Laryngeal sensory dysfunction in laryngeal hypersensitivity syndrome

Abstract

These discrete clinical laryngeal syndromes display considerable overlap in their clinical features and a common sensory dysfunction, supporting the 'laryngeal hypersensitivity' hypothesis. Reconceptualizing functional laryngeal disorders as a form of laryngeal hypersensitivity syndrome provides an alternative approach to management of these perplexing conditions.

An update and systematic review on drug therapies for the treatment of refractory chronic cough

“…The term sensory neuropathic cough is now often recognized in cough guidelines. It has overlap with laryngeal hypersensitivity and cough hypersensitivity [7,8] syndromes and is a component of refractory CC [9]. Early systematic evaluation and treatment guidelines for CC by Irwin and colleagues (1977) were based on the anatomic locations of the receptors and afferent pathways involved in the cough reflex [10].…”

“…Distinct higher brain circuitry for facilitating and suppressing the cough reflex has been visualized by functional magnetic resonance imaging (fMRI) [22]. CHS is associated with hypersensitivity of the larynx and upper airway and is often diagnosed by clinical history [23] and sometimes through quantitative sensory testing such as with hypertonic saline challenge, transnasal laryngoscopy with odor provocation, and cough reflex sensitivity testing with capsaicin [7,8]. Although some features of refractory CC are encompassed by the term CHS, many patients localize symptoms to the larynx [9,24] and therefore laryngeal hypersensitivity syndrome maybe a better description.…”

“…CHS is known to overlap with other laryngeal hypersensitivity syndromes including PVFM [7] and muscle tension dysphonia. [8] PVFM has been identified in around 56% of subjects with CC. [7] PVFM and refractory CC exhibit overlap in symptomatology, such as cough and dysphonia, and overlap in disease associations, namely asthma, GERD, and rhinosinusitis.…”

Dirglių Gerklų Sindromas: Šiuolaikinė Diagnostika Ir Gydymas

“…CNS įjautrinimas charakterizuojamas padidėjusiu sužadinimu centriniuose jutiminiuose laiduose. Centrinį įjautrinimą rodo gerklų jautrumo pokyčiai atliekant objektyvius gerklų jautrumo mėgi-nius, gerklų hiperjautrumas ar parestezijos, pasireiškiančios pakitusiais pojūčiais ryklėje (kutenimas, niežulys, "kąsnis"); sustiprėjęs gerklų atsakas (spazminis kosulys) į adekvačius stimulus, pavyzdžiui, dūmus, rūkymą, aspiratą bei sustiprėjęs gerklų atsakas į neadekvačius stimulus, pavyzdžiui, temperatūros svyravimus, balso vartojimą, fizinius pratimus [9,18]. Be to, naujausi tyrimai atskleidė, kad šiems pacientams padidėja smegenų žievės aktyvumas, fiksuojamas funkcinio magnetinio rezonanso metu [9].…”

“…Gerklų jautrumą, kurio pasikeitimai būdingi sergantiems DGS, galima įvertinti objektyviais metodais: naudojant hipertoninį druskos tirpalą ar fibroendoskopijos metu vedeginius gumburus mechaniškai stimuliuojant oro pliūpsniu ar liečiant fibroskopo galiuku ir sukeliant balso klosčių adukcinį refleksą [4,8,9,18]. DGS būdinga padidėjęs gerklų gleivinės chemoreceptorių jautrumas ir sumažėjęs mechanoreceptorių [17].…”