Advanced Head & Neck Rehabilitation Center of Texas
  • Start
    • Introduction video
    • Site Map
  • About
    • Meet the Staff
    • Contact
    • Informational Handouts
    • Publications
    • Links
    • Disclaimer
  • The NTLS
  • Laryngectomy
    • Stories, testimonials and clinical videos
    • Laryngectomees Making News
    • Changes following a laryngectomy >
      • Anatomical Changes After Laryngectomy
      • Functional Changes After Laryngectomy
      • Swallowing After Laryngectomy
      • Smelling after Laryngectomy
    • General Care >
      • Stoma Care
      • Using Suction
      • Saline Bullets
      • Bathing and Showering as a Laryngectomy
    • Tracheoesophageal Voice Prosthesis - TEP >
      • Cleaning Your Voice Prosthesis
      • Troubleshooting Voice Prosthesis Issues
      • Voicing Tips
      • Handsfree Speech
      • Controlling Fungal Growth
      • TEP and HME During Radiation Treatment
    • The Electrolarynx
    • HME and Tubes >
      • Using an HME Cassette
      • Cleaning Mucous From An HME
      • How To Apply An Adhesive Housing
      • Applying an OptiDerm Adhesive Housing
      • Larytube Use and Cleaning
      • Larybutton Use and Cleaning
    • Laryngectomy FAQ >
      • General Post-Op
      • Swallowing
      • HME's - Adhesives - Larybuttons
      • TEP's and voicing
    • Rescue Breathing for Laryngectomees and Neck Breathers
  • Radiation
    • Swallowing During Radiation Treatment
    • Preventing Trismus
    • Oral Care During Radiation Treatment
    • Nutrition During Radiation Treatment
    • When Nothing Tastes Right
    • TEP and HME During Radiation
    • Radiation FAQ
  • Swallowing
    • Normal Swallowing
    • Dysphagia >
      • What is Dysphagia?
      • Common Symptoms of Dysphagia
      • Evaluating Dysphagia
    • Management of Dysphagia >
      • Overview: Diet and Intake Modifications
      • Dysphagia Therapy
      • Medical Management
      • Vital-Stim Instructions
    • Trismus
    • Returning to Eating Again
    • Dietary Guidelines >
      • SOFT DIET
      • PUREED DIET
      • MOIST DIET
      • Thickening Liquids at Home
    • Therapeutic feeding
    • Swallowing exercises
  • Tracheostomy
    • Indications
    • Trach Tube Anatomy
    • Tracheostomy Tube Varieties >
      • Cuffed vs Cuffless Tubes
      • Types of Cuffs
      • Proper Cuff Inflation
      • Fenestrated vs. Non-Fenestrated Tubes
    • Being a “Neck Breather” >
      • Physiologic and Functional Changes
    • Speaking with a Tracheostomy Tube >
      • Understanding How a Voice is Produced
      • Speaking Valves and Alternatives
    • Swallowing with a Tracheostomy
    • Suction
    • Tracheostomy Care & Decannulation
    • Tracheostomy FAQ
  • Feeding Tubes
    • Feeding Tube Guide
    • Overview
    • Why Feeding Tubes are Used
    • Types of Feeding Tubes
    • Feeding Tube Methods
    • Gastrostomy Tube Troubleshooting
    • G-Tube Removal: Preparation and Post-Removal Instructions
    • Feeding Tube FAQ
  • Reflux
    • What is Reflux?
    • Evaluating Reflux
    • Reflux Management
    • Medications
    • Reflux Diet: Beneficial Dietary and Lifestyle Changes
    • Reflux Diet: So What Can I Eat?
    • Extensive Testing and Management
    • Reflux FAQ
  • Voice
    • Voice Care
    • Evaluating Voice Disorders
    • Types of Voice Disorders
    • Managing Voice Disorders
  • Chronic Cough
    • Chronic Cough Management
    • Irritable Larynx Diagnosis
    • Management of ILS
    • Vocal Hygiene
    • Cough Cessation Protocol
    • Chronic Cough FAQ

Irritable Larynx Diagnosis

Proper diagnosis is key in properly managing a chronic cough. The first step is ruling out a source in the lungs or bronchial airways. Certain heart problems may also cause a cough and this must also be ruled out.

This is a typical profile for a patient presenting with a chronic cough in this office:
​
  • All previous diagnostic examinations are normal.
  • Typical cough medicines (except those with Codeine), are ineffective.
  • Dry cough (no significant mucous is coughed).
  • Cough began during or after an upper respiratory illness (i.e., could, flu).
  • Cough has been persistent for several weeks, months or even years.
  • Coughing now is commonly triggered by a tickle.
  • Patients wake up coughing.
  • Coughing can lead to sense of being strangled, even vomiting.

The Diagnosis: Irritable Larynx Syndrome (ILS)
(previously also known as Hypersensitive Larynx Syndrome, HLS)


​In many cases, patients experiencing a chronic cough with no known cause are diagnosed by this practice as experiencing irritable larynx syndrome. This is something the SLP staff is very effective in treating, provided there is adequate patient compliance with prescribed protocols.

Before this diagnosis can be made, an otolaryngology examination will be conducted to examine both the structures as well as function of the throat. The examination typically includes one or both of the following endoscopic examinations that allow for close examination of the larynx and vocal cords (where a cough is typically triggered).

