Page 68 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 68
Laryngeal Disorders of some benign laryngeal lesions46. The third
possible way is though the reduction of air
severe asthma forum 1: severe asthma - basic and clinical views In terms of unified respiratory path (nose, flow coming from the lungs of the asthmatic
middle ear, larynx, lungs), a mediator re- patient to the vocal folds. Consequently, the
sponse in one organ can trigger similar re- available subglottic pressure does not suffice
sponses along the rest of respiratory tract. for good voice quality and causes the speak-
There is a paucity of research on allergic lar- er to change the activity of laryngeal muscles
yngitis. Some authors even doubt that such during phonation in order to compensate for
entity really exists. The diagnosis of aller- the insufficient subglottic pressure46.
gic laryngitis is a diagnosis of exclusion after
all other possible diagnoses (laryngopharyn- The fourth possible mechanism of af-
geal reflux, retronasal drip as a consequence fecting voice quality is through the influence
of sinusitis, laryngeal symptoms due to irri- of asthma treatment on larynx. Dysphonia is
tation at working place, etc) are ruled out47. the most common side effect of inhaled cor-
Most patients with suspicion of allergic laryn- ticosteroids treatment. After inhaled steroids
gitis complain because of cough, throat clear- exposure the laryngeal findings range from
ing, sensation of a foreign body and excessive vocal fold oedema, erythema, and atrophy to
mucous in the throat, postnasal drip, and dif- irregularities of the vocal fold edges, interar-
ferent voice disorders. When the researchers ytenoid thickening, and supraglottic hyperac-
studied reaction of laryngeal mucosa to var- tivity19. The vocal fold atrophy results in vo-
ious antigen exposures thick-viscous endola- cal folds’ bowing and incomplete vocal folds
ryngeal mucous and transient or chronic re- closure during phonation. Ozbilen Acar et al.
active vocal folds oedema and hyperaemia proved corticosteroid-associated myopathy
was noticed in a great majority of the cases39,6. after inhaled corticosteroids treatment by per-
There are several studies showing a link be- forming EMG and stroboscopy during thera-
tween allergic rhinitis and vocal symptoms py and after its cessation. The glottis gap and
which can improve with increased duration voice disorders improved in several weeks af-
of immunotherapy treatment31,44. ter the end of therapy35.
Voice disorders are not unusual in the Inhaled corticosteroids produce their af-
patients with asthma. Deteriorated voice fects mostly by local immunosuppression sec-
quality was noticed in asthma patients when ondary to reduced mRNA synthesis35. Lo-
compared to healthy controls with the use calized laryngopharyngeal candidiasis is the
of objective and subjective evaluation meth- most frequently documented infection after
ods14. There are several different mechanisms the use of inhaled corticosteroids. The inci-
through which the voice quality in asthma pa- dence of laryngeal candidiasis associated with
tients can be affected. According to the theo- dysphonia was estimated at 20% in those
ry of the unified respiratory disease, the vocal taking inhaled steroid therapy50. As a mat-
fold mucosa may be affected by allergic in- ter of fact, the entire microflora of the larynx
flammation thus altering the mass of the vocal changes after regular inhalation of corticos-
folds and their vibrating characteristics. The teroids, and potentially lead to the occurrence
mucous on the vocal folds can give the char- of rare opportunistic laryngeal infections49.
acteristic of »wet voice« but also forces the pa-
tient to cough. As a matter of fact, cough is Episodic Laryngeal Obstruction
one of the most prominent symptoms of asth-
ma. During cough the vocal folds violently Attacks of dyspnea and wheezing are not
strike together causing mechanical trauma, only the typical symptoms of asthma. Sud-
oedema, erythema and even the occurrence den airway obstruction at the level of the lar-
ynx was first described as a disturbance in the
possible way is though the reduction of air
severe asthma forum 1: severe asthma - basic and clinical views In terms of unified respiratory path (nose, flow coming from the lungs of the asthmatic
middle ear, larynx, lungs), a mediator re- patient to the vocal folds. Consequently, the
sponse in one organ can trigger similar re- available subglottic pressure does not suffice
sponses along the rest of respiratory tract. for good voice quality and causes the speak-
There is a paucity of research on allergic lar- er to change the activity of laryngeal muscles
yngitis. Some authors even doubt that such during phonation in order to compensate for
entity really exists. The diagnosis of aller- the insufficient subglottic pressure46.
gic laryngitis is a diagnosis of exclusion after
all other possible diagnoses (laryngopharyn- The fourth possible mechanism of af-
geal reflux, retronasal drip as a consequence fecting voice quality is through the influence
of sinusitis, laryngeal symptoms due to irri- of asthma treatment on larynx. Dysphonia is
tation at working place, etc) are ruled out47. the most common side effect of inhaled cor-
Most patients with suspicion of allergic laryn- ticosteroids treatment. After inhaled steroids
gitis complain because of cough, throat clear- exposure the laryngeal findings range from
ing, sensation of a foreign body and excessive vocal fold oedema, erythema, and atrophy to
mucous in the throat, postnasal drip, and dif- irregularities of the vocal fold edges, interar-
ferent voice disorders. When the researchers ytenoid thickening, and supraglottic hyperac-
studied reaction of laryngeal mucosa to var- tivity19. The vocal fold atrophy results in vo-
ious antigen exposures thick-viscous endola- cal folds’ bowing and incomplete vocal folds
ryngeal mucous and transient or chronic re- closure during phonation. Ozbilen Acar et al.
active vocal folds oedema and hyperaemia proved corticosteroid-associated myopathy
was noticed in a great majority of the cases39,6. after inhaled corticosteroids treatment by per-
There are several studies showing a link be- forming EMG and stroboscopy during thera-
tween allergic rhinitis and vocal symptoms py and after its cessation. The glottis gap and
which can improve with increased duration voice disorders improved in several weeks af-
of immunotherapy treatment31,44. ter the end of therapy35.
Voice disorders are not unusual in the Inhaled corticosteroids produce their af-
patients with asthma. Deteriorated voice fects mostly by local immunosuppression sec-
quality was noticed in asthma patients when ondary to reduced mRNA synthesis35. Lo-
compared to healthy controls with the use calized laryngopharyngeal candidiasis is the
of objective and subjective evaluation meth- most frequently documented infection after
ods14. There are several different mechanisms the use of inhaled corticosteroids. The inci-
through which the voice quality in asthma pa- dence of laryngeal candidiasis associated with
tients can be affected. According to the theo- dysphonia was estimated at 20% in those
ry of the unified respiratory disease, the vocal taking inhaled steroid therapy50. As a mat-
fold mucosa may be affected by allergic in- ter of fact, the entire microflora of the larynx
flammation thus altering the mass of the vocal changes after regular inhalation of corticos-
folds and their vibrating characteristics. The teroids, and potentially lead to the occurrence
mucous on the vocal folds can give the char- of rare opportunistic laryngeal infections49.
acteristic of »wet voice« but also forces the pa-
tient to cough. As a matter of fact, cough is Episodic Laryngeal Obstruction
one of the most prominent symptoms of asth-
ma. During cough the vocal folds violently Attacks of dyspnea and wheezing are not
strike together causing mechanical trauma, only the typical symptoms of asthma. Sud-
oedema, erythema and even the occurrence den airway obstruction at the level of the lar-
ynx was first described as a disturbance in the
