Chronic cough and laryngeal dysfunction improve with specific treatment of cough and paradoxical vocal fold movement

The aim of this study was to investigate effects of therapy for chronic cough and paradoxical vocal fold movement.Adults with chronic cough (n = 24) were assessed before and after treatment for chronic persistent cough by measuring quality of life, extrathoracic airway hyperresponsiveness to hypertonic saline provocation, capsaicin cough reflex hypersensitivity and fibreoptic laryngoscopy to observe paradoxical vocal fold movement. Subjects with chronic cough were classified into those with (n = 14) or without (n = 10) paradoxical vocal fold movement based on direct observation at laryngoscopy.Following treatment there was a significant improvement in cough related quality of life and cough reflex sensitivity in both groups. Subjects with chronic cough and paradoxical vocal fold movement also had additional improvements in extrathoracic airway hyperresponsiveness and paradoxical vocal fold movement. The degree of improvement in cough reflex sensitivity correlated with the improvement in extrathoracic airway hyperresponsiveness.Laryngeal dysfunction is common in chronic persistent cough, where it is manifest as paradoxical vocal fold movement and extrathoracic airway hyperresponsiveness. Successful treatment for chronic persistent cough leads to improvements in these features of laryngeal dysfunction.Chronic persistent cough is responsible for a significant illness burden in the community [1]. Laryngeal problems are increasingly recognized as being part of the chronic cough syndrome, and include voice symptoms such as dysphonia [2], hyperresponsiveness of the extrathoracic airway with enhanced glottic stop reflex [3], reduced inspiratory airflow following a provocation stimulus [4-6], and paradoxical vocal fold movement (PVFM) where the vocal folds paradoxically adduct during inspiration [7,8]. Speech language therapy is effective for laryngeal dysfunction, and a randomized controlled trial has shown that speech language therapy treatment based on the approaches used