symptoms of VCD resemble asthma, which leads to misdiagnosis and many are prescribed steroids and other medications.
- A novel approach that involves visual biofeedback, training in specific breathing techniques, and feedback regarding performance psychology has been developed.
- Around 75% of the patients perceived improvement in breathing during strenuous exercise.
Vocal cord dysfunction (also known as exercise-induced laryngeal obstruction) is a common condition characterized by the throat inexplicably closing during rigorous exercise.
‘Therapeutic laryngoscopy during exercise creates and opportunity to address both mechanical issues and performance psychology issues.’
AdvertisementIt can dramatically increase breathing difficulty, diminish performance and often causes panic in those who experience it.
"It's terrifying for these patients. Imagine running a race, then being forced to breathe through a straw on your last lap. That's essentially what it feels like for these athletes," said Tod Olin, MD, MCSC, principal investigator of the study and director of the Pediatric Exercise Tolerance Center at National Jewish Health in Denver.
Because the symptoms of VCD are similar to asthma, patients are often misdiagnosed and many are prescribed steroids and other medications that simply don't work. "Ultimately, these athletes often quit their sports out of fear or frustration," said Dr. Olin. "In some parts of the world, they are treated with surgery."
In an effort to better treat patients who did not respond to speech therapy, which is considered the first line therapy, Dr. Olin developed a novel approach that involves visual biofeedback, training in specific breathing techniques, and feedback regarding performance psychology.
"In addition to the mechanical changes in the throat, almost all of these athletes have thoughts during exercise that are working against them. Therapeutic laryngoscopy during exercise creates and opportunity to address both mechanical issues and performance psychology issues," said Dr. Olin.
In a recent study published in the journal Pediatric Pulmonology, Dr. Olin tested the approach on 41 adolescent athletes with VCD, who had not responded to other interventions.
With therapeutic laryngoscopy during exercise, Dr. Olin fits patients with a helmet that has a small camera attached to it. The camera is fed through the patient's nose and positioned just above the throat. Once the camera is in place, patients then undergo a strenuous workout on a stationary bicycle.
With real-time throat images from the camera, they can learn to control their throat's effect on breathing.
"For many of these athletes, visualization and film review are part of training," said Dr. Olin. "I think of therapeutic laryngoscopy during exercise as a highly-specialized teaching tool to cure a problem that is very difficult for patient to otherwise conceptualize."
Dr. Olin teaches breathing techniques to keep the throat open during exercise and teaches patients certain psychological tools to conquer symptoms.
"Most athletes can control their breathing without any trouble while they are in a chair. The challenge for patients with this condition is to control breathing during intense exercise," said Dr. Olin. "During our sessions, I work with patients while they are pedaling as fast as they can on a bike or while running up to 14 miles an hour on a treadmill. That way they can learn to use these techniques under intense, but real life situations."
The conclusions were that 75% of the patients perceived improvement in breathing during strenuous exercise, and 85% called the approach the most important therapy they had undergone to achieve breathing improvement.
The approach also represented the first time many of these athletes were made aware of the psychological aspect of their condition.