Vocal cord dysfunction treated with long-term tracheostomy: 2 case studies.

BACKGROUND: Vocal cord dysfunction (VCD) is an increasingly recognized condition that affects the upper airway, which can be difficult to discriminate from asthma. Speech therapy and psychological cognitive therapy are the mainstays of treatment, but other modalities have been used when response is unsatisfactory. OBJECTIVE: To present 2 case studies in which VCD has been treated with long-term tracheostomy. METHODS: In the first patient, VCD was diagnosed by nasoendoscopic demonstration of paradoxical movement of the vocal cords. The patient was transferred to a regional unit, where nasoendoscopy was performed, which revealed immobile and adducted vocal cords. The decision to perform emergency surgical tracheostomy was made. In the second patient, a possible additional diagnosis of VCD was suggested during a hospital stay, and nasoendoscopy was performed. RESULTS: Both patients report considerable subjective benefits. Objective improvement was seen in only one patient. CONCLUSIONS: Tracheostomy is an invasive procedure that carries risk of potential morbidity and should only be considered as a final option in carefully selected cases.