Irritable Larynx Research Articles

Indications and Short-Term Outcomes for In-Office Therapeutic Superior Laryngeal Nerve Block.

Superior laryngeal nerve (SLN) block consists of injection of steroid and anesthetic at the internal branch of the SLN entry site. Prior case series have demonstrated beneficial effects on neurogenic cough. SLN blocks have also recently shown benefit for paralaryngeal pain. We describe short-term outcomes for multiple symptoms of irritable larynx syndrome (ILS) including neurogenic cough, dysphonia related to laryngeal hypersensitivity, inducible laryngeal obstruction (ILO), paralaryngeal pain, and isolated globus. Retrospective review from 2 institutions of patients undergoing a single SLN block for the indications listed. Variables include age, sex, indication(s), known vagus neuropathy, and patient-reported outcomes at short-term follow-up. A total of 209 patients were included (59 males, 150 females; age: 58 ± 13 years). Twenty-six patients (12%) had a history of a vagus nerve injury. Indications included neurogenic cough (n = 149), dysphonia related to laryngeal hypersensitivity (n = 66), paralaryngeal pain (n = 50), ILO (n = 23), and isolated globus (n = 3). Some patients had multiple indications. Significant improvements in patient-reported measures occurred after a single SLN block within 2 to 4 weeks for neurogenic cough (cough severity index; 25.2 ± 11.2 to 19.0 ± 12.8; P < .001), dysphonia (voice handicap index-10; 22.1 ± 12.2-18.0 ± 13.3; P = .005), and ILO (dyspnea index; 21.0 ± 14.9-14.7 ± 15.7; P = .017). Subjective pain improved in 23 of 39 patients with paralaryngeal pain. There was no observed improvement for isolated globus. Presence of known vagal neuropathy or therapy around the time of SLN block did not affect outcome. SLN block can be an effective component of treatment for a variety of ILS symptoms. Patients may experience some improvement after 1 injection. Symptoms of irritable larynx syndrome, such as neurogenic cough, paralaryngeal pain, inducible laryngeal obstruction, and dysphonia related to laryngeal hypersensitivity can be challenging to manage. In-office Superior Laryngeal Nerve blocks can serve as a quick, well tolerated, adjunctive treatment with positive short-term outcomes. 4.

Occupational aspects of irritable larynx syndrome.

The aim of this article is to provide an update on occupational aspects of irritable larynx syndrome (ILS). It is being increasingly recognized that ILS is common amongst certain occupations. This is particularly true of occupations that require frequent voice use such as teachers; where there is exposure to workplace irritants such as World Trade Center responders; or mechanical factors that cause laryngeal dysfunction such as elite athletes. Work associated ILS impacts on quality of life but responds to speech and language therapy focusing on education, vocal hygiene, and laryngeal exercises that reduce cough and treat acute laryngeal obstruction episodes. ILS may be caused or exacerbated by many occupational exposures, causes significant symptoms, and impacts on quality of life. It is potentially treatable and may well be preventable. More research in this important area is required.

Evidence of Possible Irritable Larynx Syndrome in Obstructive Sleep Apnea: An Epidemiologic Approach

