Anne E Vertigan

University of Newcastle Australia · School of Medicine and Public Health

Objectives Chronic refractory cough (CRC) is a challenging condition that responds to speech pathology intervention. Clinical observation suggests abnormal breathing patterns occur in CRC and may be indirectly addressed as part of behavioural treatment, yet breathing pattern changes in CRC are poorly understood. The aims of this study were to (1) d...

Introduction Cough is the most common symptom leading to medical consultation. Chronic cough results in significant health care costs, impairs quality of life, and may indicate the presence of a serious underlying condition. Here, we present a summary of an updated position statement on cough management in the clinical consultation. Main recommend...

Background Elderly individuals with asthma have the greatest burden and worst outcomes, and there is increasing evidence that chronic cough (CC) is associated with asthma severity and poor prognosis. However, clinical characteristics in elderly patients with both asthma and CC have been largely unexplored. Methods Participants with stable asthma u...

Chronic cough is a common problem that can be refractory to medical treatment. Non-pharmaceutical management of chronic cough has an important role in well selected patients. This review article outlines the history of chronic cough management, current approaches to speech pathology management of the condition and new modalities of non-pharmaceutic...

Purpose: Poor oral health is a known predictor of aspiration pneumonia in vulnerable populations such as the elderly and chronically ill. This study examined the feasibility of using myofunctional devices during a 5-week intervention for the management of oral care and dysphagia for residents in a residential aged-care facility. Method: Feasibility...

Background: Individuals with asthma experienced severe and prolonged symptoms following the Australian 2019-2020 landscape fire period. Many of these symptoms, such as throat irritation, are referrable to the upper airway suggesting that laryngeal hypersensitivity contributes to persistent symptoms following smoke exposure. Objective: The study...

Background: Vocal cord dysfunction / inducible laryngeal obstruction (VCD/ILO) is characterised by breathing difficulties in association with excessive supraglottic or glottic laryngeal narrowing. The condition is common, and can occur independently, however, it may also be comorbid with other disorders or mimic them. Presentations span multiple s...

Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO), is a common condition characterized by breathlessness associated with inappropriate laryngeal narrowing. Important questions remain unresolved, and to improve collaboration and harmonization in the field, we convened an international Roundtable conference on VCD/ILO in Melbourne, Aus...

Background The 2019/2020 Australian landscape fires (bushfires) resulted in prolonged extreme air pollution; little is known about the effects on breastfeeding women and their infants. This study aimed to examine the impact of prolonged landscape fires on infant feeding methods and assess the concentration of polycyclic aromatic hydrocarbons (PAHs)...

Introduction Currently there is no consistent and widely accepted approach to the diagnosis of vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO). Harmonised diagnostic methods are vital to enable optimal diagnosis, advance management and enable research. We aim to obtain consensus on how expert clinicians recognise and diagnose VCD/I...

Background: Little is known about the physical and mental health impact of exposure to landscape fire smoke in women with asthma. This study examined the health impacts and information-seeking behaviours of women with asthma exposed to the 2019/2020 Australian fires, including women who were pregnant. Methods: Women with asthma were recruited fr...

Purpose This study aimed to explore the use of myofunctional devices (MDs) by speech-language pathologists (SLPs) to gain a better understanding of how SLPs are utilizing these in the treatment of their patients. Method Eleven SLPs from four countries participated in semistructured interviews. The interview transcripts were analyzed using qualitat...

The aim of the study was to examine the following: (a) the trajectory of external and internal head and neck lymphoedema (HNL) in patients with head and neck cancer (HNC) up to 12 months post-chemoradiotherapy (CRT) and (b) the relationship between HNL and swallowing function. Using a prospective longitudinal cohort study, external/internal HNL and...

Background Poor oral health is a known predictor of aspiration pneumonia in vulnerable populations such as the elderly and chronically ill and has been linked to systemic disease, morbidity, and mortality. Reduced oral health not only places individuals at a greater risk of aspiration pneumonia but may result in pain or poorer dentition which can i...

