This review summarizes recent literature regarding the association of nonorganic laryngeal dysfunction with occupational exposures. Laryngeal dysfunction may masquerade as asthma and is an important consideration in patients with work-associated respiratory symptoms.
Although there is lack of consensus regarding clinical features, vocal cord dysfunction (VCD) is the most well appreciated form of nonorganic laryngeal dysfunction. There are significant gaps in the literature regarding the occupational epidemiology of laryngeal dysfunction, however, occupational exposures such as upper airway irritants may be associated with the onset of symptoms. Recurrent work-associated laryngeal dysfunction has been described in occupational groups including the military and professional athletes. Recent theories have considered that VCD may be a state of laryngeal hyperresponsiveness associated with both intrinsic and extrinsic factors.
Laryngeal dysfunction is an important consideration in patients with work-associated respiratory symptoms. Clinicians should have a high index of suspicion, in particular, if symptoms are associated with exposure to a respiratory irritant. Situations of high psychological stress may also be associated with recurrent symptoms. There is a requirement for evidence-based guidelines for the diagnosis and management of laryngeal dysfunction, which should also address work-related factors.
aDepartment of Allergy, Immunology and Respiratory Medicine, Alfred Hospital
bDepartment of Epidemiology and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
Correspondence to Ryan Hoy, MBBS, MOEH, FRACP, Monash Centre for Occupational and Environmental Health, SPHPM, Monash University, The Alfred, Commercial Road, Melbourne VIC 3004, Australia. Tel: +61 3 9903 0595; fax: +61 3 9903 0556; e-mail: email@example.com