Laryngeale Neuropathie und „irritable larynx syndrome“: Synonyme oder differente Entitäten?

Zusammenfassung

Hintergrund:

Der Begriff „laryngeale Neuropathie“ (LN) wurde erstmalig in der Veterinärmedizin für die idiopathische, typischerweise mit einem belastungsabhängigen Inspirationsgeräusch einhergehende Parese des N. laryngeus inferior bei Pferden, verwendet. Mittlerweile findet sich der Begriff der LN auch in der Humanmedizin, allerdings eher im Zusammenhang mit einer intermittierenden Stimmlippenbeweglichkeitsstörung. Andere Autoren verwenden für eine ähnliche Symptomatik den Begriff „irritable larynx syndrome“ (ILS). Hier soll anhand einer Literaturrecherche der aktuelle Kenntnisstand zur LN und ILS aufgearbeitet werden.

Methodik:

Übersichtsarbeit nach selektiver Literaturrecherche in PubMed.

Ergebnisse:

Es fanden sich 35 Arbeiten im Bereich der Tiermedizin und 17 Arbeiten im Bereich der Humanmedizin, davon 4 über das „irritable larynx syndrome“.

Diskussion:

Die LN betrifft bei Pferden fast ausschließlich den linken N. laryngeus inferior, beruht auf einer distalen Axonopathie und führt i. d. R. zu einer Einschränkung der Stimmlippen-Abduktionsbewegung und einem konsekutiven Inspirationsgeräusch, insbesondere bei körperlicher Belastung (Galopp). Bei Hunden tritt die LN auch beidseitig auf. In den relativ wenigen humanmedizinischen Publikationen zur LN wird der Begriff deutlich weniger scharf definiert verwendet.

Der Begriff „irritable larynx syndrome“ findet sich ausschließlich in der humanmedizinischen Literatur. Mit ILS soll eine Überempfindlichkeit laryngealer Strukturen gegen äußere Reize, die ebenfalls zu einer Dyspnoe, aber auch anderen Symptomen wie Husten usw. führen kann, bezeichnet werden.

Der aktuelle Forschungsstand sowohl zur LN als auch zum ILS ist letztlich unbefriedigend. Daher bietet es sich in der Humanmedizin derzeit nicht an, bei entsprechender Symptomatik unklarer Ätiologie von einer LN zu sprechen, es sollte besser der Begriff laryngeale Bewegungsstörung für Einschränkungen der Stimmlippenbeweglichkeit verwendet werden. Mit dem deskriptiven Begriff „irritable larynx syndrome“ kann sicher zutreffend eine laryngeale Überempfindlichkeit benannt werden.

Abstract

Laryngeal Neuropathy’ and ‘Irritable Larynx Syndrome’: Synonyms or Distinct Entities

Background:

The term ‘laryngeal neuropathy’ (LN) has first been used in veterinary medicine to describe an idiopathic and typically exercise induced inspiratory noise in horses.

Nowadays, the term is often used in relation with intermittent vocal cord pareses in humans. Some authors use the term ‘irritable larynx syndrome’ (ILS) in a similar context. This article reviews the state of knowledge regarding LN and ILS and discusses the somewhat confusing terminology.

Method:

For this systematic review a selective literature research in PubMed has been carried out.

Results:

35 articles were found, which report on LN in animals and 17 articles reported on humans. 4 of these articles used the term ‘irritable larynx syndrome’.

Discussion:

Laryngeal neuropathy in horses usually affects the left recurrent laryngeal nerve and results in decreased vocal cord abduction and an inspiratory roaring or whistling noise, particularly during exercise. In dogs LN has been reported to also occur bilaterally. In association with humans LN has not been defined clearly in the literature. The term ILS on the other hand has only been used in relation to humans. The term describes a hypersensitivity of the laryngeal structures towards external stimuli, which causes symptoms such as dyspnea or cough among others. Sufficient knowledge does not exist for either of the 2 diseases, ILS or LN. As of yet, the term LN should not be used in human medicine to describe according symptoms of unknown aetiology. The term ‘laryngeal movement disorder’ seems a lot more appropriate. The symptom oriented term irritable larynx syndrome also seems suitable to describe laryngeal hypersensitivity appropriately.

