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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Laryngeal dysfunction: assessment and management for the clinician.Am J Respir Crit Care Med. 2016; 194: 1062-1072
- Laryngeal hypersensitivity in chronic cough.Pulm Pharmacol Ther. 2015; 35: 111-116
- Cough, a vital reflex. mechanisms, determinants and measurements.Acta bio-medica : Atenei Parmensis. 2019; 89: 477-480
- 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
- 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
- Sensitivity of the cough reflex in patients with chronic cough.Eur Respir J. 1992; 5: 296-300
- Chronic cough from the patient's perspective.Mayo Clin Proc. 2007; 82: 56-60
- Are there clinical features of sensitized cough reflex?.Pulm Pharmacol Ther. 2009; 22: 59-64
- Prevalence of psychomorbidity among patients with chronic cough.Cough. 2006; 2: 4
- Quality of life in patients with chronic cough.Ther Adv Respir Dis. 2010; 4: 49-55
- Treatment of unexplained chronic cough: CHEST guideline and expert panel report.Chest. 2016; 149: 27-44
- Efficacy of speech pathology management for chronic cough: a randomised placebo controlled trial of treatment efficacy.Thorax. 2006; 61: 1065-1069
- Voice therapy techniques adapted to treatment of habit cough: a pilot study.J Commun Disord. 1988; 21: 393-400
- Respiratory retraining of refractory cough and laryngopharyngeal reflux in patients with paradoxical vocal fold movement disorder.Laryngoscope. 2004; 114: 1341-1345
- Characterization of laryngeal dysfunction in chronic persistent cough.Laryngoscope. 2009; 119: 640-645
- 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
- Development and validation of the Newcastle laryngeal hypersensitivity questionnaire.Cough. 2014; 10: 1
- Anatomy and neurophysiology of the cough reflex: ACCP evidence-based clinical practice guidelines.Chest. 2006; 129: 33S-47S
Article info
Publication history
Published online: January 13, 2023
Accepted:
November 10,
2022
Publication stage
In Press Corrected ProofFootnotes
CH and EV contributed equally to this work and will be co-first authors.
This research was presented at Fall Voice 2020, accepted at ASHA 2020, and presented orally at ASHA 2021.
Supported by: The authors have no funding, financial relationships, or conflicts of interest to disclose
Identification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
