Refractory chronic cough (RCC) and unexplained chronic cough (UCC) are common problems seen in primary care and subspecialty clinics. The role of cough hypersensitivity and laryngeal dysfunction in contributing to the persistence of cough in RCC/UCC is not well recognised.Data of patients with RCC and UCC evaluated in 2019 by an interdisciplinary cough clinic led by a pulmonologist and speech–language pathology team was reviewed. Patients completed validated questionnaires including the Leicester cough questionnaire (LCQ), voice handicap index (VHI) and dyspnoea index (DI) questionnaire at initial encounter. Presence of cough hypersensitivity was based upon a history of allotussia and hypertussia. Laryngeal dysfunction was diagnosed in those with a history of laryngeal paresthesias, throat clearing, voice abnormalities, upper airway dyspnoea and documentation of functional or anatomic laryngeal abnormalities on nasoendoscopy.Of the 60 UCC/RCC patients analysed, 75% of patients were female and 85% were over 40 years of age. Cough hypersensitivity was documented in all patients and multiple cough triggers occurred in 75% of patients. 95%, 50% and 25% of patients reported laryngeal paresthesias, voice abnormalities and upper airway dyspnoea, respectively. Significant associations between LCQ and VHI and DI scores occurred when adjusting for age, sex, ethnicity and body mass index. Laryngeal functional abnormalities were documented on 44 out of 60 patients on nasoendoscopy.Hypertussia, allotussia and laryngeal dysfunction are common in patients with RCC and UCC. Evaluation of UCC and RCC can delineate laryngeal hypersensitivity and allows appropriate treatment to be directed at this phenotype.

Objectives: This study characterized the clinical phenotypes of individuals with vocal tremor (VT) using tremor classification criteria published by the International Parkinson and Movement Disorder Society (IPMDS) including laryngeal features from the American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS).Methods: VT phenotypic descriptors were extracted from participant medical records from 2017 to 2019. Clinical phenotype descriptors included the: (a) chief complaint and discipline for the first appointment, (b) demographics, (c) tremor body distribution, condition, frequency, and progression, (d) exacerbating/alleviating factors, (e) treatment approaches, and (g) neurologic comorbidities. Descriptive statistics were conducted.Results: Of 179 meeting inclusion criteria, 2/3 were female; tremor onset affected voice (43%) or extremity (32%) and 2/3 were documented with tremor duration of 3 years or more. Those with primary VT first saw otolaryngology or speech language pathology (59%), whereas those with primary extremity/head tremor first saw neurology (36%). Documentation commonly omitted tremor clinical features such as (a) observed conditions of tremor (64%), (b) laryngeal features (64%), and (c) tremor frequency (92%). Thus, VT classification was based on comorbidity in 49% of patients (ie, essential tremor (48%), dystonia (72%), and Parkinson's disease (100%)) and 32% had inadequate documentation to classify.Conclusion: The majority of individuals with VT were unable to be classified based on documented clinical features highlighting the need for consistent multidisciplinary assessment of tremor affecting speech structures. The primary site of tremor determined the first discipline seen. Most commonly classified VT categories included essential tremor (47%), dystonia (28%), Parkinsonism (7%), and isolated VT (19%).Level of Evidence: 4.

Voice disorders are thought to affect approximately one third of all individuals within the United States during their lifetime. Individuals who require the use of their voice as part of their occupations are at highest risk for developing voice problems. Unfortunately, efficient diagnosis and effective management of voice disorders can be challenged by difficulty accessing professionals with the necessary expertise to diagnose and treat voice problems efficiently. Within the next decade, technological advancements show promise for improving the efficiency and effectiveness of intervention for voice disorders. Exciting developments in laryngeal imaging, modeling of patient-specific vocal patterns, and implementation of smart mobile technology and telehealth will greatly improve the accuracy of diagnosing voice problems and enhance implementation and carryover of effective voice treatment methods to daily communication demands.

Purpose: This pilot study systematically compared voice symptomatology across varied sensory trick conditions in those with laryngeal dystonia (LD), those with essential vocal tremor (EVT), and vocally normal controls (NCs). Sensory tricks are considered signature characteristics of dystonia and were hypothesized to reduce voice symptoms in those with LD compared to EVT and NC groups. Method: Five participants from each group (LD, EVT, and NC) completed speech recordings under control and sensory trick conditions (delayed auditory feedback [DAF], vibrotactile stimulation [VTS], and nasoendoscopic recordings with and without topical anesthesia). Comparisons between groups and conditions were made using (a) a paired-comparison paradigm (control vs. sensory condition) listener ratings of voice quality, (b) participant-perceived vocal effort ratings, and (c) average smoothed cepstral peak prominence (CPPS). Results: Participants with EVT displayed significantly worse listener ratings under most sensory trick conditions, whereas participants with LD were rated significantly worse for DAF and VTS conditions only. However, participant vocal effort ratings were similar across all sensory trick conditions. Average CPPS values generally supported listener ratings across conditions and speakers except during DAF, wherein CPPS values increased (i.e., measurably improved voice quality), whereas listener ratings indicated worsened voice quality for both voice disorder groups. Conclusions: Outcomes of this study did not support the hypothesized influences of sensory trick conditions on LD voice symptoms, with both LD and EVT groups experiencing worsened symptoms under VTS and DAF conditions. These adverse effects on voice symptoms warrant further research to further evaluate neural pathways and associated sensorimotor response patterns that distinguish individuals with LD and EVT. Supplemental Material: https://doi.org/10.23641/asha.28462292