Schlüsselwörter

laryngeale Neuropathie - N. laryngeus Parese - irritable larynx syndrome - chronischer Husten - laryngeale Bewegungsstörung

Key words

laryngeal neuropathy - vocal cord paresis - irritable larynx syndrome - chronic cough - laryngeal movement disorder

• Literatur

• 1 Dixon PM. Variation in laryngeal function in mature horses and progressive cases of recurrent laryngeal neuropathy (RLN). In: Dixon P, Robinson E, Wade JF. Hrsg Proceedings of a workshop on equine recurrent laryngeal neuropathy (Havemeyer Foundation, 7^th–10^th September 2003, Stratford-upon-Avon, UK). R & W Publications; Newmarket: 2004: 35-36
• 2 Ellis DR, Greet TRC, Lane JG. Sales: Problems in diagnosis of RLN – UK perspective. In: Dixon P, Robinson E, Wade JF. Hrsg Proceedings of a workshop on equine recurrent laryngeal neuropathy (Havemeyer Foundation, 7^th–10^th September 2003, Stratford-upon-Avon, UK). R & W Publications Limited; Newmarket: 2004: 39-41
• 3 Löbert HB. Zum Einfluss des Sedativums Detomidin und einer Langzeitlaufbandbelastung auf die endoskopisch evaluierbare Funktion der oberen Atemwege beim Pferd. Vet Med Diss; Tierhochschule Hannover: 2009
• 4 Dupuis MC, Zhang Z, Druet T et al. Results of a haplotype-based GWAS for recurrent laryngeal neuropathy in the horse. Mamm Genome 2011;
• 5 Davidson EJ, Martin BB, Boston RC et al. Exercising upper respiratory videoendoscopic evaluation of 100 nonracing performance horses with abnormal respiratory noise and/or poor performance. Equine Vet J 2011; 43: 3-8
• 6 Mayhew IG. Neurology of recurrent laryngeal neuropathy and the thoraco-laryngeal reflex. In: Dixon P, Robinson E, Wade JF. Hrsg Proceedings of a workshop on equine recurrent laryngeal neuropathy (Havemeyer Foundation, 7^th–10^th September 2003, Stratford-upon-Avon, UK). R & W Publications Limited; Newmarket: 2004: 5-8
• 7 Hahn C. Review of the pathological changes in equine recurrent laryngeal neuropathy. In: Dixon P, Robinson E, Wade JF. Hrsg Proceedings of a workshop on equine recurrent laryngeal neuropathy (Havemeyer Foundation, 7^th–10^th September 2003, Stratford-upon-Avon, UK). R & W Publications Limited; Newmarket: 2004: 9-11
• 8 Hahn CN, Matiasek K, Dixon PM et al. Histological and ultrastructural evidence that recurrent laryngeal neuropathy is a bilateral mononeuropathy limited to recurrent laryngeal nerves. Equine Vet J 2008; 40: 666-672
• 9 Cahill JI, Goulden BE. Equine laryngeal hemiplegia. Part II: an electron microscopic study of peripheral nerves. N Z Vet J 1986; 34: 170-175
• 10 Duncan ID, Griffiths IR, Madrid RE. A light and electron microscopic study of the neuropathy of equine idiopathic laryngeal hemiplegia. Neuropathol Appl Neurobiol 1978; 4: 483-501
• 11 Cahill JI, Goulden BE. Equine laryngeal hemiplegia. Part I: a light microscopic study of peripheral nerves. N Z Vet J 1986; 34: 161-169
• 12 Rhee HS, Steel CM, Derksen FJ et al. Immunohistochemical analysis of laryngeal muscles in normal horses and horses with subclinical recurrent laryngeal neuropathy. J Histochem Cytochem 2009; 57: 787-800
• 13 Duncan ID, Reifenrath P, Jackson KF et al. Preferential denervation of the adductor muscles of the equine larynx. II: nerve pathology. Equine Vet J 1991; 23: 99-103
