Laryngeal Hypersensitivity

The ENT speech and language therapy team provides care for patients with a disorders of the upper airway.

What is laryngeal hypersensitivity?

Laryngeal hypersensitivity refers to a cluster of symptoms that occur secondary to sensory dysfunction in the larynx (voice box). This means that the nerves in the larynx become too sensitive or too reactive to stimuli and sensations that they usually wouldn’t detect. Noticing these small sensations can result in a large sensory response, these responses may include:

A heightened awareness of normal sensations in the throat, such as our normal secretions or crumbs of food after eating. We may perceive these sensations as a foreign body in the throat, for example a lump, a sticking sensation or even a hair.
A dry cough to environmental irritants we wouldn’t usually notice, such as cold air or strong smells.
A choking or blockage sensation or a feeling that the space in the throat is narrow or closed, this may occur after exercise or vocal tasks such as laughing.

Disorders associated with laryngeal hypersensitivity:

Laryngeal muscle tension – tight muscles within the larynx and throat. You may feel this as something sticking, a lump or even a choking sensation. For some people, the muscles around the larynx are so tight during speaking that voice production is affected, the voice may sound hoarse and feel effortful to produce.
Persistent throat symptoms – an irritation or discomfort in the throat, this could be a dry, tight, or itchy sensation, a feeling of burning or the feeling of some other sensation, such as excessive mucus/catarrh. These symptoms may include a hoarse voice or the persistent urge to cough or clear the throat.
Difficulty swallowing – this includes an awareness of food sticking in the throat after eating, the feeling of increased effort when swallowing or the urge to swallow more frequently.
Refractory cough – an unexplained dry cough lasting more than 8 weeks. This can be frequent episodes of coughing, as well as coughing bouts, often in response to an irritation in the environment (e.g. aerosols, strong smells, smoke) or irritation in the throat such (e.g. an itch, a tickle, or a sticking sensation).
Inducible laryngeal obstruction – a sudden onset of breathlessness symptoms, often with difficulty breathing in and an associated feeling of choking, tightening and/or narrowing in the throat.

What causes laryngeal hypersensitivity?

It is unclear why people experience laryngeal hypersensitivity; some evidence suggests that it may be caused by a change to the nerve pathways after a viral infection or following chronic irritation to throat tissue. Often, there is an initial trigger to hypersensitivity, such as a cold or chest infection, but sometimes symptoms can occur with no obvious cause. There are certain risk factors that can make people more vulnerable to these symptoms, these include:

Exposure to environmental irritants e.g., dust, chemicals, smoke, perfumes
Internal irritants e.g., reflux, post-nasal drip, allergies
Chronic coughing or throat-clearing
Exertion, i.e. physical exercise, including slight exertion such as walking upstairs or getting dressed.
Emotion e.g., stress or emotional situations.
Lower airway disease e.g., asthma, COPD, bronchiectasis.
Increased awareness of the throat e.g., after surgery or infection or at times of worry.
Side effect to medications.

Laryngeal hypersensitivity is often caused by multiple contributing factors, rather than there being one cause and effect.

Assessment of laryngeal hypersensitivity

During assessment, we will ask patients for information about their medical history, throat health and the impact of their symptoms. Assessment may include laryngoscopy, continuous laryngeal endoscopy or Fibreoptic Endoscopic Examination of Swallowing (FEES).

Treatment of laryngeal hypersensitivity

Your speech and language therapist can help to identify the contributing factors to your laryngeal hypersensitivity. Treatment may include:

Education and biofeedback to help you understand the nature and cause of your symptoms
Environmental adaptations
Throat care advice to reduce laryngeal irritation e.g., hydration.
Management of internal irritation e.g., lifestyle changes for the management of reflux, strategies to help reduce post-nasal drip.
Exercises to reduce muscle tightness.
Breathing exercises
Cough control strategies
Onward referral for medical treatment, if indicated.