Assessing laryngeal function and hypersensitivity

Famokunwa, Bamidele; Walsted, Emil Schwarz; Hull, James H.

doi:10.1016/j.pupt.2019.04.003

Cited by 30 publications

(20 citation statements)

References 59 publications

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“…Despite being a retrospective, single-centre study, this report offers important insights into the value of an interdisciplinary assessment for UCC/RCC that includes systematic laryngeal evaluation. Currently, there is no agreement on the protocol for laryngeal evaluation for chronic cough due to the lack of consensus regarding functional laryngeal anomalies and laryngeal hypersensitivity [42]. The operator dependency of results, sporadic nature of laryngeal complaints, lack of validated cutoffs for laryngeal closure and lack of understanding of how mechanical or other stimuli uncover laryngeal dysfunction can further confound the diagnosis of laryngeal hypersensitivity [42].…”

Section: Limitationsmentioning

confidence: 99%

“…Currently, there is no agreement on the protocol for laryngeal evaluation for chronic cough due to the lack of consensus regarding functional laryngeal anomalies and laryngeal hypersensitivity [42]. The operator dependency of results, sporadic nature of laryngeal complaints, lack of validated cutoffs for laryngeal closure and lack of understanding of how mechanical or other stimuli uncover laryngeal dysfunction can further confound the diagnosis of laryngeal hypersensitivity [42]. To address reliability issues inherent with clinical interpretation of laryngeal structure and function in nasoendoscopy recordings, an SLP independently documented impressions blind to the original finding for purposes of this study.…”

Section: Limitationsmentioning

confidence: 99%

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Is laryngeal hypersensitivity the basis of unexplained or refractory chronic cough?

Sundar

Stark

et al. 2021

ERJ Open Res

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BackgroundRefractory chronic cough (RCC) and unexplained chronic cough (UCC) are common problems seen in primary care and subspecialty clinics. The role of cough hypersensitivity and laryngeal dysfunction in contributing to the persistence of cough in RCC/UCC is not well recognised.MethodsData of patients with RCC and UCC evaluated in 2019 by an interdisciplinary cough clinic led by a pulmonologist and speech-language pathology team was reviewed. Patients completed validated questionnaires including the Leicester cough questionnaire (LCQ), voice handicap index (VHI) and dyspnea index questionnaire (DI) at initial encounter. Presence of cough hypersensitivity was based upon a history of allotussia and hypertussia. Laryngeal dysfunction was diagnosed in those with a history of laryngeal paresthesias, throat clearing, voice abnormalities, upper airway dyspnoea and documentation of functional or anatomic laryngeal abnormalities on nasoendoscopy.FindingsOf the 60 UCC/RCC patients analysed, 75% of patients were female and 85% were over 40 years of age. Cough hypersensitivity was documented in all patients and multiple cough triggers occurred in 75% of patients. 95%, 50% and 25% of patients reported laryngeal paresthesias, voice abnormalities and upper airway dyspnoea, respectively. Significant associations between LCQ and VHI and DI scores occurred when adjusting for age, gender, ethnicity and body mass index. Laryngeal functional abnormalities were documented on 44/60 patients on nasoendoscopy.InterpretationHypertussia, allotussia and laryngeal dysfunction are common in patients with RCC and UCC. Evaluation of UCC and RCC can delineate laryngeal hypersensitivity and allows appropriate treatment to be directed at this phenotype.

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Section: Limitationsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Is laryngeal hypersensitivity the basis of unexplained or refractory chronic cough?

