Speech Therapy for Inducible Laryngeal Obstruction (ILO)/Vocal Cord Dysfunction (VCD)
If you’ve ever felt like you can’t get air in, especially during exercise or stress, but asthma treatment isn’t helping, you may be experiencing Inducible Laryngeal Obstruction (ILO).
What is ILO?
ILO (also known as Vocal Cord Dysfunction or VCD) occurs when the vocal cords/supraglottic structures narrow instead of staying open during breathing.
What are the symptoms of ILO?
People with ILO often report:
· Difficulty breathing in
· A tight or blocked feeling in the throat
· Noisy breathing (stridor)
· Sudden episodes that come and go
· Symptoms triggered by exercise, stress, or irritants
ILO vs Asthma: What’s the difference?
ILO is commonly mistaken for asthma, and the two often coexist.
Key differences:
· ILO affects the upper airway (larynx/throat)
· Asthma affects the lower airways (lungs)
· ILO often feels like there is more trouble breathing in
· Asthma causes trouble breathing out
Sometimes ILO can be misdiagnosed as asthma. This can lead to high-dose inhalers or steroids that don’t feel like they are effectively helping, as these medications don’t treat ILO.
How is ILO diagnosed?
The most accurate way to diagnose ILO is through laryngoscopy and multidisciplinary assessments.
Laryngoscopy: A small camera is used to observe how your vocal cords behave during breathing. At Speak and Swallow, we use functional laryngoscopy to assess breathing, voice, and swallowing in real-life tasks.
Respiratory Assessments: respiratory physicians complete their assessments to rule out/confirm asthma or other underlying respiratory concerns.
ENT: Ear Nose and Throat doctors may be involved to complete a laryngoscopy to rule out any pathology of the vocal cords/throat.
Gastroenterology: may be referred to if there are obvious underlying concerns including reflux
Allergist: may be referred to for allergy testing
What triggers ILO?
Common triggers include:
· Exercise
· Stress or anxiety
· Reflux (GORD)
· Strong smells or irritants
· Breathing pattern changes
· Sinus or nasal issues
ILO often occurs alongside:
· Anxiety and depression
· Gastro-oesophageal reflux (GORD)
· Breathing pattern disorder
· Rhinosinusitis
These can make symptoms worse and delay recovery if not addressed.
How is ILO treated?
Recent research has shown the effectiveness of this speech therapy approach in treating Inducible Laryngeal Obstruction/Vocal Cord Dysfunction.
A comprehensive review of 13 studies found that individuals whose treatment relied solely on glottic airway and respiratory retraining as the main intervention, without medical treatments, significantly reduced symptoms. Participants experienced a notable reduction in the frequency of ILO episodes, with daily ILO episodes decreasing from 72% to 10% after completing speech therapy. This research highlights the essential role that speech therapy plays in treating ILO and improving quality of life for those affected by the condition
Therapy is individualised to each person and guided by their specific presentation, goals, and triggers. It is practical and structured, often following a stepwise approach to support meaningful progress. A holistic focus is essential, incorporating strategies to optimise laryngeal function, breathing control, and nervous system regulation, alongside addressing unhelpful patterns or responses that may be maintaining symptoms. Importantly, therapy is grounded in real-life situations, ensuring skills translate into everyday activities such as talking, exercising, and managing symptoms as they arise.
1. Education
Understanding what’s happening in your airway helps you:
· Recognise symptoms
· Identify triggers
· Reduce fear during episodes
2. Respiratory Re-training and laryngeal desensitisation
Speech pathology helps you:
· Learn what normal and abnormal breathing patterns feel like and how it impacts your breathing, voice and swallowing
· Keep your airway open during breathing
· Reduce throat tension
· Regain control during episodes of irritation
3. Managing contributing factors
Effective treatment often includes:
· Reflux management
· Anxiety support
· Breathing pattern retraining
· Upper airway care
Appropriate referrals should be made based on an individual’s presentation and concerns.
4. Medical or specialist options (less common)
In some cases other medical professionals (e.g. ENT, Respiratory Physicians) may explore medical management treatment options, e.g. Positive airway pressure or Botulinum toxin
When should you seek help?
You may benefit from assessment if:
· Your asthma treatment isn’t working
· You struggle to breathe in
· Symptoms are triggered by exercise, stress, irritants
· Tests are “normal” but symptoms persist
How we can help?
At Speak and Swallow Speech Therapy, we offer:
· Functional laryngoscopy
· Holistic therapy
· Integrated care for breathing, voice, and swallowing