"Irritable larynx syndrome" (ILS) often refers to a constellation of laryngeal-based symptoms including chronic cough (CC), diurnal dyspnea, and dysphonia. In patients with OSA, we examined: (1) the frequency, severity, comorbidity, risks and triggers of each problem, (2) whether these symptoms were compatible with stereotypic ILS and (3) the role of CPAP in their expression. Cross-sectional, descriptive epidemiology study. Sleep-Wake Center at University of Utah Health Care, Salt Lake City, UT. Ninety-four individuals with OSA (53 men, 41 women; mean age 54.7 ± 12.8 yrs.) underwent an extensive telephone interview that addressed study objectives. Long-term CC, daytime breathing and voice problems were common, especially among women despite less severe OSA. Women, more than men, reported all three chronic conditions alone or in combination: CC (44% vs 11.3%), diurnal dyspnea (41.5% vs 13.2%) and voice disorders (41.5% vs 13.2%). Symptoms were not associated with age, BMI or Apnea Hypopnea Index after adjusting for sex. Although evidence supporting stereotypic ILS symptomatology was inconsistent, those participants with a voice disorder were 3.3 (95% CI=1.8-6.0) times more likely to report CC and 2.4 (95% CI=1.3-4.4) times more likely to experience diurnal dyspnea. Esophageal reflux, post-nasal drip, and frequent sinus infections were significantly associated with all three conditions. Triggers that provoked or made symptoms worse varied by condition and sex. Nightly, humidified CPAP use was associated with fewer symptoms overall and improved quality of life. Symptoms suggestive of possible ILS are common in OSA, especially among women, and lessened by nightly CPAP use.

Irritable larynx syndrome (Internal and external correlates)

Irritable larynx is a condition of laryngeal dysfunction at which there is abnormal spasmodic closure of both vocal folds during inspiration. Patient complains of many symptoms as stridor, dysphonia, chocking, globus sensation, and dyspnea. These symptoms are not specific for irritable larynx only, but; they are frequently confused with other disorders such as gastroesophageal reflux, asthma, and different causes of chronic cough. The golden method for diagnosis is to visualize both vocal folds abducted during inspiration in acute attack by indirect laryngoscopy. To review recent available literature concerning irritable larynx syndrome to get essential recent data as a primary step for understanding this disorder.

Cough related to swallowing in asthma patients.

BackgroundOccurrence of cough during swallowing is common among asthma patients, but has not been investigated in detail.ObjectiveWe conducted an observational study to determine the prevalence of swallowing-related cough (SRC) and its characteristics in asthma patients.MethodsAsthma patients attending our outpatient department between May 2005 and April 2007 were interviewed to investigate if they had ever experienced SRC, as well as postnasal drip or heartburn and cough related to these conditions.ResultsAmong 417 patients who completed the questionnaire, 121 patients (29.0%) had experienced SRC. Spicy and sour foods were the most frequent tussigenic foods, causing cough in 76.0% and 53.7% of the 121 patients, respectively. In patients without SRC, the prevalence rates of postnasal drip and postnasal drip-induced cough were 35.8% (106 of 296) and 7.8% (23 of 296), respectively. The corresponding prevalence rates in patients with SRC were 50.4% (61 of 121) and 37.2% (45 of 121), which were both significantly higher than in patients without cough (p = 0.006 and p < 0.001 respectively). In patients without SRC, the prevalence rates of heartburn and heartburn-induced cough were 22.2% (66 of 296) and 2.4% (7 of 296), respectively. The corresponding prevalence rates in patients with SRC were 45.5% (55 of 121) and 16.5% (20 of 121), with both being significantly higher than in patients without cough (p = 0.002 and p < 0.001, respectively).ConclusionSRC was frequent in asthma patients, and was closely related to postnasal drip and heartburn. Irritable larynx is one of the possible underlying mechanisms of SRC. This study was registered with the University Hospital Medical Information Network clinical trials registry (registration number: UMIN000017426).

Predicting Patient Needs for Interdisciplinary Services in a Voice and Swallowing Center

