Last reviewed: 23 Sep 2021
Last updated: 25 May 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • previous treatment for asthma without response to bronchodilators
  • episodic shortness of breath: rapid onset and resolution
  • difficulty inhaling
  • cough
  • inspiratory stridor
  • increased sensitivity to non-specific triggers after initial exposure
  • palpable laryngeal tension
  • loss of consciousness

Risk factors

  • laryngopharyngeal reflux (LPR)
  • GORD
  • asthma
  • occupational/environmental irritant exposure
  • female sex
  • competitive athletics
  • anxiety
  • multi-system atrophy (MSA)
  • muscle tension dysphonia
  • adductor laryngeal breathing dystonia
  • surgery

Diagnostic investigations

1st investigations to order

  • flexible fibre-optic nasendoscopy
  • PFTs/flow-volume plot

Investigations to consider

  • sinus CT
  • laryngeal sensory discrimination testing

Treatment algorithm

Contributors

Authors

Sherri K. Zelazny, MA, RSLP, CCC-SLP
Sherri K. Zelazny

Senior Clinical Speech Language Pathologist

Surrey Voice Clinic

Abilities Neurological Rehabilitation

Surrey

British Columbia

Canada

Disclosures

SKZ has received income from Northern Speech Services for educational webinar production on Paradoxical Vocal Fold Motion and Chronic Cough. SKZ is President of Speech and Hearing BC (2017-2019), and on the Board of Directors of Parkinson Society BC.

Susan L. Thibeault, PhD
Susan L. Thibeault

Assistant Professor

Director of Voice and Swallowing Clinic

Division of Otolaryngology - Head and Neck Surgery

University of Wisconsin School of Medicine and Public Health

Health Sciences Learning Center

Madison

WI

Disclosures

SLT declares that she has no competing interests.

Acknowledgements

Ms Sherri K. Zelazny and Dr Susan L. Thibeault would like to gratefully acknowledge Dr Michael Johns, a previous contributor to this topic. MJ declares that he has no competing interests.

Peer reviewers

Julina Ongkasuwan, MD

Associate Professor

Otolaryngology - Head and Neck Surgery

Baylor College of Medicine

Texas Children’s Hospital

Houston

TX

Disclosures

JO receives book royalties from Springer and Elsevier.

Janet Wilson, BSc, MD, FRCSEd, FRCSEng

Professor of Otolaryngology - Head and Neck Surgery

Newcastle University

Honorary Consultant Otolaryngologist

Freeman Hospital

Newcastle-Upon-Tyne

UK

Disclosures

JW declares that she has no competing interests.

Ryner Jose Dela Cruz Carrillo, MD, MSc, FPSOHNS, FPAHNS

Associate Professor

Department of Otorhinolaryngology

Department of Anatomy

University of the Philippines

College of Medicine

Manila

Philippines

Disclosures

RJDCC declares that he has no competing interests.

Tom Murry, PhD

Professor of Speech Pathology

Department of Otolaryngology - Head and Neck Surgery

Clinical Director of the Voice and Swallowing Center

College of Physicians and Surgeons

Columbia University at New York Presbyterian Hospital

New York

NY

Disclosures

TM declares that he has no competing interests.

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