Rhinogenic Laryngitis, Cough, and the Unified Airway
Section snippets
Laryngeal involvement in the unified airway
While there has been extensive discussion of how the upper and lower airways interact in acute and chronic illness, the role of the larynx has not been widely described and is currently not well understood. While clinicians have frequently considered the role of allergic rhinitis and asthma in their patients with laryngitis, dysphonia, and cough, systematic study in this area has been uncommon. The larynx possesses a unique anatomic role. It is situated between the upper and lower airways and
Mucus, neurologic reflexes, and neurogenic inflammation
The many roles of mucus are important in both health and disease. Mucus is continuous from the nasal vestibule to the distal alveoli, and serves multiple functions including:
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Humidification of inspired air, which lowers oxygen tension for circulatory exchange and reduces dehydration of the mucosa
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Warming of the inspired air to provide temperature equilibration in the lungs
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Mechanical protection of the underlying mucosa, clearance of foreign particles (including bacterial, viral, and fungal
Diagnosis of chronic rhinogenic laryngitis
For the purposes of this discussion, chronic rhinogenic laryngitis is defined as inflammation of the larynx resulting in related symptoms and signs that last for at least 2 weeks.17 The term rhinogenic laryngitis is not fully satisfactory, since inflammation of the larynx can occur from both upstream and downstream influences, but will frame the problem accurately for the otolaryngologist treating these types of patients. It may be also be argued that the term rhinogenic laryngitis refers to
Model for chronic rhinogenic laryngitis
It is clear that the respiratory tract functions as an integrated, unified airway unit, and that influences in one portion of this system can result in changes in other, more distant sites. It is also clear that the larynx functions as an integral component of this unified airway, and that common influences from both the upper and lower respiratory tracts can lead to changes in the larynx and the production of laryngeal symptoms, including hoarseness, throat clearing, and cough. These laryngeal
Summary
The increasing recognition of concurrent and synergistic inflammatory processes in respiratory pathophysiology and their effects on the larynx suggests that an evaluation of patients with laryngeal symptoms, such as hoarseness, throat clearing, and cough, should involve an assessment of acute and chronic processes in the upper and lower airways. Direct effects of allergic inflammation in the nose, paranasal sinuses, and lungs; trafficking of mucus and mucopurulent secretions upstream and
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Prevalence of Self-Reported Dysphonia and Dysphagia in Patients with Allergy
2023, Journal of VoiceCitation Excerpt :There was a significant difference in mean VHI-10 scores between patients testing positive for at least one allergen and the control group (P= 0.0002). Allergy-induced dysphonia has been attributed to several mechanisms, most important of which is nasal dysfunction and trafficking of mucus postnasally.15,16,17 Nasal dysfunction in patients with allergy can predispose to mouth breathing and dehydration of the vocal folds.
Prevalence of Laryngopharyngeal Reflux Related Symptoms in Patients With Allergy
2022, Journal of VoiceCitation Excerpt :The high prevalence of vocal symptoms in patients with allergy can be ascribed to the location of the larynx between the upper and lower airways, which makes it susceptible to environmental allergens and inflammatory changes. Based on the unified airway concept described by Krouse et al,11 atopic diseases of the airway are the manifestation of one inflammatory process which requires an integrated unified approach for management.12 Local inflammation in one part of the airway induces systemic signaling that results in inflammatory cell release into different sites of the airway.
Predictive fiberoptic endoscopic findings of upper airway in children with allergic rhinitis
2019, International Journal of Pediatric OtorhinolaryngologyThe Role of Allergy in Phonation
2019, Journal of VoiceCitation Excerpt :This is partly because of the limited research that has been done on allergic laryngitis, our poor understanding over this clinical entity, and the poor existing data to support such a clinical diagnosis. However, accumulating epidemiological and experimental evidence suggest that there may be a causal association between allergy and vocal pathologies in some patients and that allergy may be the trigger and causative mechanism responsible for the laryngeal inflammation and symptomatology.5,33,34 The underlined allergic reaction in allergic laryngitis can be an immediate or delayed hypersensitivity to inhaled or digested allergens.
Allergic laryngitis
2019, Revue Francaise d'Allergologie