In a subspecialty interdisciplinary voice and swallowing clinic, patient referrals come from a wide variety of disciplines for various reasons, which can make scheduling their initial evaluations challenging. Depending on the nature of complaints and symptoms, patients may best be evaluated either by a single provider (a laryngologist) or by an interdisciplinary team that includes a speech-language pathologist. If not scheduled appropriately, the provider and the patient may lose valuable time, resources, and money. This was a retrospective chart review of 76 patients who received an interdisciplinary evaluation in our Voice and Swallowing Center's first 7 months of operation. Two factors were examined for their predictive values: the most common reasons for referral and the disciplines that commonly refer to the clinic. The goal was to probe for any variables known at the time of referral that could inform us whether an interdisciplinary evaluation would be beneficial or not. This information informs resource planning for space, equipment, scheduling, and staffing. The results showed that the most common reasons for a referral to the Voice and Swallowing Center were dysphonia (34.8%), dyspnea/paradoxical vocal fold motion ("PVFM," 20.2%), and dysphagia (18%). Statistical analysis of the results indicated that certain reasons for referral were more likely to require an interdisciplinary evaluation than others: dysphonia, irritable larynx syndrome/chronic cough, and PVFM. Referrals most commonly came from providers with a background discipline of primary care (26%) and otolaryngology (22%). The discipline of a referring provider alone was not a strong enough indicator to reliably predict the type of evaluation needed. Examining the available data on referral patterns, as this study has done, has the potential to inform providers how to better anticipate their patients' needs and also improve clinic operations.

Minimal Important Difference in Voice Handicap Index–10

The minimal important difference (MID) on patient-reported outcome measures can indicate how much of a change on that scale is meaningful. To use an anchor-based approach to estimate MID in the Voice Handicap Index-10 (VHI-10) total score. In this cohort study, a volunteer sample of adult patients visiting the voice clinic at the University of Minnesota from April 7, 2013, through July 3, 2016, completed the VHI-10 (range, 0-40, with higher scores indicating greater voice-related handicap) at baseline and 2 weeks later in conjunction with a global rating of change. An anchor-based approach was used to identify an MID. The association between the global change score and change in VHI-10 score was analyzed using Pearson rank correlation. A distribution-based method was used to corroborate the findings. Global rating of change on the VHI-10. Of the 273 participants, 183 (67.0%) were women and 90 (33.0%) were men (mean [SD] age, 54.3 [15.6] years); 259 (94.9%) were white. Participants had a variety of voice disorders, most commonly muscle tension dysphonia, irritable larynx, benign vocal fold lesions, and motion abnormalities. Among patients reporting no change on the global change score, the mean (SD) change in VHI-10 score was 1 (5). Among those reporting a small change, the mean (SD) change in VHI-10 was also 1 (5). Among those reporting a moderate change in voice symptoms, the mean (SD) change in VHI-10 score was 6 (8). Among those with a large change, the mean (SD) change in VHI-10 score was 9 (13). The correlation between the global change score and the change in VHI-10 score was 0.32 (95% CI, 0.12-0.49). Distribution-based analyses identified effect sizes comparable to those of the anchor-based categories. These findings suggest that a difference of 6 on the VHI-10 may represent an MID. This difference was associated with a moderate change on the global rating scale, and the small-change and no-change categories were indistinguishable. Given the lack of differentiation between small and no change and the modest correlation between the global change score and change in the VHI-10 score, additional studies are needed.

Irritable Larynx Syndrome with Dyspnea

Irritable Larynx Syndrome with Dyspnea

Design, development and validation of a new laryngo-pharyngeal endoscopic esthesiometer and range-finder based on the assessment of air-pulse variability determinants.