• 14 Salvadori C, Tartarelli CL, Baroni M et al. Neuronal vacuolation, myelopathy and laryngeal neuropathy in a mixed-breed dog. J Vet Med A Physiol Pathol Clin Med 2007; 54: 445-448
• 15 Salvadori C, Tartarelli CL, Baroni M et al. Peripheral nerve pathology in two Rottweilers with neuronal vacuolation and spinocerebellar degeneration. Vet Pathol 2005; 42: 852-855
• 16 Davies DR, Irwin PJ. Degenerative neurological and neuromuscular disease in young Rottweilers. J Small Anim Pract 2003; 44: 388-394
• 17 Anderson BH, Kannegieter NJ, Goulden BE. Endoscopic observations on laryngeal symmetry and movements in young racing horses. In: Dixon P, Robinson E, Wade JF. Hrsg Proceedings of a workshop on equine recurrent laryngeal neuropathy (Havemeyer Foundation, 7^th–10^th September 2003, Stratford-upon-Avon, UK). 2004: 33-34
• 18 Dixon PM, Pratschke KM. Laryngeal paralysis in Dogs. In: Robinson P, Dixon E, Wade JF. Hrsg Proceedings of a workshop on equine recurrent laryngeal neuropathy (Havemeyer Foundation, 7^th–10^th September 2003, Stratford-upon-Avon, UK). R & W Publications Limited; Newmarket: 2004: 16-17
• 19 Witte SH, Witte TH, Harriss F et al. Association of owner-reported noise with findings during dynamic respiratory endoscopy in thoroughbred racehorses. Equine Vet J 2011; 43: 9-17
• 20 Franklin SH, Naylor JR, Lane JG. Effect of dorsal displacement of the soft palate on ventilation and airflow during high-intensity exercise. Equine Vet J Suppl 2002; 34: 379-383
• 21 Greet TRC. Decision making in practice for treatment of recurrent laryngeal neuropathy. In: Dixon P, Wade Robinson EF. Hrsg Proceedings of a workshop on equine recurrent laryngeal neuropathy (Havemeyer Foundation, 7th–10^th September 2003, Stratford-upon-Avon, UK). R & W Publications Limited; Newmarket: 2004: 59-59
• 22 Dixon PM, McGorum BC, Railton DI et al. Laryngeal paralysis: a study of 375 cases in a mixed-breed population of horses. Equine Vet J 2001; 33: 452-458
• 23 Dixon PM, McGorum BC, Railton DI et al. Clinical and endoscopic evidence of progression in 152 cases of equine recurrent laryngeal neuropathy (RLN). Equine Vet J 2002; 34: 29-34
• 24 Robinson P, Derksen FJ, Stick JA et al. Effects of unilateral laser-assisted ventriculocordectomy in horses with laryngeal hemiplegia. Equine Vet J 2006; 38: 491-496
• 25 Morris EA, Seeherman HJ. Evaluation of upper respiratory tract function during strenuous exercise in racehorses. J Am Vet Med Assoc 1990; 196: 431-438
• 26 Hackett RP, Ducharme NG, Fubini SL et al. The reliability of endoscopic examination in assessment of laryngeal function in horses. Part I: development of a laryngeal grading system. Vet Surg 1991; 20: 174-179
• 27 Ducharme NG, Hackett RP, Fubini SL et al. The reliability of endoscopic examination in assessment of laryngeal function in horses. Part II: side of examination, influence of re-examination, and sedation. Vet Surg 1991; 20: 180-184
• 28 Ducharme NG. 4-grade system for equine laryngeal function. In: Dixon P, Robinson E, Wade JF. Hrsg Proceedings of a workshop on equine recurrent laryngeal neuropathy (Havemeyer Foundation, 7^th–10^th September 2003, Stratford-upon-Avon, UK). R & W Publications; Newmarket: 2004: 21-23
