Tuesday, December 27, 2022
“The Human Voice is the most perfect instrument of all.” –Arvo Pärt, Classical Composer
When patients begin to lose their voice, for various reasons, it can be life altering. Our voice is our connection to the outside world, much like sight, touch, smell. Voice cord dysfunction (VCD) is thankfully rare, but it does affect approximately 2% of the population.
Most patients with VCD experience mild symptoms and recover within weeks to months. If left untreated, however, a clinical condition like VCD can result in permanent voice changes, even loss of ability to speak.
What are the symptoms of VCD?
Clinical features of VCD include:
- difficulty breathing
- throat clearing
- throat tightness
Vocal cord dysfunction symptoms can be intermittent and usually appear gradually. The diagnosis of VCD is based on the presence of a combination of VCD symptoms.
What are vocal cords?
The Vocal Cord is a part of your voice box, the larynx. It sits atop the esophagus and visibly moves up and down when you swallow. The vocal folds that make up the vocal cord are full of ligaments, laryngeal muscles and mucous membranes. They are directly responsible for phonation, your ability to speak and produce sound. This area is innervated mainly by the recurrent laryngeal nerve, and all of its nerve endings that culminate in the neuromuscular junctions, to produce movement, sound and speech.
What causes VCD?
A lot can irritate or damage the vocal cords. Causes include airborne irritants, upper airway obstruction, asthma, allergies, inflammation, poor nutrition, emotional trauma, thyroid disease, vocal cord tumors, muscle disease affecting throat muscles, and conditions leading to neuromuscular junction disruption and vocal cord paralysis, like in ALS VCD patients.
How is VCD diagnosed?
A correct diagnosis of VCD takes into account the symptoms and stages. A differential diagnosis includes mainly gastroesophageal reflux disease, breathing disorders like asthma, extrathoracic obstruction, immunologic disorders and more.
Gastroesophageal reflux disease is often a leading differential diagnosis. Acid reflux, laryngopharyngeal reflux, gastroesophageal reflux can all cause throat irritation leading to abnormal movement and constriction of the cords, directly affecting our ability to project voice with strength and clarity.
VCD is also often misdiagnosed as asthma exacerbation, due to the dyspnea in each acute episode. When the vocal cords close (vocal cord adduction) during the breathing in (inspiratory adduction) and/or breathing out (expiratory flow adduction) of the respiratory cycle, this obstructs airflow. Bronchial asthma, exercise-induced asthma, factitious asthma are all diagnostic options.
VCD is considered a mimicker of asthma. Hoarse voice, throat tightness, irritation in the throat, asthma symptoms, exercise-induced symptoms, respiratory symptoms affecting flow-volume loop, inspiratory loop and expiratory loop, chest-tightness, chest pain, can all point to a diagnosis of asthma in VCD patients.
What differentiates VCD is the gradual onset of dysfunction in vocal fold motion and vocal fold closure. VCD patients have functional breathing normally, good oxygenation (dyspnea without hypoxia), they just have a progressively harder and harder time speaking and producing sound.
There are times when VCD episodes lead to emergency department visit, due to acute symptoms and respiratory symptoms. VCD attack without severe asthma or concomitant asthma had, on average 9.7 emergency department visits at the year prior to the VCD diagnosis, one study found. Recurrent episodes are common.
Approach to diagnosis can lead to more options, more functional disorder types, like laryngo-malacia, vocal cord paresis, laryngeal obstruction, movement disorders, immunologic disorders, CNS dysfunction, strong emotions. All of these and more can be a part of VCD differential diagnosis.
How is VCD treated?
Usual treatment includes pharmaceuticals (asthma medications), herbal supplements, acupuncture, voice therapy, physical therapy, and more aggressive therapies like chemotherapy and surgery. Response to treatment of VCD varies depending on underlying conditions. Environmental irritants, psychological conditions, neurological conditions, respiratory failure and many other risk factors all require their unique approach.
Physicians in a clinical setting are looking at deep rooted structural, physiological and psychological factors and other precipitating factors to find effective long-term treatment.