BackgroundLaryngo-pharyngeal mechano-sensitivity (LPMS) is involved in dysphagia, sleep apnea, stroke, irritable larynx syndrome and cough hypersensitivity syndrome among other disorders. These conditions are associated with a wide range of airway reflex abnormalities. However, the current device for exploring LPMS is limited because it assesses only the laryngeal adductor reflex during fiber-optic endoscopic evaluations of swallowing and requires a high degree of expertise to obtain reliable results, introducing intrinsic expert variability and subjectivity.MethodsWe designed, developed and validated a new air-pulse laryngo-pharyngeal endoscopic esthesiometer with a built-in laser range-finder (LPEER) based on the evaluation and control of air-pulse variability determinants and on intrinsic observer variability and subjectivity determinants of the distance, angle and site of stimulus impact. The LPEER was designed to be capable of delivering precise and accurate stimuli with a wide range of intensities that can explore most laryngo-pharyngeal reflexes.ResultsWe initially explored the potential factors affecting the reliability of LPMS tests and included these factors in a multiple linear regression model. The following factors significantly affected the precision and accuracy of the test (P < 0.001): the tube conducting the air-pulses, the supply pressure of the system, the duration of the air-pulses, and the distance and angle between the end of the tube conducting the air-pulses and the site of impact. To control all of these factors, an LPEER consisting of an air-pulse generator and an endoscopic laser range-finder was designed and manufactured. We assessed the precision and accuracy of the LPEER’s stimulus and range-finder according to the coefficient of variation (CV) and by looking at the differences between the measured properties and the desired values, and we performed a pilot validation on ten human subjects. The air-pulses and range-finder exhibited good precision and accuracy (CV < 0.06), with differences between the desired and measured properties at <3 % and a range-finder measurement error of <1 mm. The tests in patients demonstrated obtainable and reproducible thresholds for the laryngeal adductor, cough and gag reflexes.ConclusionsThe new LPEER was capable of delivering precise and accurate stimuli for exploring laryngo-pharyngeal reflexes.

Work-associated irritable larynx syndrome.

The purpose of this study is to review the relevant literature concerning work-associated irritable larynx syndrome (WILS), a hyperkinetic laryngeal disorder associated with occupational irritant exposure. Clinical symptoms are variable and include dysphonia, cough, dyspnoea and globus pharyngeus. WILS is a clinical diagnosis and can be difficult to differentiate from asthma. Treatment options for WILS include medical and behavioural therapy. Laryngeal-centred upper airway symptoms secondary to airborne irritants have been documented in the literature under a variety of diagnostic labels, including WILS, vocal cord dysfunction (VCD), laryngeal hypersensitivity and laryngeal neuropathy and many others. The underlying pathophysiology is as yet poorly understood; however, the clinical scenario suggests a multifactorial nature to the disorder. More recent literature indicates that central neuronal plasticity, inflammatory processes and psychological factors are all likely contributors. Possible mechanisms for WILS include central neuronal network plasticity after noxious exposure and/or viral infection, inflammation (i.e. reflux disease) and intrinsic patient factors such a psychological state. Treatment is individualized and frequently includes one or more of the following: environmental changes in the workplace, GERD therapy, behavioural/speech therapy, psychotherapy counselling and neural modifiers.

It's Not Always Reflux: What Are We Missing?

Program Description: Laryngopharyngeal reflux (LPR) is commonly diagnosed in patients seen by otolaryngologists. Prescribing of proton pump inhibitors (PPIs) increased 5-fold from 1990 to 2001 and accounts for 10% of costs in evaluation and management of patients with voice disorders. In response, 46.5% of general otolaryngologists feel they are overdiagnosing LPR. Considering this, what diagnoses are otolaryngologists missing due to the reflexive diagnosis of LPR? The goal of this program is to present a clear clinical approach to the diagnosis and treatment of patients complaining of LPR-like symptoms and suggest alternative diagnoses and treatments as well as an approach to patients unresponsive to PPI therapy. Educational Objectives: (1) Diagnose efficiently and effectively treat a patient who has LPR-like symptoms but is unresponsive to PPI management. (2) Describe the unified airway concept and how it alters the diagnostic and therapeutic approach to patients with LPR-like symptoms. (3) Implement treatment for postviral vagal neuropathy and irritable larynx syndrome.