Sundar

Stark

et al. 2021

ERJ Open Res

View full text Add to dashboard Cite

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“…The focus is primarily on management of the upper airway and approaches can be divided in to short and long term strategies. The reduction of irritants through the practice of good upper airway hygiene and awareness/management of triggers can reduce sensitivity and hyper-responsiveness (26,58), whilst acute symptoms can be controlled by activities that promote and maintain vocal cord abduction such as sniffs and vocal fricatives (59). Longer term retraining of glottic and supraglottic activity can be achieved through laryngeal aperture control (with or without the addition of therapeutic laryngoscopy) and use of the Accent method (60,61).…”

Section: Therapeuticmentioning

confidence: 99%

Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management

et al. 2020

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Dysfunctional breathing (DB) is an overarching term describing deviations in the normal biomechanical patterns of breathing which have a significant impact on quality of life, performance and functioning. Whilst it occurs in both children and adults, this article focuses specifically on children. DB can be viewed as having two components; breathing pattern disorder (BPD) and inducible laryngeal obstruction (ILO). They can be considered in isolation, however, are intricately related and often co-exist. When both are suspected, we propose both BPD and ILO be investigated within an all-encompassing multidisciplinary dysfunctional breathing clinic. The MDT clinic can diagnose DB through expert history taking and a choice of appropriate tests/examinations which may include spirometry, breathing pattern analysis, exercise testing and laryngoscopic examination. Use of the proposed algorithm presented in this article will aid decision making regarding choosing the most appropriate tests and understanding the diagnostic implications of these tests. The most common symptoms of DB are shortness of breath and chest discomfort, often during exercise. Patients with DB typically present with normal spirometry and an altered breathing pattern at rest which is amplified during exercise. In pediatric ILO, abnormalities of the upper airway such as cobblestoning are commonly seen followed by abnormal activity of the upper airway structures provoked by exercise. This may be associated with a varying degree of stridor. The symptoms, however, are often misdiagnosed as asthma and the picture can be further complicated by the common co-presentation of DB and asthma. Associated conditions such as asthma, extra-esophageal reflux, rhinitis, and allergy must be treated appropriately and well controlled before any directed therapy for DB can be started if therapy is to be successful. DB in pediatrics is commonly treated with a course of non-pharmaceutical therapy. The therapy is provided by an experienced physiotherapist, speech and language therapist or psychologist depending on the dominant features of the DB presentation (i.e., BPD or ILO in combination or in isolation) and some patients will benefit from input from more than one of these disciplines. An individualized treatment program based on expert assessment and personalized goals will result in a return to normal function with reoccurrence being rare.

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“…However, no clinical studies have considered the whole respiratory tract system of people with symptoms at workplaces with MD. Not only pulmonary diseases, but also laryngeal dysfunction may cause dyspnea, hoarseness and coughing [ 20 ]. Several studies have described laryngeal symptoms that develop at work and are associated with exposure to fumes, odors, or other airborne substances [ 21 , 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Findings among Patients with Respiratory Symptoms Related to Moisture Damage Exposure at the Workplace—The SAMDAW Study

et al. 2021

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Background: Respiratory tract symptoms are associated with workplace moisture damage (MD). The focus of this observational clinical study was patients with workplace MD-associated symptoms, to evaluate the usefulness of different clinical tests in diagnostics in secondary healthcare with a special interest in improving the differential diagnostics between asthma and laryngeal dysfunction. Methods: In patients referred because of workplace MD-associated respiratory tract symptoms, we sought to systematically assess a wide variety of clinical findings. Results: New-onset asthma was diagnosed in 30% of the study patients. Laryngeal dysfunction was found in 28% and organic laryngeal changes in 22% of the patients, and these were common among patients both with and without asthma. Most of the patients (85%) reported a runny or stuffy nose, and 11% of them had chronic rhinosinusitis. Atopy was equally as common as in the general population. Conclusions: As laryngeal changes were rather common, we recommend proper differential diagnostics with lung function testing and investigations of the larynx and its functioning, when necessary, in cases of prolonged workplace MD-associated symptoms. Chronic rhinosinusitis among these patients was not uncommon. Based on this study, allergy testing should not play a major role in the examination of these patients.

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Assessing laryngeal function and hypersensitivity

Cited by 30 publications

References 59 publications

Is laryngeal hypersensitivity the basis of unexplained or refractory chronic cough?

Is laryngeal hypersensitivity the basis of unexplained or refractory chronic cough?

Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management

Clinical Findings among Patients with Respiratory Symptoms Related to Moisture Damage Exposure at the Workplace—The SAMDAW Study

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