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Functional Disorders of the Larynx: Muscle Tension Dysphonia, Paradoxical Vocal Cord Dysfunction, and Globus Pharyngeus

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Functional Illness of the Head and Neck

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Abstract

Functional disorders of the larynx can present in a diverse manner with symptoms such as dysphonia, dyspnea, and dysphagia. Muscle tension dysphonia (MTD) may cause disrupted phonation due to overactive laryngeal musculature. MTD is diagnosed by a thorough clinical history and laryngoscopic visualization of the vocal cords and supra-glottic region. Vocal hygiene and voice therapy are the foundations of MTD treatment with concomitant medical therapy when indicated. Paradoxical vocal cord dysfunction (PVCD) can cause shortness of breath due to inappropriate vocal cord adduction during respiration. Laryngoscopic evaluation is the gold standard in the diagnosis of PVCD and remains an important investigation to differentiate PVCD from other respiratory conditions. Patient reassurance during an acute event of PVCD is most often indicated, whereas speech therapy is the principal treatment for the prevention of further episodes. Globus pharyngeus may present as the sensation of a lump in the throat, although the etiology of this functional disorder remains unclear. The diagnosis of globus pharyngeus requires the exclusion of alternative diagnoses such as gastroesophageal reflux disease and major esophageal motor disorders. Globus pharyngeus is a benign disorder that can be treated with careful reassurance, a trial of gastric acid suppression, or neuromodulator medications. Altogether, functional disorders of the larynx require careful attention from clinicians. When such disorders are appropriately diagnosed and treated, the quality of life of patients can greatly improve.

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  1. Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada

    Brendan D. McNeely & Amanda Hu

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  1. Otolaryngology, University of Manitoba, Winnipeg, MB, Canada

    Brian W. Blakley

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    Joan E. Blakley

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McNeely, B.D., Hu, A. (2023). Functional Disorders of the Larynx: Muscle Tension Dysphonia, Paradoxical Vocal Cord Dysfunction, and Globus Pharyngeus. In: Blakley, B.W., Blakley, J.E. (eds) Functional Illness of the Head and Neck. Springer, Cham. https://doi.org/10.1007/978-3-031-12998-8_18

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