Development and validation of the Newcastle laryngeal hypersensitivity questionnaire

BackgroundLaryngeal hypersensitivity may be an important component of the common disorders of laryngeal motor dysfunction including chronic refractory cough, pdoxical vocal fold movement (vocal cord dysfunction), muscle tension dysphonia, and globus pharyngeus. Patients with these conditions frequently report sensory disturbances, and an emerging concept of the ‘irritable larynx’ suggests common features of a sensory neuropathic dysfunction as a part of these disorders. The aim of this study was to develop a Laryngeal Hypersensitivity Questionnaire for patients with laryngeal dysfunction syndromes in order to measure the laryngeal sensory disturbance occurring in these conditions.MethodsThe 97 participants included 82 patients referred to speech pathology for behavioural management of laryngeal dysfunction and 15 healthy controls. The participants completed a 21 item self administered questionnaire regarding symptoms of abnormal laryngeal sensation. Factor analysis was conducted to examine correlations between items. Discriminant analysis and responsiveness to change were evaluated.ResultsThe final questionnaire comprised 14 items across three domains: obstruction, pain/thermal, and irritation. The questionnaire demonstrated significant discriminant validity with a mean difference between the patients with laryngeal disorders and healthy controls of 5.5. The clinical groups with laryngeal hypersensitivity had similar abnormal scores. Furthermore the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) showed improvement following behavioural speech pathology intervention with a mean reduction in LHQ score of 2.3.ConclusionThe Newcastle Laryngeal Hypersensitivity Questionnaire is a simple, non-invasive tool to measure laryngeal pesthesia in patients with laryngeal conditions such as chronic cough, pdoxical vocal fold movement (vocal cord dysfunction), muscle tension dysphonia, and globus pharyngeus. It can successfully differentiate patients from healthy controls and measure change following intervention. It is a promising tool for use in clinical research and practice.

Invited Commentary: Frontiers in Neurolaryngology

Neurolaryngology is perhaps the most complex and poorly understood area of laryngology. Laryngologists largely treat neurological disorders of the larynx at the end organ level through static and symptom based manipulations. Interest in laryngology as a subspecialty of otolaryngology is rising with growth in formal clinical training programs, collaboration with neurology, neurosciences, and speech language pathology. This growth is creating a critical mass of individuals committed to narrowing the knowledge gap in neurolaryngology that presently limits optimum intervention for neurolaryngological disorders. An immediate and tangible frontier is the expansion and role of laryngeal electromyography in the field. Understanding laryngeal motor and sensory function peripherally and centrally over time will allow for dynamic and motion specific reanimation of vocal fold paralysis. The role of neural dysfunction in age-related voice change will help clarify the spectrum of disease in older patients and lead to functional therapies. Hyperfunctional disorders of the larynx, such as spasmodic dysphonia, vocal tremor, primary muscle tension dysphonia and paradoxical vocal fold dysfunction will be more precisely diagnosed with targeted intervention at the source. Understanding, diagnosing, and treating sensory dysfunction of the larynx remains a final frontier with implications not only for disorders such as laryngeal sensory neuropathic cough, but also disorders that have been traditionally thought of as primary motor problems, such as spasmodic dysphonia. Finally, improved understanding of the afferent neural supply to the larynx will aid in the site-specific treatment of neurogenic cough and irritable larynx syndrome.

Laryngeale Neuropathie und „irritable larynx syndrome“: Synonyme oder differente Entitäten?

The term 'laryngeal neuropathy' (LN) has first been used in veterinary medicine to describe an idiopathic and typically exercise induced inspiratory noise in horses.Nowadays, the term is often used in relation with intermittent vocal cord pareses in humans. Some authors use the term 'irritable larynx syndrome' (ILS) in a similar context. This article reviews the state of knowledge regarding LN and ILS and discusses the somewhat confusing terminology.For this systematic review a selective literature research in PubMed has been carried out.35 articles were found, which report on LN in animals and 17 articles reported on humans. 4 of these articles used the term 'irritable larynx syndrome'.Laryngeal neuropathy in horses usually affects the left recurrent laryngeal nerve and results in decreased vocal cord abduction and an inspiratory roaring or whistling noise, particularly during exercise. In dogs LN has been reported to also occur bilaterally. In association with humans LN has not been defined clearly in the literature. The term ILS on the other hand has only been used in relation to humans. The term describes a hypersensitivity of the laryngeal structures towards external stimuli, which causes symptoms such as dyspnea or cough among others. Sufficient knowledge does not exist for either of the 2 diseases, ILS or LN. As of yet, the term LN should not be used in human medicine to describe according symptoms of unknown aetiology. The term 'laryngeal movement disorder' seems a lot more appropriate. The symptom oriented term irritable larynx syndrome also seems suitable to describe laryngeal hypersensitivity appropriately.

