The irritable larynx syndrome

Muscular tension dysphonia, episodic laryngospasm, globus, and cough may be considered to be hyperfunctional laryngeal symptoms. Suggested etiological factors for these symptoms include gastroesophageal reflux, psychological problems, and/or dystonia. We propose a unifying hypothesis that involves n eural plastic change to brainstem laryngeal control networks through which each of the above etiologies, plus central nervous system viral illness, ca n play a role. We suggest that controlling neurons are held in a "spasm-rea dy" state and that symptoms may be triggered by various stimuli. Inclusion criteria for the irritable larynx syndrome are episodic laryngospasm and/or dysphonia with or without,globus or chronic cough; Visible or palpable evi dence of tension or tenderness in laryngeal muscles; and a definite symptom -triggering stimulus. thirty nine patients with irritable larynx syndrome w ere studied. Gastroesophageal reflux was felt or proven to play a major rol e in a large number of the group (>90%), and about one third were deemed to have psychological causative factors. Viral illness seemed quite prevalent , with one third of patients able to relate the onset of symptoms to a vira l illness that we feel might lead to central nervous system changes. Our pr oposed hypothesis includes a mechanism whereby acquired plastic change to c entral brainstem nuclei may lead to this form of hyperkinetic laryngeal dys function. It gives structure and reason to an array of therapy measures and suggests direction for basic research.