Vocal cord dysfunction in de pediatrische praktijk

Vocal cord dysfunction (VCD) is a functional vocal cord disorder characterized by a variable extrathoracic airway obstruction due to paradoxical adduction of the vocal cords during inspiration. The exact pathophysiology and etiology of VCD have not yet been fully elucidated and various comorbidities (asthma, gastroesophageal reflux) and triggers (exercise, irritants) are associated with this disorder. The clinical spectrum of VCD is diverse and an initial misdiagnosis as asthma is common. Extensive diagnostic evaluations and unnecessary asthma medication are the cause of additional morbidity and iatrogenic complications in many pediatric VCD patients with an incorrect asthma diagnosis. The diagnosis of VCD in children is based on a thorough clinical and possibly laryngoscopic evaluation, preferably at the time of the symptoms, combined with pulmonary function testing. The differential diagnosis of VCD is, however, broad and additional investigations are planned according to the clinical presentation. Speech therapy with breathing exercises is the cornerstone of pediatric VCD treatment and is associated with an efficient short-term symptom control in the majority of the patients. Additional treatment options with beneficial effects in VCD subgroups include psychotherapy and inhaled anticholinergic drug therapy. The long-term prognosis of VCD in children and adolescents has not yet been clarified.