Paradoxical vocal cord motion: Classification and treatment

Paradoxical vocal cord motion (PVCM), or vocal cord dysfunction, is a descriptive term for inappropriate adduction of the vocal folds during respiration. The laryngeal mistiming leads to breathing difficulty and is often misdiagnosed as refractory asthma. The etiology of PVCM has been unclear but has long been hypothesized to be psychological. The present thesis is a prospective study of 170 patients older than 18 years being evaluated for PVCM, with 117 of the 170 (68.8%) identified as having PVCM by video laryngoscopy. Laryngeal edema (P = .021) and reflux (P = .026) were increased in patients with PVCM. A flat inspiratory arm of the flow volume loop during spirometry testing was a predictor of PVCM (P = .034). A subgroup of 47 newly diagnosed patients with PVCM underwent psychological analysis. The psychological profiles were elucidated using the Minnesota Multiphasic Personality Inventory and the Life Experiences Survey to evaluate stress. Compared to established normative data, PVCM demonstrated a conversion disorder pattern (P < .01) but not an anxiety disorder or a correlation with stress. A subgroup, 11 of the 47 (23.4%), had normal psychological outcomes, and two of the 47 (4.3%) were identified as malingering. Previous studies have suggested that PVCM is strictly a psychological disorder. It is proposed that PVCM is a descriptive term that is multifactorial and the etiology should direct treatment. A classification scheme divides PVCM into primary, or psychological, and secondary. The secondary form consists of medical disorders divided into irritable larynx syndrome and neurologic disorders.

Chronic cough and irritable larynx

Chronic cough and irritable larynx

Chronic cough and irritable larynx

Perennial rhinitis (PR), chronic rhinosinusitis (CRS), or both, asthma, and gastroesophageal reflux disease (GERD) are the most frequent triggers of chronic cough (CC). Extrathoracic airway receptors might be involved in all 3 conditions because asthma is often associated with PR/CRS and gastroesophageal refluxate might reach the upper airway. We previously found that most patients with rhinosinusitis, postnasal drip, and pharyngolaryngitis show laryngeal hyperresponsiveness (LHR; ie, vocal cord adduction on histamine challenge) that is consistent with an irritable larynx. We sought to evaluate the role of LHR in patients with CC. LHR and bronchial hyperresponsiveness (BHR) to histamine were assessed in 372 patients with CC and in 52 asthmatic control subjects without cough (asthma/CC-). In 172 patients the challenge was repeated after treatment for the underlying cause of cough. The primary trigger of CC was PR/CRS in 208 (56%) patients, asthma in 41 (11%) patients (asthma/CC+), GERD in 62 (17%) patients, and unexplained chronic cough (UNEX) in 61 (16%) patients. LHR prevalence was 76% in patients with PR/CRS, 77% in patients with GERD, 66% in patients with UNEX, 93% in asthma/CC+ patients, and 11% in asthma/CC- patients. Upper airway disease was found in most (95%) asthma/CC+ patients and in 6% of asthma/CC- patients. BHR discriminated asthmatic patients and atopy discriminated patients with PR/CRS from patients with GERD and UNEX. Absence of LHR discriminated asthmatic patients without cough. After treatment, LHR resolved in 63% of the patients and improved in 11%, and BHR resolved in 57% and improved in 18%. An irritable larynx is common in patients with CC and indicates upper airway involvement, whether from rhinitis/sinusitis, gastric reflux, or idiopathic sensory neuropathy.

