Summary
Objectives
Trauma related to chronic cough and forceful glottal closure has been associated with
lesions of the vocal process; however, there is limited description of cough leading
to membranous vocal fold lesions. We present a series of mid-membranous vocal fold
lesions in a cohort of patients with chronic cough, with a proposed mechanism of lesion
formation.
Methods
Patients treated for chronic cough with membranous vocal fold lesions affecting phonation
were identified. Presentation, diagnosis, treatment strategies (behavioral, medical,
and surgical), patient-reported outcome measures (PROMs), and videostroboscopy were
reviewed.
Results
Five patients are included (four females, one male, aged 56±16 years). Mean cough
duration was 2.6±3.5 years. All patients were on acid suppressive medications for
existing gastroesophageal reflux disease (GERD) prior to referral. All lesions were
identified at the mid-membranous vocal folds and morphologically encompassed a wound
healing spectrum between ulceration and/or granulation tissue (granuloma) formation.
Patients were treated in an interdisciplinary fashion with behavioral cough suppression
therapy, superior laryngeal nerve block, and neuromodulators. Three had persistent
lesions requiring procedural intervention (one office-based steroid injection and
two surgical excisions). At the completion of treatment, all five patients had improvement
in Cough Severity Index with an average decrease of 15.2±4.8. All but one patient
had improvement in their Voice Handicap Index-10 with an average decrease of 13.2±11.1.
One patient undergoing surgical intervention was noted to have a persistent lesion
on follow-up.
Conclusion
Mid-membranous vocal fold lesions in patients with chronic cough are uncommon. When
they do occur, they represent epithelial change arising in context of shear injury
and are distinct from phonotraumatic lesions in the lamina propria. An interdisciplinary
approach including behavioral cough suppression therapy, neuromodulators, superior
laryngeal nerve block, and acid suppression are reasonable for initial management,
reserving surgical intervention for refractory lesions once the inciting source of
injury has been controlled.
Key Words
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Article info
Publication history
Published online: March 11, 2023
Accepted:
February 6,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
