Development and validation of the Newcastle laryngeal hypersensitivity questionnaire

Abstract

BackgroundLaryngeal hypersensitivity may be an important component of the common disorders of laryngeal motor dysfunction including chronic refractory cough, pdoxical vocal fold movement (vocal cord dysfunction), muscle tension dysphonia, and globus pharyngeus. Patients with these conditions frequently report sensory disturbances, and an emerging concept of the ‘irritable larynx’ suggests common features of a sensory neuropathic dysfunction as a part of these disorders. The aim of this study was to develop a Laryngeal Hypersensitivity Questionnaire for patients with laryngeal dysfunction syndromes in order to measure the laryngeal sensory disturbance occurring in these conditions.MethodsThe 97 participants included 82 patients referred to speech pathology for behavioural management of laryngeal dysfunction and 15 healthy controls. The participants completed a 21 item self administered questionnaire regarding symptoms of abnormal laryngeal sensation. Factor analysis was conducted to examine correlations between items. Discriminant analysis and responsiveness to change were evaluated.ResultsThe final questionnaire comprised 14 items across three domains: obstruction, pain/thermal, and irritation. The questionnaire demonstrated significant discriminant validity with a mean difference between the patients with laryngeal disorders and healthy controls of 5.5. The clinical groups with laryngeal hypersensitivity had similar abnormal scores. Furthermore the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) showed improvement following behavioural speech pathology intervention with a mean reduction in LHQ score of 2.3.ConclusionThe Newcastle Laryngeal Hypersensitivity Questionnaire is a simple, non-invasive tool to measure laryngeal pesthesia in patients with laryngeal conditions such as chronic cough, pdoxical vocal fold movement (vocal cord dysfunction), muscle tension dysphonia, and globus pharyngeus. It can successfully differentiate patients from healthy controls and measure change following intervention. It is a promising tool for use in clinical research and practice.

Comparative analysis of clinical profile: Chronic cough vs paradoxical vocal fold motion

“…While significantly higher than population norms, mean VHI scores remained well below the threshold for classification as a mild impairment (score ≥33 11 ). Compared to those previously published 24 , mean VHI scores for CC were similar, yet mean VHI scores for PVFM were over 10 points lower. Levels of general anxiety for most cases were minimal to mild at most for both groups, and although RSI scores were found to distinguish between those with CC versus PVFM, the difference was a mere 3.4 points on a scale of 0–45.…”

Management of chronic refractory cough

“…The laryngeal hypersensitivity questionnaire can be used to measure laryngeal hypersensitivity. 31 It is a validated, reproducible, and responsive questionnaire that comprises 14 items grouped into subscales of pain/thermal, irritation, and obstruction. The cut-off point for normal function is 17.1 and the minimally important difference is 1.3.…”

“…31 These are easily adaptable and do not require additional equipment. Tests such as ambulatory cough frequency monitoring and cough reflex sensitivity testing can be used to provide objective measures.…”

Gabapentin in chronic cough

“…In fact approximately one third of patients with refractory chronic cough report that they cough deliberately in response to cough triggers [12]. The Newcastle Laryngeal Hypersensitivity Questionnaire (NLHQ) [26] was developed in attempt to quantify the patient experience of laryngeal irritation in attempt to quantify this practice gap. The questionnaire scores items are using a seven point likert scale ranging from 1 All of the time to 7 None of the time.…”