Wildfires are increasing and cause health effects. The immediate and ongoing health impacts of prolonged wildfire smoke exposure in severe asthma are unknown. This longitudinal study examined the experiences and health impacts of prolonged wildfire (bushfire) smoke exposure in adults with severe asthma during the 2019/2020 Australian bushfire perio...

Background Poor oral health is a known predictor of aspiration pneumonia in vulnerable populations such as the elderly and chronically ill and has been linked to systemic disease, morbidity, and mortality. Reduced oral health not only places individuals at a greater risk of aspiration pneumonia but may result in pain or poorer dentition which can i...

Objective To determine if treatment effectiveness can be established for a range of Vocal Cord Dysfunction (VCD) interventions in adolescents and adults. Design A systematic review of the literature and risk of bias appraisal was completed using the Joanna Briggs Institute Critical Appraisal Tools. Data were qualitatively synthesised in the broad...

Background and objective: Inhalational challenge with dry mannitol powder may potentially induce cough by two mechanisms: airway bronchoconstriction or laryngeal irritation. This prospective observational study investigated laryngeal and bronchial components of cough induced by mannitol challenge. Methods: We recruited consecutive patients refer...

Research question Objective quantification of cough is rarely utilised outside of research settings and the role of cough frequency monitoring in clinical practice has not been established. This study examined the clinical utility of cough frequency monitoring in an outpatient clinical setting. Methods The study involved a retrospective review of...

Background Chronic cough and vocal cord dysfunction are manifestations of laryngeal hypersensitivity syndrome. Objective The aim of the study was to determine the clinical utility of functional transnasal laryngoscopy in patients with laryngeal hypersensitivity syndromes. Methods This study was a prospective observational cross sectional study de...

Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the m...

Objective To analyze the validity of the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ-Br) in Brazilian Portuguese. Methods The present study sample consisted of 89 individuals from the laryngeal hypersensitivity group and 41 individuals from the healthy group. The Newcastle Laryngeal Hypersensitivity Questionnaire's validation process f...

Lymphoedema is a disorder of the lymphatic system that presents as an atypical swelling and accumulation of protein-rich fluid within the interstitial spaces. Head and neck lymphoedema (HNL) is highly prevalent in patients who have been treated for head and neck cancer (HNC) and may manifest externally on the face and neck; internally within the or...

Non-pharmacological control of cough is an important component in the management of chronic cough that is refractory to medical management. This chapter outlines the components of non-pharmacological approaches and evidence for treatment. The mechanisms underlying improvement in cough following non-pharmacological approaches are explored as well as...

Purpose A growing number of speech-language pathologists (SLPs) are using orofacial myofunctional therapy (OMT) and/or myofunctional devices (MDs) in the treatment of their clients. However, governing bodies suggest SLPs carefully consider the availability and quality of evidence in the utilization of these therapies in speech-language pathology tr...

Background: To examine the relationship between chronic external and internal head and neck lymphedema (HNL) and swallowing function in patients following head and neck cancer (HNC) treatment. Methods: Seventy-nine participants, 1-3 years post treatment were assessed for external HNL using the MD Anderson Cancer Centre Lymphedema Rating Scale, a...

Background: Laryngeal disorders can contribute to disease burden in severe asthma yet the nature of laryngeal disorders in severe asthma is poorly understood. Objective: The aim of this study was to examine laryngeal function in patients with severe asthma. Method: A cross-sectional observational study involving 97 participants compared laryng...

Background This study aimed to examine the prevalence, location, and severity of chronic internal, external, and combined head and neck lymphedema (HNL) in patients with head and neck (HNC) who were treated with definitive chemoradiotherapy (CRT) or postoperative radiotherapy (PORT). Methods Sixty‐two participants between 1 and 3 years post‐treatm...

