Management of recurrent laryngeal sensory neuropathic symptoms.
OBJECTIVE
We identify management strategies for the treatment of upper respiratory tract symptoms stemming from dysfunction of the recurrent laryngeal nerve.


METHODS
We present a retrospective case series of patients who had symptoms of sensory neuropathy, including persistent dysphonia, laryngospasm, and chronic cough. The patients were followed for symptomatic improvement after initiation of treatment with a neuromodulator. Treatment outcome was defined by improvement or resolution of symptoms on a self-reported outcome scale.


RESULTS
Of 12 patients identified, 75% exhibited evidence of motor neuropathy on laryngoscopy and 83% had symptoms related to chronic cough treated with neuromodulator therapy over a mean follow-up of 20.4 months. The median dose of amitriptyline hydrochloride was 25 mg daily, and that of gabapentin was 300 mg 3 times daily. The mean time from the initiation of therapy to a complete response was 2 months.


CONCLUSIONS
Patients with suspected neuropathy of the recurrent laryngeal nerve frequently respond to neuromodulator therapy. The addition of reflux precautions and acid suppression therapy is helpful in cases of chronic and recurrent laryngospasm. Patients with evidence of motor neuropathy appear to have better outcomes with neuromodulator therapy.
Norris
Byron K
BK
Department of Otolaryngology and Communicative Sciences, University of Mississippi, Jackson, Mississippi, USA.
Schweinfurth
John M
JM
D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D000588:Amines / Q000008:administration & dosage* / Q000627:therapeutic use; D000639:Amitriptyline / Q000008:administration & dosage* / Q000627:therapeutic use; D003371:Cough / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D003389:Cranial Nerve Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D000077206:Gabapentin; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D012009:Recurrent Laryngeal Nerve; D012189:Retrospective Studies; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage* / Q000627:therapeutic use
D018759:Adrenergic Uptake Inhibitors; D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D018691:Excitatory Amino Acid Antagonists; D018377:Neurotransmitter Agents; D000639:Amitriptyline; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin