Laryngeal sensory deficits in patients with chronic cough and paradoxical vocal fold movement disorder

Murry, Thomas; Branski, Ryan C.; Yu, Kathy; Cukier-Blaj, Sabrina; Duflo, S.; Aviv, Jonathan E.

doi:10.1002/lary.20985

Cited by 82 publications

(59 citation statements)

References 16 publications

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“…The retrospective review looked at 16 patients with CRC who underwent a series of breathing retraining exercises with a speech pathologist including rhythmic breathing, breathing with vocal resistance, pulsed exhalation, and abdominal focus at rest. 78 Fifteen patients reported improved cough symptoms. The reflux symptom index score improved by a mean of 3.74 points and all patients improved (P<0.01).…”

Section: Pharmacologic Therapy Neuromodulatorsmentioning

confidence: 98%

“…74 The review included one single blinded randomized controlled trial, 29 three prospective noncomparison studies, [75][76][77] and one retrospective review. 78 Meta-analysis was not possible so the included studies are discussed separately below.…”

Section: Non-pharmacologic Therapiesmentioning

confidence: 99%

“…80 Three uncontrolled longitudinal case series have confirmed that speech pathology treatment improves laryngeal hypersensitivity, cough reflex hypersensitivity, and the aberrant laryngeal motor response (PVFM) in CRC (fig 3). [76][77][78] The third prospective study assessed a physiotherapy intervention for 23 patients with CRC. 75 The intervention comprised education and lifestyle advice, cough suppression exercises, breathing retraining, and vocal hygiene.…”

Section: Pharmacologic Therapy Neuromodulatorsmentioning

confidence: 99%

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Management of chronic refractory cough

Gibson

Vertigan

2015

BMJ

107

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Chronic refractory cough (CRC) is defined as a cough that persists despite guideline based treatment. It is seen in 20-46% of patients presenting to specialist cough clinics and it has a substantial impact on quality of life and healthcare utilization. Several terms have been used to describe this condition, including the recently introduced term cough hypersensitivity syndrome. Key symptoms include a dry irritated cough localized around the laryngeal region. Symptoms are not restricted to cough and can include globus, dyspnea, and dysphonia. Chronic refractory cough has factors in common with laryngeal hypersensitivity syndromes and chronic pain syndromes, and these similarities help to shed light on the pathophysiology of the condition. Its pathophysiology is complex and includes cough reflex sensitivity, central sensitization, peripheral sensitization, and paradoxical vocal fold movement. Chronic refractory cough often occurs after a viral infection. The diagnosis is made once the main diseases that cause chronic cough have been excluded (or treated) and cough remains refractory to medical treatment. Several treatments have been developed over the past decade. These include speech pathology interventions using techniques adapted from the treatment of hyperfunctional voice disorders, as well as the use of centrally acting neuromodulators such as gabapentin and pregabalin. Potential new treatments in development also show promise.

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Section: Pharmacologic Therapy Neuromodulatorsmentioning

confidence: 98%

Section: Non-pharmacologic Therapiesmentioning

confidence: 99%

Section: Pharmacologic Therapy Neuromodulatorsmentioning

confidence: 99%

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Management of chronic refractory cough

Gibson

Vertigan

2015

BMJ

107

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“…A number of studies have reported on the co-occurrence of dysphonia and PVFM. Murry et al [36] reported a significant reduction in dysphonia symptoms after treatment in patients with PVFM and chronic cough and Vertigan et al [41] reported similar findings. In our study, those who reported feelings of control and activity improvement also reported a greater reduction in the severity of their voice complaints.…”

Section: Discussionmentioning

confidence: 85%

Functional Outcomes after Behavioral Treatment of Paradoxical Vocal Fold Motion in Adults