How can stem cells and exosomes help vocal cord dysfunction?
Major trigger of acute VCD episodes is inflammation due to some form of irritation in the throat tissues. This can be from airborne irritants or from within the body. Pluripotent exosomes, the secretions from pluripotent stem cells, contain immunomodulatory factors that quench inflammation and repair structural and DNA damage in the tissues. Local injections of exosomes can turn around sequelae from an acute attack and set the vocal cord area into repair.
Long term management of VCD (vocal cord dysfunction) due to conditions that affect the neuromuscular junctions can benefit from intravenous applications of pluripotent stem cells and exosomes. These have the capacity to signal repair in all 220+ tissue types, including muscle, nerve, cartilage, tendon, ligaments, mucous membranes (all tissues of the voice box). The reparative peptides, mRNA and microRNA repair DNA damage, mitochondrial damage, and protein misfolding in the cells. They bring in new blood vessels and nerves to allow for better perfusion and sensation and movement. They repair and replenish damaged cells and allow for the reprogramming of the tissue to a healthy state.
We have ample clinical evidence that pluripotency therapy with stem cells and exosomes can restore function of the voice box. Here are two recent patient experiences.
Vocal Cord Paralysis Recovery Stories
Patient Story: Betsy
In 2007, Betsy took Cipro for her sinusitis, an antibiotic that many of us have been prescribed over the years, not realizing that its effects can be systemically damaging. What followed for Betsy was a fluoroquinolone toxicity reaction that has brought her life to a halt.
By the time she arrived at the Stemaid Institute in 2019, she had suffered over a decade of severely declining health, debilitating pain, bone fractures, tendon and ligament damage. The list of symptoms was endless.
Betsy could barely speak on her first visit, she could not project her voice from the damage to her voice box. She was suffering from spasmodic laryngeal dystonia, a vocal cord motion disorder in which voice folds lose elasticity, become stiff and the voice cannot be projected as usual.
Betsy received IVs and local injections of Pluripotent stem cells during her programs at Stemaid.
"The stem cells and exosomes are repairing my vocal cord as well as the area involving swallowing. I have more inflection and it's still easier to swallow. It's apparent to those around me. This is remarkable!" - Betsy
The proteins and peptides and transcriptions factors secreted from stem cells and delivered to the vocal cords via exosomes have potent growth factors, anti-fibrotic factors, DNA repair factors and elastin and collagen factors that help to repair the connective damage. The improvement is gradual of the weeks.
"I can't thank you enough for saving my life three years ago and giving me my voice back." - Betsy
In Betsy's case, the vocal cord movement should continue improving. She is monitoring that closely, her voice is precious to her. Being able to take part in a dinner table conversation at a busy restaurant, and be heard past the background noise, was a huge turning point at the end of her last treatment with us.
Patient Story: Vicky
Vicky is a patient that came to Stemaid Institute with ALS. Her symptoms began with a loss of sensation in her tongue, then loss of its mobility, and ultimately led to inability to swallow and speak. The neuromuscular junctions are directly affected in a condition like ALS and the laryngeal area is one of the first areas to lose function. Vocal cord paralysis is a part of this degenerative functional disorder. She and her family have tried it all, sought out the best of regenerative care, yet the condition kept progressing. She was losing her smile.
At Stemaid Institute, Vicky received IVs and local injections of pluripotent stem cells and exosomes, peptides, and regenerative IVs on a daily basis. She slept throughout her treatments, she was so worn out, yet gradually the sensory receptors in her tongue and throat resumed. This was so key for her! A glimmer of hope of healing ahead. Vocal fold movement became noticeable in the 3rd week of treatment and she began producing sound, humming and some intonation. Her daughter noticed she said a clear 'no' to her one day. This moved them to tears.
Vocal fold motion disorder is a part of ALS and if we can get patients resume gentle humming and ultimately speech, it goes a long way on the path to recovery. Voice therapy, speech therapy and physical therapy are a part of the steps ahead. A speech therapist could help Vicky keep reactivating the neuromuscular junctions. We hope to see Vicky continue to improve in months and years ahead.