Background and aim Vocal Cord Dysfunction (VCD) and chronic [Reviewer 2 comment 1] cough (CC) are challenging conditions which lead to significant quality of life impairment. The underlying mechanisms are poorly understood, but laryngeal dysfunction may be common to both conditions. The aim of this study was to determine the characteristics of coug...

Objective To translate and cross-culturally adapt the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) to the Brazilian Portuguese language. Material and methods The translation and cross-cultural adaptation procedures were performed in five stages: translation, synthesis, back-translation, committee review, and pretest performance. Resul...

Chronic cough is a common, debilitating condition that can persist for years with little relief from medical treatment. Speech pathology treatment is an effective treatment option for patients with chronic cough. This review outlines current speech pathology assessment and treatment for chronic cough and describes the evidence supporting the interv...

Purpose of Review Chronic cough is a common and debilitating problem that remains refractory to medical treatment. Laryngeal dysfunction frequently occurs in chronic cough. The goal of this review was to explore new developments in the mechanism treatment of chronic cough particularly those that target laryngeal function. Recent Findings Treatment...

Speech pathology intervention is effective for chronic refractory cough (CRC). Speech pathology treatment for CRC includes therapy exercises to teach cough suppression and reduce laryngeal closure during respiration. Aim: The aim of this study was to evaluate the benefit of providing patients with supplemental pre-recorded videos of speech pathol...

Head and neck lymphoedema (HNL) is common following head and neck cancer (HNC) treatment, and may contribute to numerous physical, functional and psychological symptoms. However, its impact on swallowing, voice and speech is less well understood. The aim of this study was to use interpretive description to explore patient perceptions relating to th...

There are a range of conditions associated with reflux, aspiration and lung disease that are managed by speech-language pathologists (SLP). In many cases the SLP role is to treat the symptoms or consequences of the disease while management of the underlying disease is the role of the medical practitioner. Laryngeal conditions related to reflux, asp...

Background: Chronic refractory cough (CRC), a phenotype of cough hypersensitivity syndrome (CHS), is a disabling problem. Laryngeal dysfunction may be important in CRC and CHS because laryngeal symptoms are common; however, the role of laryngeal dysfunction in CHS has not been systematically examined. Objective: To determine the nature of laryng...

Introduction: Chronic Cough (CC) is common and often associated with significant comorbidity and decreased quality of life. In up to 50% of cases, the cough is refractory despite extensive investigation and treatment trials. It is likely that the key abnormality in refractory CC is dysfunctional, hypersensitive sensory nerves, similar to conditions...

Objective/hypothesis: Talking is a significant trigger for cough in patients with chronic cough; however, the stimulus required to trigger cough has not been quantified. The aim of this study was to examine the effect of a vocal loading task on phonation and cough behavior in patients with chronic cough and identify change following therapy. Stud...

The term psychogenic cough has been used to describe cough without obvious medical etiology, which is refractory to medical management and considered to have a psychiatric or psychological basis. However there are limitations in the research into psychogenic cough with limited empirical data on how to define the condition or differentially diagnose...

Evidence indicates that daily listening to music can improve outcomes in patients recovering from a recent stroke. This study investigated the feasibility and impact of music-listening in addition to standard stroke unit care. It was hypothesized that patients (N = 38) who listened to 70 hours of self-selected music via MP3 players in the first 12...

Background: In response to occupational and environmental exposures, cough can be an isolated symptom reflecting exposure to an irritant with little physiological consequence, or can be a manifestation of more significant disease. This document reviews occupational and environmental contributions to chronic cough in adults, focusing on aspects not...

Chronic refractory cough (CRC) is defined as a cough that persists despite guideline based treatment. It is seen in 20-46% of patients presenting to specialist cough clinics and it has a substantial impact on quality of life and healthcare utilization. Several terms have been used to describe this condition, including the recently introduced term c...