Drake

Palmer

Schindler

et al. 2017

Folia Phoniatr Logop

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Objective: Paradoxical vocal fold motion (PVFM) is responsive to behavioral therapy, often resulting in a remission of symptoms, but little is known about whether treatment is beneficial with regard to PVFM-associated psychological symptoms or functional limitations. The goal of the study was to identify patient perceptions of the impact of treatment for PVFM and characteristics associated with treatment outcomes. Methods: A survey was conducted of all adults who had received at least 1 session of treatment for PVFM in our outpatient clinic over a 2-year period. Results: The 39 participants ranged in age from 18 to 82 and had received a median of 3 treatment sessions. At a median follow-up of 10 months following treatment, respondents reported improvements in a wide range of areas, including sports and leisure, daily activities, and social participation. The majority reported improvements in feelings of anxiety, helplessness, and control. Poorer outcomes were associated with more severe voice symptoms, fewer treatment sessions, and needing oral steroids for asthma control. Conclusion: There was a reduction in a wide range of activity limitations after treatment. Feelings of control were strongly associated with positive outcomes. The therapy appeared to be equally effective for adults with exercise-induced and environmental variants of PVFM.

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“…There is recent evidence, however, that even minimal stimulation caused by routine vocal fold vibration is sufficient to instigate cough in those with hypersensitivity syndrome. 17,18 Complicating this association is that GERD is similarly implicated. 19 It is important to study the differential effects of these two potential triggers to advance the understanding of idiopathic chronic cough pathophysiology and to identify potential methods and targets for prevention and treatment.…”

Section: Discussionmentioning

confidence: 99%

Airway Hypersensitivity, Reflux, and Phonation Contribute to Chronic Cough

Francis

Slaughter

Ateş

et al. 2016

Clinical Gastroenterology and Hepatology

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Background & Aims Although chronic cough is a common, its etiology is often elusive, making patient management a challenge. Gastroesophageal reflux and airway hypersensitivity can cause chronic cough. We explored the relationship between reflux, phonation, and cough in patients with idiopathic chronic cough. Methods We performed a blinded, cross-sectional study of non-smoking patients with chronic cough (duration > 8 weeks) refractory to reflux treatment referred to the Digestive Disease Center at Vanderbilt University. All underwent 24-hour acoustic recording concurrently and temporally synchronized with ambulatory pH-impedance monitoring. Cough, phonation, and pH-impedance events were recorded. We evaluated the temporal relationship between cough and phonation or reflux events using Poisson and logistic regression. Results Seventeen patients met the inclusion criteria (88% female; 100% Caucasian; median age, 63 years and interquartile age range, 52–66 years; mean body mass index, 30.6 and interquartile range 27.9–34.0); there were 2048 analyzable coughing events. The probability of subsequent coughing increased with higher burdens of preceding cough, reflux, or phonation. Within the first 15 min after a cough event, the cough event itself was the main trigger of subsequent cough events. After this period, de novo coughing occurred with increases of 1.46-fold in association with reflux alone (95% confidence interval, 1.17–1.82; P<.001) and 1.71-fold in association with the combination of phonation and reflux events. Conclusion Antecedent phonation and reflux increased the rate of cough events in patients with idiopathic chronic cough. Reflux events were more strongly associated with increased rate of coughing. Our findings support the concept that airway hypersensitivity is a cause of chronic cough, and that the vocal folds may be an effector in chronic cough. ClinicalTrials.gov number, NCT01263626.

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Laryngeal sensory deficits in patients with chronic cough and paradoxical vocal fold movement disorder

Abstract: Aberrant laryngeal sensation was identified in patients with PVFM and chronic cough. This response, however, normalized following a limited course of respiratory retraining, corresponding with improved patient symptoms.

Cited by 82 publications

References 16 publications

Management of chronic refractory cough

Management of chronic refractory cough

Functional Outcomes after Behavioral Treatment of Paradoxical Vocal Fold Motion in Adults

Airway Hypersensitivity, Reflux, and Phonation Contribute to Chronic Cough

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