• 29 Lane JG. 5-point grading system of laryngeal function in horses during quiet breathing. In: Dixon P, Robinson JF, Wade JF. Hrsg Proceedings of a workshop on equine recurrent laryngeal neuropathy (Havemeyer Foundation, 7^th–10^th September 2003, Stratford-upon-Avon, UK). R & W Publications Limited; Newmarket: 2004: 24-25
• 30 Dixon PM. Endoscopic grading system for laryngeal paralysis – 6 grade system. In: Dixon P, Robinson E, Wade JF. Hrsg Proceedings of a workshop on equine recurrent laryngeal neuropathy (Havemeyer Foundation, 7^th–10^th September 2003, Stratford-upon-Avon, UK). R & W Publications; Newmarket: 2004: 26-27
• 31 Lane JG. Differences between resting and tradmill endoscopic findings in regard to RLN. In: Dixon P, Robinson E, Wade JF. Hrsg Proceedings of a workshop on equine recurrent laryngeal neuropathy (Havemeyer Foundation, 7^th–10^th September 2003, Stratford-upon-Avon, UK). R&W Publications Limited; Newmarket: 2004: 47-48
• 32 Davidson EJ, Martin Jr BB, Parente EJ. Use of successive dynamic videoendoscopic evaluations to identify progression of recurrent laryngeal neuropathy in three horses. J Am Vet Med Assoc 2007; 230: 555-558
• 33 Strand E, Martin GS, Haynes PF et al. Career racing performance in thoroughbreds treated with prosthetic laryngoplasty for laryngeal neuropathy: 52 Cases (1981–1989). J Am Vet Med Assoc 2000; 217: 1689-1696
• 34 Derksen FJ, Stick JA, Scott EA et al. Effect of laryngeal hemiplegia and laryngoplasty on airway flow mechanics in exercising horses. Am J Vet Res 1986; 47: 16-20
• 35 Witte TH, Mohammed HO, Radcliffe CH et al. Racing performance after combined prosthetic laryngoplasty and ipsilateral ventriculocordectomy or partial arytenoidectomy: 135 thoroughbred racehorses competing at less than 2400 m (1997–2007). Equine Vet J 2009; 41: 70-75
• 36 Cramp P, Derksen FJ, Stick JA et al. Effect of ventriculectomy versus ventriculocordectomy on upper airway noise in draught horses with recurrent laryngeal neuropathy. Equine Vet J 2009; 41: 729-734
• 37 Fulton I. Laryngeal re-innervation in the horse. In: Dixon P, Robinson E, Wade JF. Hrsg Proceedings of a workshop on equine recurrent laryngeal neuropathy (Havemeyer Foundation, 7^th–10^th September 2003, Stratford-upon-Avon, UK). R & W Publications Limited; Newmarket: 2004: 60-62
• 38 Ducharme NG, Cheetham J, Sanders I et al. Considerations for pacing of the cricoarytenoid dorsalis muscle by neuroprosthesis in horses. Equine Vet J 2010; 42: 534-540
• 39 Simpson DM, Sternman D, Graves-Wright J et al. Vocal cord paralysis: clinical and electrophysiologic features. Muscle Nerve 1993; 16: 952-957
• 40 Lau DP, Lo YL, Wee J et al. Vocal fold paralysis following radiotherapy for nasopharyngeal carcinoma: laryngeal electromyography findings. J Voice 2003; 17: 82-87
• 41 Lee B, Woo P. Chronic cough as a sign of laryngeal sensory neuropathy: diagnosis and treatment. Ann Otol Rhinol Laryngol 2005; 114: 253-257
• 42 Lee SI, Pyun SB, Jang DH. Dysphagia and hoarseness associated with painless aortic dissection: a rare case of cardiovocal syndrome. Dysphagia 2006; 21: 129-132
