Irritable larynx syndrome (ILS) encompasses a range of\nconditions including chronic throat clearing, chronic cough, paradoxical vocal\ncord movement (PVFM)\/vocal cord dysfunction (VCD), and laryngospasm. In ILS,\nthe larynx (voice box) becomes very sensitive to stimuli leading to episodes of\nunnecessary and counterproductive vocal fold closure (PVFM and laryngospasm),\nchronic throat clearing, and chronic cough. Some common stimuli include strong\nsmells, cold air, talking, etc. <\/p>\n\n\n\n
There are a couple\ntheories surrounding the cause of ILS. The most common theory is that ILS is\nrelated to a viral illness that causes inflammation of the nerve that supplies\nthe voice box. This in turn \u201cresets\u201d the sensitivity of the voice box and\ncauses the nerve to react to stimuli at a much lower stimulus level, thereby\nmaking the voice box hypersensitive. Some believe that gastroesophageal reflux\ncan cause chronic irritation of the voice box, leading to ILS. Allergies,\nsinusitis, certain medications, environmental exposures, and stressful life\noccurrences can also play a role in ILS. <\/p>\n\n\n\n
Symptoms of ILS usually last for longer than 3 weeks and have no other identifiable cause. Symptoms may include frequent non-productive throat clearing, chronic coughing attacks that bring up little or no mucus, difficulty breathing with the sudden onset of stridor (noisy breathing). These episodes can be triggered by exercise or physical exertion, stress, voice use, variations in weather, or environmental irritants such as strong smells, dust, or smoke. Sometimes no specific trigger is identified. <\/p>\n\n\n\n
A laryngologist and speech language\npathologist jointly perform the work-up for ILS. A comprehensive history and\nexam is obtained. The exam includes a thorough\nlaryngoscopic and stroboscopic examination to examine patterns of vocal fold\nmotion and vocal fold vibration.<\/p>\n\n\n\n
Most of the time, an\nextensive work-up has already been performed to rule-out other causes of the\nsymptoms including evaluation of the lungs for asthma or other pulmonary\ndisease, evaluation of the sinuses and nose for sinusitis, post-nasal drip, and\nallergies, and evaluation of the esophagus and stomach for reflux disease. <\/p>\n\n\n\n
Because the\ncause of ILS is usually multifactorial, treatment may involve multiple\nstrategies. The first line of treatment for ILS is typically behavioral\nintervention, which consists of voice therapy performed by a speech and\nlanguage pathologist. Voice therapy will focus on desensitizing the\nthroat\/larynx and retraining the body\u2019s response to triggers. This is\naccomplished through education on vocal hygiene, respiratory retraining\ntechniques, laryngeal massage, and voice efficiency techniques. Medical\nintervention may also be recommended\ndepending on the findings of the initial evaluation and the response to\nbehavioral intervention. If your doctor suspects a medication, may be\ncontributing to your symptoms, he or she may suggest changing the medication If\nreflux is suspected to be an issue, you may be started on a reflux medication\nor suggested lifestyle modifications. Many times, irritable larynx needs to be\ntreated with medications in addition to voice therapy. Medications are used to reduce the\nsensitivity of the nerve that supplies your voice box. <\/p>\n\n\n\n
Medications used for this may include\nElavil, gabapentin, lyrica, trileptal, and tramadol. All of these medications\nhave side effects and are, therefore, started at a low dose and gradually\nincreased if needed and tolerated. <\/p>\n\n\n