Hoarseness as a Sign of Possible Nonspecific Mucosal Hyperreactivity in Vocal Tract

Abstract

The aim of the present paper was to evaluate the possible impact of methacholine challenge on the voice and vocal tract in ten patients reporting hoarseness due to presumable hyperreactivity to some environmental factors. Ten age-and gender-matched healthy subjects served as controls. Methacholine was used for hypersensitivity challenge and saline solution (0.9% NaCl) as control substance. Subjects were examined on two separate challenge occasions testing either methacholine in increasing doses (3, 6, 12 mg) or NaCl. Voice recordings, videolaryngoscopy, and measurement of nasal secretion were performed before and after each sniffing session. Subjective complaints were documented. Data were statistically analyzed with three-way analysis of variance (ANOVA) and group comparisons performed. Perceptual analysis of voice recordings showed an increase of the grade of voice disorder in patients after exposure to both substances. Moreover, one of the patients became aphonic and another severely dysphonic after NaCl. No voice quality changes were detected in controls. The videolaryngoscopy findings divergent from normal did not increase in any group. Nasal secretion was significantly higher after sniffing of methacholine than NaCl in both groups. The frequency of subjective complaints was equal in both groups after both substances. However, there was a qualitative difference in the character of the symptoms: the patients complained of throat, vocal and nasal symptoms while the controls complained exclusively of nasal symptoms.The study supports the view that vocal dysfunction after exposure to non-specific environmental irritating factors may be triggered mainly by emotional mechanisms such as off-warding reaction or dissociative disorder. BACKGROUND AND AIM

Validation and Development of Voice Handicap Index-Throat for Koreans

“…Throat symptoms are one of the most common complaints of patients referred to general physicians and can significantly influence health-related quality of life, thus requiring appropriate treatment [1,2]. Throat symptoms can be caused by laryngopharyngeal reflux, nonspecific mucosal hyperactivity, and lesions in the throat area [3][4][5]. Additionally, throat symptoms such as throat clearing, globus sensation, and irritated throat are frequently reported by patients with dysphonia [6].…”

Throat related symptoms and voice: development of an instrument for self assessment of throat-problems

“…In the area of voice, throat symptoms may be interpreted either as the cause of functional voice disturbances and in reverse they may also be interpreted as a consequence of voice load or inappropriate vocal behavior [9]. Apart from vocal behavior, non-specific mucosal hyperreactivity [10], laryngo-pharyngeal reflux [11], allergy [12] and mass lesions in the throat region are often considered as causative factors. Thus, throat related problems are a rather common concern in patients referred to voice clinics.…”