• 43 Lee JH, Sung IY, Park JH et al. Recurrent laryngeal neuropathy in a systemic lupus erythematosus (SLE) Patient. Am J Phys Med Rehabil 2008; 87: 68-70
• 44 Aboussouan LS, Lewis RA, Shy ME. Disorders of pulmonary function, sleep, and the upper airway in charcot-marie-tooth disease. Lung 2007; 185: 1-7
• 45 Benson B, Sulica L, Guss J et al. Laryngeal neuropathy of charcot-marie-tooth disease: further observations and novel mutations associated with vocal fold paresis. Laryngoscope 2010; 120: 291-296
• 46 Vertigan AE, Gibson PG. Chronic refractory cough as a sensory neuropathy: evidence from a reinterpretation of cough triggers. J Voice 2010;
• 47 Norris BK, Schweinfurth JM. Management of recurrent laryngeal sensory neuropathic symptoms. Ann Otol Rhinol Laryngol 2010; 119: 188-191
• 48 Heman-Ackah YD, Joglekar SS, Caroline M et al. The prevalence of undiagnosed thyroid disease in patients with symptomatic vocal fold paresis. 2011; J Voice 25: 496-500
• 49 Bock JM, Blumin JH, Toohill RJ et al. 2011; A new noninvasive method for determination of laryngeal sensory function. Laryngoscope 121: 158-163
• 50 Lee JK, Mintz S. Chronic cough as a sign of laryngeal sensory neuropathy: diagnosis and treatment. Ann Otol Rhinol Laryngol 2006; 115: 871
• 51 Altman KW, Simpson CB, Amin MR et al. Cough and paradoxical vocal fold motion. Otolaryngol Head Neck Surg 2002; 127: 501-511
• 52 Spring PJ, Kok C, Nicholson GA et al. Autosomal dominant hereditary sensory neuropathy with chronic cough and gastro-oesophageal reflux: clinical features in two families linked to chromosome 3p22-p24. Brain 2005; 128: 2797-2810
• 53 Morrison M, Rammage L, Emami AJ. The irritable larynx syndrome. J Voice 1999; 13: 447-455
• 54 Ryu JS, Lee JH, Kang JY et al. Evaluation of dysphagia after cervical surgery using laryngeal electromyography. Dysphagia 2011;
• 55 Bastian RW, Vaidya AM, Delsupehe KG. Sensory neuropathic cough: a common and treatable cause of chronic cough. Otolaryngol Head Neck Surg 2006; 135: 17-21
• 56 Stemple J, Weinrich B, Baker Brehm S. Phonatory aerodynamic system: a clinical manual 2008;
• 57 Hoy RF, Ribeiro M, Anderson J et al. Work-associated irritable larynx syndrome. Occup Med (Lond) 2010; 60: 546-551
• 58 Andrianopoulos MV, Gallivan GJ, Gallivan KH. PVCM, PVCD, EPL, and irritable larynx syndrome: what are we talking about and how do we treat it?. J Voice 2000; 14: 607-618
• 59 Bucca CB, Bugiani M, Culla B et al. Chronic cough and irritable larynx. J Allergy Clin Immunol 2011; 127: 412-419
• 60 Mintz S, Lee JK. Gabapentin in the treatment of intractable idiopathic chronic cough: Case Reports. Am J Med 2006; 119: e13-e15
• 61 Ryan NM, Vertigan AE, Bone S et al. Cough reflex sensitivity improves with speech language pathology management of refractory chronic cough. Cough 2010; 6: 5
• 62 Lane JG. Long term longitudinal study of laryngeal function in 187 foals. In: Dixon P, Robinson JF, Wade JF. Hrsg Proceedings of a workshop on equine recurrent laryngeal neuropathy (Havemeyer Foundation, 7^th–10^th September 2003, Stratford-upon-Avon, UK). R & W Publications Limited; Newmarket: 2004: 31-32