Allergic Disease and Laryngeal Dysfunction

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Allergic Disease and Laryngeal Dysfunction

Allergy
Author Credentials 

Camysha Wright MD 
American Academy of Otolaryngic Allergy

Module Summary

Allergic rhinitis can have symptoms that manifest with laryngeal disease. It can mimic some of the symptoms traditionally felt to be associated with reflux disease. A key to diagnosis includes a detailed history and physical examination.  Testing modalities such as fiberoptic nasopharyngoscopy and videostroboscopy can be used to assess the larynx.  It is also imperative to understand the role of functional tests to assess measures such as quality of life - which can be utilized before and after treatment used for the management of allergic disease.

Module Learning Objectives 
  1. Explain signs and symptoms of allergic disease of the larynx.
  2. Describe epidemiology and impact of allergies on the larynx. 
  3. Recognize key components of a history and physical exam to evaluate allergic symptoms.
  4. Recognize and understand key testing modalities and evaluation of the findings.
  5. Be aware of the role of screening questionnaires to aid in evaluating patients with allergic rhinitis and laryngeal disease.

Anatomy

Learning Objectives 
  1. Describe how allergic rhinitis can affect the larynx.  What laryngeal physical exam findings can be generally noted in patients with allergic laryngitis?
References 
  1. Lin, SY. Allergy Primer: Current Concepts in the Diagnosis and Management of Allergic Rhinitis. Int Forum Allergy Rhinol. 2014 Sep;4 Suppl 2:S17

Pathogenesis

Learning Objectives 
  1. Explain the immunologic reactions involved in allergic disease of the larynx and cough.
References 

Kravos, A. The role of allergy in the etiology of Reinke’s edema on vocal folds. Weiner klinishce Wochenschrigt May 2010; 122 Suppl 2:44-48
C Bucca: Chronic cough and irritable larynx. Journal of Allergy and clinical immunology. Feb 2011; 127 (2): 412-9

 

Incidence

Learning Objectives 
  1. Identify the patient population impact of allergic disease and the larynx.
References 
  1. Hamden, A. The use of screening questionnaire to determine the incidence of allergic rhinitis in singer’s with dysphonia. Arch Otolaryngol Head Neck Surg 2006; 132 (5): 547-49
  2. Shah, M.  Prevalence of Laryngeal and Pharyngeal symptoms in Patients with Environmental Allergy. International Journal of Phonosurgery and Laryngology. Jan-June2014; 4(1):1-4

Patient Evaluation

Learning Objectives 
  1. Summarize key factors in history and evaluation of the patient; Consideration of testing to determine possible predictors of allergic disease.
References 
  1. Lin, SY. Allergy Primer: Current Concepts in the Diagnosis and Management of Allergic Rhinitis. Int Forum Allergy Rhinol. 2014 Sep;4 Suppl 2:S17

Measurement of Functional Status

Learning Objectives 
  1. Explain the role and use of various functional status tests such as vocal handicap index and the quality of life index  - V-RQOL (a measure of voice related quality of life) and the use of screening questionnaires to evaluate allergic disease in patients with dysphonia.

 

Testing

  1. Explain various testing modalities used to determine presence of allergic disease of the larynx and findings noted on exam.  
  2. Describe the limits of testing modalities and how to blend various testing techniques.  
  • Testing modalities include 
    • Fiberoptic nasolaryngoscopy
    • Videostroboscopy

 

References 
  1. Jacobson, BH. Voice Handicap Index (VHI): development and validation. J Voice, 12 (1998), p. 540-550
  2. Hogikyan, N. Validation of an instrument to measure voice-related quality of life (V-RQOL) J Voice, 13 (4) (1999), p. 557-569
  3. Hamden A: The use of screening questionnaire to determine the incidence of allergic rhinitis in singers with dysphonia. Archives of otolaryngology –head &neck surgery. May 2006; 132 (5): 547-9

 

Testing References: 

  1. Brook, C. Predictive findings of allergic disease in fiberoptic nasolaryngoscopy. Laryngoscope. 2015 Feb;125(2):286-90
  2. Koç EA, Koç B, Erbek S. Comparison of Acoustic and Stroboscopic Findings and Voice Handicap Index between Allergic Rhinitis patients and Controls. Balkan Med J. 2014 Dec;31(4):340-4

 

 

Case Studies

  1. A 42 year old teacher presents for a chronic cough and vocal complaints.  She has a history of allergic rhinitis, reflux, and smoking 20 years prior.  Nasolaryngoscopy shows edema of the inferior turbinates and non-specific edema of the vocal folds with increased laryngeal mucous and no discrete lesion.  A trial of both antihistamines and reflux medications with voice therapy results in mild improvement in vocal symptoms and cough.  The patient undergoes allergy testing and a sensitization to dust mites is identified.  Environmental measures to decrease dust mite exposure is employed and the patient is prescribed additional allergy medications, including intranasal steroid sprays and intranasal antihistamines.  She has improvement in vocal symptoms and cough with interventions for dust mite allergy.  
Resources 

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