Cough and paradoxical vocal fold motion.
OBJECTIVE
The differential diagnosis and treatment of patients with chronic cough, paradoxical vocal fold motion, and disordered breathing can be a challenge to most practicing otolaryngologists. Tracheobronchial (ie, asthma, bronchitis, and tracheal stenosis), laryngeal (ie, vocal fold paralysis and neoplasms), and rhinologic (ie, allergies and rhinosinusitis) etiologies are commonly diagnosed and treated effectively. However, occasionally one is faced with patients who are refractory to medical treatment and have no obvious rhinologic, laryngeal or pulmonary cause.


METHODS
We conducted a review of the literature.


METHODS
We present a thorough review of the current medical literature exploring the complex neurologic mechanisms involved in the production of cough and the relationship between gastroesophageal reflux disease, vagal neurapathy, and paradoxical vocal fold motion.


RESULTS
The diagnosis and successful treatment of chronic cough can be complex. It requires a thorough understanding of the neurologic mechanisms behind cough excitation and suppression. Successful treatment strategies include aggressive management of the patient's reactive airway disease, gastroesophageal reflux disease, and, in select cases, paradoxical vocal fold motion. This may involve a well-coordinated effort among pulmonologists, otolaryngologists, gastroenterologists, and speech pathologists.


CONCLUSIONS
Gastroesophageal reflux disease, vagal neuropathy, and paradoxical vocal fold motion are additional causes of chronic cough and disordered breathing that need to be considered, in the absence of obvious laryngotracheal and/or rhinologic pathology. A high index of suspicion is essential in making the diagnosis and formulating an effective multidisciplinary treatment plan for these patients.
Altman
Kenneth W
KW
Department of Otolaryngology, Northwestern University Medical School, Chicago, IL, USA.
Simpson
C Blake
CB
Amin
Milan R
MR
Abaza
Mona
M
Balkissoon
Ron
R
Casiano
Roy R
RR
D002908:Chronic Disease; D003371:Cough / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D003937:Diagnosis, Differential; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D018570:Risk Assessment; D020421:Vagus Nerve Diseases / Q000150:complications* / Q000175:diagnosis; D014826:Vocal Cord Paralysis / Q000150:complications* / Q000175:diagnosis; D014827:Vocal Cords / Q000294:innervation