2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Laryngeal sensory dysfunction

Table 1 Previous treatment for participants prior to referral to speech pathology

All patients ( n = 91)

CRC only ( n = 28)

PVFM only ( n = 35)

Globus only ( n = 10)

MTD only ( n = 18)

Previous treatment

Reflux medications

60 54 27 15

24 19 10

21 23

7 5 2 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 1 0 1 1

8 7 6 3 0 1 0 0 2 0 0 1 0 1 1 0 0 1 0 0 0 4

Asthma meds

Allergy/rhinitis treatment

9 7 0 4 4 1 2 0 2 1 1 1 0 1 0 0 0 1 0 0

Prednisone Gabapentin Antibiotics

5 7 1 0 6 1 3 1 1 0 0 1 0 2 0 0 0 0 1

7 6 4 7 5 4 3 3 2 2 2 2 2 1 1 1 1 6

Over the counter reflux medications Over the counter cough medications

Weight loss

Surgery (ENT/Gastroenterology) Continuous Positive Airway Pressure Diet changes/referred to dietician

Lifestyle strategies for reflux Thyroid treatment/surgery

Psych medications

Previous speech pathology

Cease ACE I †

Voice rest

Mouth guard

Smoking cessation

Reduce stress

Nil

† ACE I had been ceased for between 6 weeks and 3 years prior to inclusion in the study. ACE, angiotensin converting enzyme; CRC, chronic refractory cough; MTD, muscle tension dysphonia; PVFM, paradoxical vocal fold movement.

psychosis, schizophrenia or mood disorders that pre- vented participation in the assessment) or neurologi- cal impairment. Previous treatment received by participants in the clinical groups is reported in Table 1. The 33 participants with CRC had been referred by respiratory physicians for behavioural management of cough. 6 The cough had persisted for longer than 8 weeks despite medical treatment based on the ana- tomic diagnostic protocol. 7 The 28 patients with PVFM had been diagnosed by either respiratory phy- sicians or otolaryngologists using flow volume loops and/or fibre optic nasendoscopy. They presented with symptoms of PVFM such as inspiratory dyspnoea, noisy breathing and throat tightness. Asthma and other pulmonary diseases had been excluded as a reason for the respiratory problems. The third group included 11 patients with globus who presented with globus sensation such as a sensation of an irritation, lump or tightness in the throat in the absence of oropharyngeal dysphagia. Structural lesions had been excluded prior to referral. The 18 patients with MTD were diagnosed by otolaryngologists and had a devia- tion in perceptual voice quality and excessive tension in the intrinsic and/or extrinsic laryngeal muscles 8,9 in the absence of any structural, neurological or signifi- cant psychological pathology. These participants had not received any formal speech pathology intervention. Healthy controls were recruited from the Hunter Medical Research Institute Healthy Control Register

neuropathy involving the laryngeal nerve (‘sensory neuropathic cough’). 5 We now propose that each of these syndromes are manifestations of laryngeal sensory dysfunction, and hypothesize that there is a common disturbance of laryngeal function in CRC, PVFM, globus and MTD, termed laryngeal hypersen- sitivity syndrome. The aim of the study was to compare sensory symp- toms and results of quantitative testing in patients with CRC, PVFM, globus andMTD.We planned first to compare clinical groups to controls in order to iden- tify whether a sensory disturbance was present, and second to compare the case groups to each other in order to identify the degree of similarity in sensory disturbance. We studied 103 participants comprising healthy con- trols ( n = 13) and four clinical case groups: CRC ( n = 33), PVFM ( n = 28), globus ( n = 11), and MTD ( n = 18). The case groups were recruited from con- secutive referrals ( n = 128) to the Speech Pathology department. Participants underwent a comprehen- sive medical examination prior to referral to inclusion in the study. Exclusion criteria included recent upper respiratory tract infection, current smoking, untreated asthma, untreated rhinitis, untreated gastroesopha- geal reflux, significant psychological factors (such as © 2013 The Authors Respirology © 2013 Asian Pacific Society of Respirology METHODS Participants

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