Speech pathology for chronic cough: A new approach

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Abstract

Chronic cough may persist despite systematic evaluation and medical treatment of known associated diseases such as asthma, rhinitis, and gastro-esophageal reflux. These patients have refractory chronic cough and many exhibit laryngeal hypersensitivity that is manifest at both a sensory and motor level. Examples of this are heightened sensitivity of the cough reflex to capsaicin, and laryngeal motor dysfunction with hoarse vocal quality and paradoxical vocal cord movement. Chronic cough that persists despite medical treatment may respond to speech pathology intervention. A multidimensional speech pathology treatment programme was designed based upon methods used to treat hyperfunctional voice disorders and paradoxical vocal fold movement. This included education, vocal hygiene training, cough suppression strategies and psychoeducational counseling. When tested in a single-blind, randomized, placebo-controlled trial involving 87 patients, participants in the treatment group demonstrated a significant reduction in cough, breathing, voice and upper airway symptoms following intervention, as well as improvements in auditory perceptual ratings of voice quality (breathy, rough, strain and glottal fry) and significant improvement in voice acoustic parameters (maximum phonation time, jitter and harmonic-to-noise ratio). Speech pathology intervention can be an effective way to treat refractory chronic cough.

Section snippets

Refractory chronic cough

Chronic cough is generally assessed and managed using a systematic assessment based on knowledge of specific disease associations and trials of therapy. This approach is generally successful in most people with chronic cough. However, it is now increasingly recognized that cough may persist despite medical treatment based on the anatomic diagnostic protocol in between 12 and 42% of cases [1], [2], [3], [4], [5], [6]. When cough persists because a specific cause has not been identified after

Cough and laryngeal dysfunction

Cough is a motor act involving forced expiration against an initially closed glottis, with subsequent opening of the glottis and generation of an expulsive sound. The larynx is involved in several aspects of the cough reflex, and it is not surprising that there is a close association between laryngeal dysfunction and chronic cough. In addition to cough, other laryngeal functions include phonation, participation in respiration as part of the conducting airway and swallowing. Chronic cough can be

Speech pathology treatment for chronic cough

Several studies have evaluated speech pathology treatment for chronic cough [20], [21], [22]. The components of successful therapeutic programmes include: education, vocal hygiene, cough suppression strategies and psychoeducational counseling [24] (Table 1).

Efficacy of speech pathology for refractory chronic cough

The speech pathology programme described above was evaluated in a single -blind, randomized placebo-controlled trial conducted in patients with refractory chronic cough [22]. The speech pathology intervention was delivered in four sessions over a 2 month period by a qualified speech pathologist. The control or placebo group received a course of healthy lifestyle education delivered similarly in four sessions over a 2 month period. The four components of the placebo program included relaxation,

Conclusions

These observations of abnormalities of laryngeal motor function in chronic cough, and the success of speech pathology for refractory chronic cough represent a new direction in cough research and management. Protocols for the management of chronic cough using the anatomic diagnostic protocol could be expanded to include speech pathology treatment either for refractory or non-specific cough or for patients with suspected associated PVFM. Research on mechanisms of the effects of speech pathology

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