2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Laryngeal sensory dysfunction

Laryngeal paraesthesia Laryngeal paraesthesia scores were significantly worse in each of the case groups (CRC 66.7 (16.6); PVFM 60.4 (18.1); globus 53.0 (15.0); MTD 67.5 (16.1)) in comparison with controls (93.2 (3.1); P < 0.001)). There was no significant difference in scores between the clinical groups ( P = 0.066). Quantitative testing Quantitative testing measured the four domains of swallowing, breathing, cough and vocalization. Table 4 shows effects of stimulation across diagnostic groups. Swallowing: timed swallow test The case groups had significantly worse Timed Swallow Test results ( P < 0.0125) than controls, indi- cating a less efficient swallowing mechanism in each of the CRC, PVFM and globus groups. The Timed Swallow Test was not different between the case groups, indicating that the changes were present in each of the syndromes of laryngeal dysfunction. The values were however in the normal range ( > 10 mL/s) for all groups (Table 4; Fig. 2), and the majority of par- ticipants in all groups had clinically normal swallows, with no difference in the clinical evaluation of swal- lowing between groups. Mild and clinically insignifi- cant abnormalities in swallowing were noted in between one and three participants in each group. Voice handicap index (VHI) scores were significantly impaired in each of the case groups compared to con- trols ( P < 0.001, Table 4). VHI scores were similar between case groups with the exception that the MTD group had worse scores than the CRC group ( P < 0.001). While it is expected that the MTD group would have the worst scores, the abnormal values in the CRC, PVFM and globus groups confirm the extent of voice symptoms in these other case groups, con- sistent with hypothesis 2. Auditory perceptual voice analysis (Table 4) 18 revealed abnormal ratings in the case groups. Ratings were significantly higher in the case groups than the controls ( P < 0.0125). Ratings in the MTD group were also significantly higher than the CRC and PVFM groups ( P < 0.008). Mean maximum phonation time (MPT) was in the abnormal range in all case groups (Table 4) and was significantly worse than controls ( P < 0.001). There was no significant difference in MPT values between case groups ( P > 0.05). The Dysphonia Severity Index (Table 4; Fig. 2) values were significantly worse in the case groups than controls ( P < 0.001). There was no significant dif- ference in Dysphonia Severity Index scores between the case groups ( P > 0.05). Cough reflex sensitivity Capsaicin cough reflex sensitivity (Table 4; Fig. 2) was heightened in cases compared to controls. The C5 Vocalization: voice handicap index, auditory perceptual and acoustic analysis

analysed using Chi-Square analysis. Planned com- parisons were used to test two hypotheses; whether (i) the case groups differed from controls, and (ii) there was any difference between the case groups. Significance was accepted when % < 0.05. A Bonfer- onni adjustment was made to account for the multiple comparisons bringing the significance level to P = 0.0125 for hypothesis 1, that is, four compari- sons, and to P = 0.008 for hypothesis 2, that is, six comparisons. The case groups were predominantly female with long symptom duration. The severity of the defining symptom for each of the case groups was similar (Table 3). The prevalence of associated diseases was significantly higher in the case groups than the control group ( P < 0.05). The Reflux Symptom Index scores were in the abnormal range for all case groups, were significantly higher than controls ( P < 0.001), but not different between the case groups. A history of asthma was more common in the MTD ( P = 0.005) and PVFM ( P = 0.001) groups than the CRC group. Rhinitis was more common in the MTD group than the globus group ( P < 0.001). Angiotensin-converting enzyme inhibitors I (ACE I) use was low and similar between groups. An upper airway/laryngeal co-morbidity index was calculated as the number of relevant co-morbidities (asthma, gastroesophageal reflux, rhinitis, ACE inhibitor use) and was scored between 0 and 4 for each participant. Co-morbidity scores were significantly higher in the clinical groups than controls with no significant difference between the clinical groups. Mean anxiety and depression scores were in the normal range for all groups with the exception of anxiety scores in the globus group which were in the ‘possible’ range. There was no significant difference in scores between groups but a trend towards lower scores in the control group. Lung func- tion was in the normal range for all groups, however the PVFM group had lower forced vital capacity ( P = 0.012) values than the control group. Assessment of sensory symptoms The clinical case groups had elevated symptom scores across several domains, in addition to the primary symptom domain ( P < 0.001 vs controls; Fig. 1). The score for the dominant symptom in each case group was high, but additionally there was elevation of symptoms outside of the dominant symptom domain. For example, the PVFM group had the worst breathing scores ( P < 0.001 vs cough; P = 0.005 vs MTD), however all other symptom domains were also abnormal in this group. Similarly, the CRC group had the highest cough scores, but also had abnormal scores for breathing, voice and upper airway, and the MTD group had the highest voice scores ( P = 0.004 vs cough) but also had abnormal upper airway and breathing scores. The globus group had the highest upper airway scores and also had abnormal voice, cough and breathing scores. © 2013 The Authors Respirology © 2013 Asian Pacific Society of Respirology RESULTS Clinical details

Respirology (2013) 18 , 948–956

105