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Vocal cord dysfunction and laryngeal hyperresponsiveness: a function of altered autonomic balance?
  1. J G Ayres1,
  2. P L A Gabbott2
  1. 1Department of Respiratory Medicine, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK
  2. 2Department of Experimental Pyschology, South Parks Road, Oxford OX1 3UD, UK
  1. Correspondence to:
    Professor J G Ayres, Department of Respiratory Medicine, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK;
    ayresj{at}heartsol.wmids.nhs.uk

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The interrelationships between vocal cord dysfunction and laryngeal hyperresponsiveness may have profound implications in the diagnosis and management of patients with difficult respiratory symptoms.

The ability of land animals to oxygenate via the lung as they developed from aquatic species means that a system also evolved for protecting the lung from flooding—the glottis. Although in man this is considered primarily as an organ of speech, disturbance of its protective function will threaten the integrity of the lung. While obstructive conditions in the larynx can cause breathlessness, abnormal function of an otherwise structurally normal larynx can also lead to symptoms. Such a condition is vocal cord dysfunction, characterised by paradoxical movement of the vocal cords resulting in marked reductions in airflow and breathlessness.1

During normal respiration the false vocal cords move very little while the true cords abduct slightly during both inspiration and expiration.2 In vocal cord dysfunction, paradoxical movement of the true and/or false cords occur during inspiration, expiration, or both.2,3 Vocal cord dysfunction frequently co-exists with asthma4,5 and is usually considered as being exclusively associated with psychopathology,1,4 a view which is perpetuated in part by the diagnosis only being considered in that situation. However, vocal cord dysfunction can occur in psychologically normal …

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