Elsevier

Journal of Voice

Volume 13, Issue 3, September 1999, Pages 447-455
Journal of Voice

The irritable larynx syndrome*

https://doi.org/10.1016/S0892-1997(99)80049-6Get rights and content

Summary

Muscular tension dysphonia, episodic laryngospasm, globus, and cough may be considered to be hyperfunctional laryngeal symptoms. Suggested etiological factors for these symptoms include gastroesophageal reflux, psychological problems, and/or dystonia. We propose a unifying hypothesis that involves neural plastic change to brainstem laryngeal control networks through which each of the above etiologies, plus central nervous system viral illness, can play a role. We suggest that controlling neurons are held in a “spasm-ready” state and that symptoms may be triggered by various stimuli. Inclusion criteria for the irritable larynx syndrome are episodic laryngospasm and/or dysphonia with or without globus or chronic cough; visible or palpable evidence of tension or tenderness in laryngeal muscles; and a definite symptom-triggering stimulus. thirty-nine patients with irritable larynx syndrome were studied. Gastroesophageal reflux was felt or proven to play a major role in a large number of the group (>90%), and about one third were deemed to have psychological causative factors. Viral illness seemed quite prevalent, with one third of patients able to relate the onset of symptoms to a viral illness that we feel might lead to central nervous system changes. Our proposed hypothesis includes a mechanism whereby acquired plastic change to central brainstem nuclei may lead to this form of hyperkinetic laryngeal dysfunction. It gives structure and reason to an array of therapy measures and suggests direction for basic research.

References (33)

  • MorrisonMD et al.

    Muscle misuse voice disorders: description and classification

    Acta Otolaryngol

    (1993)
  • MorrisonMD

    A pathophysiological model for dysphonia

  • RammageLA et al.

    Aerodynamic, laryngoscopic and perceptual-acoustic characteristics of dysphonic females with posterior glottal chink: a retrospective study

    J Voice

    (1991)
  • MilenkovicP et al.

    Acoustic and perceptual characterization of vocal nodules

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC:...
  • NewmanKB et al.

    Clinical features of vocal cord dysfunction

    Am J Respir Crit Care Med

    (1995)
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    *

    This paper was presented at the 27th Symposium of The Voice Foundation, June 5, 1998, Philadelphia, Pennsylvania, U.S.A.

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