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Paradoxical Vocal Cord Movement in Chronic Cough

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Paradoxical vocal cord movement (PVCM) is a condition that results in the vocal cords closing rather than opening when a person breathes in. Recently, researchers at the University of Newcastle identified that 50% of chronic cough (CC) sufferers have PVCM coexisting with CC. Symptomatic extrathoracic airway hyperresponsiveness (EAHR) results in reduced inspiratory airflow after saline provocation. The underlying mechanisms in PVCM and EAHR are similar. PVCM can be effectively treated with speech pathology.

The aim of the study was to investigate the effects of treatment for chronic cough using the Anatomic Diagnostic Protocol (ADP) with addition of speech therapy for PVCM on cough outcomes.Methods: Subjects with CC+PVCM (14 adults, 22-78 years), and CC without PVCM (10 adults, 47-70 years) were diagnosed and treated using the ADP. Associated disorders following ADP assessment included Rhinitis (n=20), GERD (15), Asthma (9), eosinophilic bronchitis (3), and ACE-I use (3). PVCM was identified by fiberoptic laryngoscopy (FOL). Each subject completed symptom questionnaires, the Leicester Cough Questionnaire (LCQ), capsaicin cough reflex sensitivity (CRS) testing and assessment of EAHR to hypertonic (4.5%) saline. Results: Following treatment there was a significant improvement in quality of life (LCQ) and cough threshold (CRS) for both groups; p<0.008 for CC+PVCM and p<0.02 for CC. There was a significant change (p=0.01) in EAHR for the CC+PVCM subjects following speech pathology treatment while in the untreated CC group EAHR remained unchanged.Conclusions: PVCM and EAHR are important efferent manifestations of CC that can be effectively treated by speech therapy. Speech pathology assessment and treatment should be included in the ADP for CC. Conflict of Interest: NoneFunding: CCRE in Respiratory and Sleep Medicine(Source : Nicole M Ryan (Nicole.Ryan@newcastle.edu.au), Peter G Gibson: School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute : Newcastle, NSW, Australia : April 2007.)

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Posted On: 18 April, 2007
Modified On: 21 July, 2015

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