Rationale: Chronic refractory cough (CRC) is a difficult problem to treat. Speech pathology treatment (SPT) improves symptoms but resolution is incomplete. Centrally acting neuromodulators also improve cough symptoms but not cough reflex sensitivity and the effect is short lived. We hypothesised that combined SPT and centrally acting neuromodulato...

Background: Unexplained chronic cough (UCC) causes significant quality of life impairment. There is a need to identify effective assessment and treatment approaches for UCC. Methods: This systematic review of randomized controlled clinical trials asked: What is the efficacy of treatment compared to usual care on cough severity, cough frequency,...

Chronic cough is regarded as a challenging clinical problem due to its frequency and often limited therapeutic options. Chronic cough that remains refractory to usual medical treatment causes significant quality of life impairment. Recent developments in the treatment of cough include the use of speech pathology and pharmacotherapy with gabapentin....

We conducted a systematic review on the management of psychogenic cough, habit cough, and tic cough to update the recommendations and suggestions of the 2006 guideline on this topic. We followed the CHEST methodological guidelines and the GRADE framework. The Expert Cough Panel based their recommendations on data from the systematic review, patient...

Bronchopulmonary C-fibers and a subset of mechanically sensitive, acid-sensitive myelinated sensory nerves play essential roles in regulating cough. These vagal sensory nerves terminate primarily in the larynx, trachea, carina and large intrapulmonary bronchi. Other bronchopulmonary sensory nerves, sensory nerves innervating other viscera as well a...

This overview will demonstrate that cough is a common and potentially expensive health care problem. Improvement in the quality of care of those with cough has been the focus of study for a variety of disciplines in medicine. The purpose of the Cough Guideline and Expert Panel is to synthesize current knowledge in a form that will aide clinical dec...

Several pharmacological and non-pharmacological therapeutic options have been used to treat cough that is not associated with a pulmonary or extrapulmonary etiology. We conducted a systematic review to summarize the evidence supporting different cough management options in adults and children with psychogenic, tic and habit cough. Medline, EMBASE,...

Laryngeal hypersensitivity may be an important component of the common disorders of laryngeal motor dysfunction including chronic refractory cough, paradoxical vocal fold movement (vocal cord dysfunction), muscle tension dysphonia, and globus pharyngeus. Patients with these conditions frequently report sensory disturbances, and an emerging concept...

To review recent developments in the mechanisms of chronic cough. Although cough prevalence is similar across the world, there are significant regional differences in the diseases associated with cough. This may represent regional differences in diet, environmental exposure, and diagnostic assessment and labelling. Cough can be reliably measured us...

Diseases associated with laryngeal dysfunction include chronic refractory cough (CRC), paradoxical vocal fold movement (PVFM), muscle tension dysphonia (MTD) and globus pharyngeus. We hypothesized the presence of a common sensory laryngeal dysfunction, the ‘laryngeal hypersensitivity’ syndrome, in these conditions. The aim of the study was to compa...

This article describes a practice-based, mixed-method research methodology - Clinical Data-Mining (CDM) - as a strategy for engaging international practitioners for describing, evaluating and reflecting upon endogenous forms of practice with the ultimate goal of improving practice and contributing to knowledge (Epstein, 2010). These knowledge contr...

To systematically evaluate auditory perceptual voice characteristics in people with thyroid disease prior to undergoing thyroid surgery. This study examined the auditory perceptual voice characteristics of 96 individuals with thyroid disease. Participants were categorised by type of thyroid disease (i.e. multinodular goitre, thyroid cancer, thyroid...

Cough remains refractory to medical treatment in approximately 20% of cases. Speech pathology intervention is a useful treatment option for patients with chronic cough that is refractory to treatment based on the anatomic diagnostic protocol. One of the reasons for this is that the larynx can be implicated in the pathogenesis of chronic refractory...