Flexible Fiberoptic Endoscopy For this examination, a nasopharyngoscope is passed through the passageway of the nose into the throat. The endoscope allows for visualization of the structures of the throat, in this way, assessing the overall health and status of the various structures. In some cases, you may be referred for closer assessment of the larynx (voice box) using Stroboscopy.
​
Picture

Stroboscopic Examination


​Stroboscopy is an endoscopic procedure that utilizes advanced technology to closely examine the larynx. During this examination procedure a rigid endoscope is utilized in combination with strobe lighting. This allows for magnified imaging of the larynx and surrounding structures as well as for direct visualization of the vocal cords during vibration.

**Many times, clinical changes indicating worsening, stability or improvement in the condition of the laryngeal structures are best assessed with stroboscopic examination. For this reason, following your initial diagnosis, you may be monitored with periodic stroboscopy. 
​
Picture

Endoscopic - Stroboscopic Findings


​There can be significant inflammation of the vocal cords, due in large part to the persistent and traumatic coughing behavior. There may be inflammation of other portions of the larynx as well, most commonly, the back (posterior sections), when laryngopharyngeal reflux is a component to the hypersensitivity. There are otherwise normal exam findings.
​
Picture
Healthy Larynx
Picture
Irritable Larynx

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  • Start
    • Introduction video
    • Site Map
  • About
    • Meet the Staff
    • Contact
    • Informational Handouts
    • Publications
    • Links
    • Disclaimer
  • The NTLS
  • Laryngectomy
    • Stories, testimonials and clinical videos
    • Laryngectomees Making News
    • Changes following a laryngectomy >
      • Anatomical Changes After Laryngectomy
      • Functional Changes After Laryngectomy
      • Swallowing After Laryngectomy
      • Smelling after Laryngectomy
    • General Care >
      • Stoma Care
      • Using Suction
      • Saline Bullets
      • Bathing and Showering as a Laryngectomy
    • Tracheoesophageal Voice Prosthesis - TEP >
      • Cleaning Your Voice Prosthesis
      • Troubleshooting Voice Prosthesis Issues
      • Voicing Tips
      • Handsfree Speech
      • Controlling Fungal Growth
      • TEP and HME During Radiation Treatment
    • The Electrolarynx
    • HME and Tubes >
      • Using an HME Cassette
      • Cleaning Mucous From An HME
      • How To Apply An Adhesive Housing
      • Applying an OptiDerm Adhesive Housing
      • Larytube Use and Cleaning
      • Larybutton Use and Cleaning
    • Laryngectomy FAQ >
      • General Post-Op
      • Swallowing
      • HME's - Adhesives - Larybuttons
      • TEP's and voicing
    • Rescue Breathing for Laryngectomees and Neck Breathers
  • Radiation
    • Swallowing During Radiation Treatment
    • Preventing Trismus
    • Oral Care During Radiation Treatment
    • Nutrition During Radiation Treatment
    • When Nothing Tastes Right
    • TEP and HME During Radiation
    • Radiation FAQ
  • Swallowing
    • Normal Swallowing
    • Dysphagia >
      • What is Dysphagia?
      • Common Symptoms of Dysphagia
      • Evaluating Dysphagia
    • Management of Dysphagia >
      • Overview: Diet and Intake Modifications
      • Dysphagia Therapy
      • Medical Management
      • Vital-Stim Instructions
    • Trismus
    • Returning to Eating Again
    • Dietary Guidelines >
      • SOFT DIET
      • PUREED DIET
      • MOIST DIET
      • Thickening Liquids at Home
    • Therapeutic feeding
    • Swallowing exercises
  • Tracheostomy
    • Indications
    • Trach Tube Anatomy
    • Tracheostomy Tube Varieties >
      • Cuffed vs Cuffless Tubes
      • Types of Cuffs
      • Proper Cuff Inflation
      • Fenestrated vs. Non-Fenestrated Tubes
    • Being a “Neck Breather” >
      • Physiologic and Functional Changes
    • Speaking with a Tracheostomy Tube >
      • Understanding How a Voice is Produced
      • Speaking Valves and Alternatives
    • Swallowing with a Tracheostomy
    • Suction
    • Tracheostomy Care & Decannulation
    • Tracheostomy FAQ
  • Feeding Tubes
    • Feeding Tube Guide
    • Overview
    • Why Feeding Tubes are Used
    • Types of Feeding Tubes
    • Feeding Tube Methods
    • Gastrostomy Tube Troubleshooting
    • G-Tube Removal: Preparation and Post-Removal Instructions
    • Feeding Tube FAQ
  • Reflux
    • What is Reflux?
    • Evaluating Reflux
    • Reflux Management
    • Medications
    • Reflux Diet: Beneficial Dietary and Lifestyle Changes
    • Reflux Diet: So What Can I Eat?
    • Extensive Testing and Management
    • Reflux FAQ
  • Voice
    • Voice Care
    • Evaluating Voice Disorders
    • Types of Voice Disorders
    • Managing Voice Disorders
  • Chronic Cough
    • Chronic Cough Management
    • Irritable Larynx Diagnosis
    • Management of ILS
    • Vocal Hygiene
    • Cough Cessation Protocol
    • Chronic Cough FAQ