presented by Mary J. Sandage
Irritable larynx syndrome (ILS) provides a vital theoretical framework from which to consider assessment and treatment of those conditions believed to fall on its continuum: chronic throat clearing, chronic cough, paradoxical vocal fold motion, and laryngospasm. Upper airway disorders will be delineated with the distinction between obstructive conditions and behavioral conditions emphasized.
Mary J. Sandage, Ph.D., CCC-SLP is an Assistant Professor in the Department of Communication Disorders at Auburn University. She earned her M.S. degree in speech language pathology from the University of Iowa and her Ph.D. in Exercise Science at Auburn University. She has been a clinician for over 24 years, specializing in the assessment and treatment of upper airway and voice disorders, with a particular expertise in the assessment and treatment of chronic cough and paradoxical vocal fold motion. During her doctoral program in the School of Kinesiology at Auburn University she was fortunate to have access to the Auburn University swim team and learn about their training practices and breathing techniques. This experience, combined with her experience treating other athletes with paradoxical vocal fold motion, expanded her clinical approach in a meaningful, functional direction. Dr. Sandage, a singing teacher for over 20 years and a member of the National Association of Teachers of Singing (NATS), was integral in developing the professional voice care clinic at the University of Wisconsin-Madison Division of Otolaryngology during her 10 years there as clinical faculty. Her current research interests include muscle bioenergetics and voice training considerations, upper airway thermoregulation, and hormonal influences on voice production. She has taught mindfulness-based stress reduction (MBSR) for over 17 years and uses its principles regularly in clinical care for individuals with voice and upper airway disorders.
This chapter will explain the theoretical construct of the irritable larynx from the basic literature with a particular emphasis on the Nobel Prize winning research completed by Eric Kandel, Ph.D. This construct will be presented in a clinician-friendly manner to serve as a rational to share with patients as they are counseled about the nature of their upper airway disorder. Many patients have been told that nothing is really wrong with them and that they should just be able to stop the behavior. This theoretical construct provides a compassionate approach to therapy that, while letting the client off the hook for the development of the disorder, provides a behavioral roadmap to overcome the behavior.
This chapter will differentiate extrathoracic obstruction conditions from the upper airway disorders that are amenable to speech language pathology assessment and treatment. There are many obstructive conditions of the upper airway that may impact breathing or cause cough without affecting voice, such as large vocal process granuloma, bilateral vocal fold paralysis, recurrent respiratory papillomatosis, and subglottic or tracheal stenosis. The importance of ruling out physically obstructing conditions that are not amenable to behavioral intervention is vital. Medical versus behavioral interventions for these conditions will be described.
This chapter will define PVFM and describe demographics for this client population. The requisite medical work up for specific differential diagnostic conditions that should occur prior to the SLP referral will be outlined: pulmonary work-up, allergy work-up, otolaryngology work-up, etc. Typical referral sources will be outlined. The case history for PVFM will be covered in detail with specific guidance provided for common pitfalls and barriers that may occur during the client interview. The complex nature of the breathing disorder requires excellent interviewing skills to discern the nature of the problem, the likely triggers for the disorder, and relevant medical and behavioral history.