Post infectious chronic cough is a disabling illness. In 2009 an influenza pandemic occurred due to a novel strain of H1N1 influenza. Prolonged symptoms such as chronic cough remaining after the infection has cleared have not been examined. This study sought to investigate the prevalence, characteristics and mechanism of chronic cough following lab...

Severe asthma affects 5-20% of the asthma population but is discordantly responsible for the major burden of illness and impairment to quality of life. Patients with severe asthma continue to experience ongoing symptoms despite maximal therapy. A severe asthma service provides a systematic approach to the management of the disease and aids in confi...

The Urge-To-Cough has recently been recognised as a significant factor in understanding the pathophysiology of cough. The principles in the urge to cough model are relevant to the behavioural management of laryngeal conditions including chronic non-specific cough, cough due to paradoxical vocal fold movement, aspiration and reflux. This paper analy...

The aims of this study were to examine cough triggers in individuals with chronic cough (CC), identify sensory symptoms consistent with central reflex sensitization (paresthesia and allotussia), and interpret this information in relation to sensory laryngeal neuropathy. Prospective observational study. Patients (n=53) with CC that was refractory to...

Speech language pathology is an effective management intervention for chronic cough that persists despite medical treatment. The mechanism behind the improvement has not been determined but may include active cough suppression, reduced cough sensitivity or increased cough threshold from reduced laryngeal irritation. Objective measures such as cough...

Participant details, supplemental methods and results.

• Cough is a common and distressing symptom that results in significant health care costs from medical consultations and medication use. • Cough is a reflex activity with elements of voluntary control that forms part of the somatosensory system involving visceral sensation, a reflex motor response and associated behavioural responses. • At the init...

Cough is a common and distressing symptom that results in significant health care costs from medical consultations and medication use. Cough is a reflex activity with elements of voluntary control that forms part of the somatosensory system involving visceral sensation, a reflex motor response and associated behavioural responses. At the initial as...

Chronic persistent cough can be associated with laryngeal dysfunction that leads to symptoms such as dysphonia, sensory hyperresponsiveness to capsaicin, and motor dysfunction with paradoxical vocal fold movement and variable extrathoracic airflow obstruction (reduced inspiratory airflow). Successful therapy of chronic persistent cough improves sym...

Chronic cough may persist despite systematic evaluation and medical treatment of known associated diseases such as asthma, rhinitis, and gastro-esophageal reflux. These patients have refractory chronic cough and many exhibit laryngeal hypersensitivity that is manifest at both a sensory and motor level. Examples of this are heightened sensitivity of...

Objective: Chronic cough (CC) and paradoxical vocal fold movement (PVFM) may be associated with voice problems. Objective acoustic and electroglottographic (EGG) measures have the capacity to delineate these vocal characteristics. This study investigated acoustic and EGG voice features of CC and PVFM. Patients and methods: Acoustic and EGG findi...

Sensory function may be important in the pathogenesis of Chronic Cough (CC) and Paradoxical Vocal Fold Movement (PVFM). This paper aims to explore sensory issues related to the pathogenesis, classification, assessment and management of these conditions. Sensory disruption of the vagus nerve can occur through neural plasticity whereby a change occur...

There is emerging evidence for the efficacy of speech pathology intervention for individuals with chronic cough (CC) that persists despite medical treatment, but there are limited resources available to assist speech-language pathologists to manage this perplexing condition. The purpose of this article is to outline a treatment approach for speech...

Voice problems have been reported to occur in association with chronic cough (CC) and can interfere with quality of life. Voice symptoms can improve following behavioral intervention for CC that persists despite medical management; however, formal measures of voice changes have not been reported. The aim of this study was to measure the changes in...

Chronic cough (CC) and paradoxical vocal fold movement (PVFM) share several common features; however, there has been no systematic comparison of these two conditions. The aims of this study were to contrast and compare the symptom profiles of CC and PVFM, to clarify the relationship between the two conditions, and to explore how symptom characteris...