Laryngospasm in an unsedated patient during elective cannula cricothyroidotomy

We report a case of laryngospasm during performance of a cannula cricothyroidotomy in a conscious patient who may have been at increased risk of this complication. A 61-year-old woman presented for mandibular eminectomy. Clinical examination suggested that intubation and ventilation might be difficult, so an awake intubation was proposed. The patient declined this procedure, but did consent to placement of a cricothyroid cannula before intravenous induction of anaesthesia. Therefore, after pre-oxygenation, we performed an awake cricothyroidotomy with a 14-G Insyte™ cannula (Becton Dickinson UK Ltd, Oxford, UK) but following this, the patient coughed and developed severe laryngospasm. We immediately performed intravenous induction of anaesthesia and found that the patient’s lungs could be easily ventilated. Conventional intubation was possible and surgery proceeded uneventfully. Nothing was injected through the cannula at any stage. At the end of surgery, we viewed the cannula with fibreoptic laryngoscopy and found it to be positioned well below the vocal cords with the tip pointing caudally, suggesting no direct contact with the cords. When the episode of laryngospasm was discussed with the patient afterwards, she described experiencing similar, self-terminating ‘attacks’ of an inability to breathe that typically would wake her from sleep and occurred several times per year. Such episodes are consistent with paroxysmal laryngospasm, in which patients experience bouts of sudden-onset, forceful adduction of the vocal cords [1]. The primary risk factor is laryngopharyngeal reflux of gastric acid, which precipitates a highly irritable, ‘spasm-ready’ airway [2]. The patient was therefore referred to an ear, nose and throat specialist who identified characteristic acid damage to the larynx with nasendoscopy. In view of the history and this finding the specialist concurred with the diagnosis of paroxysmal laryngospasm. We postulate that this patient had an irritable larynx due to silent acid reflux and that the stimulus of the cannula touching the wall of the airway was sufficient to trigger laryngospasm. Given that other disease processes, such as upper respiratory tract infections, may also precipitate an irritable larynx [2, 3], and that many of the symptoms of laryngopharyngeal reflux are non-specific, the spasm-prone patient may well not declare themselves pre-operatively. With this in mind, we suggest conscious patients should be pre-oxygenated before placement of cricothyroid cannulae and the anaesthetist should be prepared to manage laryngospasm by immediately inducing anaesthesia if necessary. No external funding and no competing interests declared. Published with the written consent of the patient. Previously presented as a poster at the Difficult Airway Society Annual Meeting, November 2010.

Work-associated irritable larynx syndrome

Work-associated respiratory symptoms may be caused by disorders of both the lower and upper respiratory tract. We propose that occupational exposures may initiate and/or trigger recurrent hyperkinetic laryngeal symptoms, predominantly episodic dyspnoea, dysphonia, cough and sensation of tension in the throat-work-associated irritable larynx syndrome (WILS). To examine characteristics of individual and work-related factors that are associated with WILS, occupational asthma (OA) and work-exacerbated asthma (WEA). Subjects with WILS, OA and WEA were identified from an occupational lung disease clinic. A review of 448 charts of patients attending the clinic between 2002 and 2006 was undertaken, with information entered onto a standardized abstraction form. Fifty subjects were identified with OA, 40 with WEA and 30 with WILS. Subjects with the diagnosis of WILS were more likely to be female and more frequently reported symptoms of gastro-oesophageal reflux. The most common triggers of workplace symptoms in the WILS group were odours, fumes, perfumes and cleaning agents. Fourteen patients with WILS identified a specific precipitating event at the workplace at the time of the onset of their symptoms and five of these subjects presented to an emergency department within 24 h of the event. Dysfunction of the upper airway is an important cause of work-associated respiratory symptoms. The identification and management of WILS requires a multidisciplinary approach with a focus on modifying work-related and intrinsic factors that may perpetuate symptoms.

Sniffs, Gasps, and Coughs

Sniffs, Gasps, and Coughs