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A review of voice and upper airway function in chronic cough and paradoxical vocal cord movement

Vertigan, Anne E; Gibson, Peter G; Theodoros, Deborah G; Winkworth, Alison L

Current Opinion in Allergy and Clinical Immunology: February 2007 - Volume 7 - Issue 1 - p 37–42
doi: 10.1097/ACI.0b013e328012c587
Upper airway disease

Purpose of the review Chronic cough and paradoxical vocal fold movement (PVFM) are perplexing conditions. This paper reviews the recent literature in relation to the nature of PVFM and chronic cough and the management of symptoms associated with these disorders.

Recent findings There are similarities in the voice and upper airway symptoms in chronic cough and PVFM. Clinically significant voice symptoms are present in approximately 40% of individuals with chronic cough and PVFM and are similar to those occurring in voice disorders such as muscle tension dysphonia. Chronic cough can be associated with PVFM in a large proportion of cases. Extrathoracic airway hyperresponsiveness is a common underlying mechanism in PVFM and chronic cough. Speech pathology intervention can be effective in controlling symptoms in chronic cough, which suggests that the anatomic diagnostic protocol could be expanded to incorporate this intervention. Chronic cough that fails to respond to medical management should be conceptualized as either due to PVFM or idiopathic. PVFM and chronic cough are not necessarily the result of underlying psychopathology.

Summary Chronic cough and PVFM manifest in a range of clinically significant voice and upper airway symptoms. The anatomic diagnostic protocol used in the management of chronic cough could be expanded to include PVFM as a potential cause of cough, and speech pathology intervention as treatment for chronic cough.

aSpeech Pathology Department, John Hunter Hospital, Newcastle, Australia

bDivision of Speech Pathology, University of Queensland, Brisbane, Australia

cDepartment of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, Australia

dSchool of Community Health, Charles Sturt University, Albury, Australia

Correspondence to Anne Vertigan, Speech Pathology Department, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, NSW 2310, Australia Tel: +61 2 49213726; fax: +61 2 49855460; e-mail:

Copyright © 2007 Wolters Kluwer Health, Inc. All rights reserved.