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Standardized Behavioral Treatment Improves Chronic Cough

Published:January 13, 2023DOI:https://doi.org/10.1016/j.jvoice.2022.11.017

      Abstract

      Objectives

      Neurogenic Laryngeal Hypersensitivity (NLH) refers to a constellation of upper airway symptoms thought to be caused by a disturbance in afferent and/or efferent neural pathways creating an exaggerated hypersensitive laryngeal response. There is evidence to support behavioral therapy as treatment for improving symptoms from laryngeal motor dysfunction to sensory disturbance. This study aims to determine if there is significant symptomatic improvement in patients with NLH who received non-pharmacologic behavioral treatment performed by trained SLPs.

      Study design

      A retrospective review.

      Methods

      A review of all patients with NLH from 2017 to 2020 was performed at a tertiary care voice and swallowing center. Subjects with persistent symptoms despite maximal medical management were considered for inclusion. Newcastle Laryngeal Hypersensitivity Questionnaire (NLHQ) was completed by patients before and after undergoing therapy by one of three trained SLPs. Posttherapy improvement was determined by utilizing the NLHQ's minimal clinically important difference of 1.7 points.

      Results

      A total of 81 patients were included in this study. Study participants included 61 women and 20 men with an average age of 60.64±14.05 years. There was a statistically significant difference between the pre and post therapy scores amongst all patients when treated by each individual SLP and all three SLPs combined (P < 0.008). There was a clinically significant change in 66% of all patients, 76% of which presented with abnormal NLHQ scores, and 14% who presented with normal NLHQ scores.

      Conclusions

      A standardized behavioral treatment protocol for patients with symptoms consistent with NLH is effective in improving symptoms in a large majority of patients. When following a standardized protocol SLPs can obtain similar results for their patients.

      Keywords

      Abbreviations:

      NLH (Neurogenic laryngeal hypersensitivity), NLHQ (Newcastle Laryngeal Hypersensitivity Questionnaire), SLP (Speech language pathologist)
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      REFERENCES

        • Hull JH
        • Backer V
        • Gibson PG
        • et al.
        Laryngeal dysfunction: assessment and management for the clinician.
        Am J Respir Crit Care Med. 2016; 194: 1062-1072
        • Hull JH
        • Menon A.
        Laryngeal hypersensitivity in chronic cough.
        Pulm Pharmacol Ther. 2015; 35: 111-116
        • Andrani F.
        • Aiello M.
        • Bertorelli G.
        • et al.
        Cough, a vital reflex. mechanisms, determinants and measurements.
        Acta bio-medica : Atenei Parmensis. 2019; 89: 477-480
        • McCabe D
        • Altman KW.
        Laryngeal hypersensitivity in the World Trade Center-exposed population: the role for respiratory retraining.
        Am J Respir Crit Care Med. 2012; 186 (PMID: 22942344): 402-403https://doi.org/10.1164/rccm.201205-0808OE
        • Chu MW
        • Lieser JD
        • Sinacori JT.
        Use of botulinum toxin type A for chronic cough: a neuropathic model.
        Arch Otolaryngol Head Neck Surg. 2010; 136 (PMID: 20479373): 447-452https://doi.org/10.1001/archoto.2010.59
        • Choudry NB
        • Fuller RW.
        Sensitivity of the cough reflex in patients with chronic cough.
        Eur Respir J. 1992; 5: 296-300
        • Kuzniar TJ
        • Morgenthaler TI
        • Afessa B
        • et al.
        Chronic cough from the patient's perspective.
        Mayo Clin Proc. 2007; 82: 56-60
        • McGarvey L
        • McKeagney P
        • Polley L
        • et al.
        Are there clinical features of sensitized cough reflex?.
        Pulm Pharmacol Ther. 2009; 22: 59-64
        • McGarvey LP
        • Carton C
        • Gamble LA
        • et al.
        Prevalence of psychomorbidity among patients with chronic cough.
        Cough. 2006; 2: 4
        • Young EC
        • Smith JA.
        Quality of life in patients with chronic cough.
        Ther Adv Respir Dis. 2010; 4: 49-55
        • Gibson P
        • Wang G
        • McGarvey L
        • et al.
        Treatment of unexplained chronic cough: CHEST guideline and expert panel report.
        Chest. 2016; 149: 27-44
        • Vertigan AE
        • Theodoros DG
        • Gibson PG
        • et al.
        Efficacy of speech pathology management for chronic cough: a randomised placebo controlled trial of treatment efficacy.
        Thorax. 2006; 61: 1065-1069
        • Blager FB
        • Gay ML
        • Wood RP
        Voice therapy techniques adapted to treatment of habit cough: a pilot study.
        J Commun Disord. 1988; 21: 393-400
        • Murry T
        • Tabaee A
        • Aviv JE
        Respiratory retraining of refractory cough and laryngopharyngeal reflux in patients with paradoxical vocal fold movement disorder.
        Laryngoscope. 2004; 114: 1341-1345
        • Ryan NM
        • Gibson PG.
        Characterization of laryngeal dysfunction in chronic persistent cough.
        Laryngoscope. 2009; 119: 640-645
        • Ahmad SR
        • Iyer VN
        The evolving clinical practice of chronic cough.
        Mayo Clin Proc. 2022; (S0025-6196(22)00105-7)https://doi.org/10.1016/j.mayocp.2022.02.005
        • Vertigan AE
        • Bone SL
        • Gibson PG.
        Development and validation of the Newcastle laryngeal hypersensitivity questionnaire.
        Cough. 2014; 10: 1
        • Canning BJ.
        Anatomy and neurophysiology of the cough reflex: ACCP evidence-based clinical practice guidelines.
        Chest. 2006; 129: 33S-47S