Laryngeal sensory neuropathy affects the nerves in the larynx, or the voice box. This area of the throat contains the vocal cords and has a role in breathing, swallowing, and talking.

Laryngeal sensory neuropathy is a type of peripheral neuropathy, meaning that it occurs due to damage to the nerves of the peripheral nervous system (PNS). The PNS is the network of nerves connecting the brain and spinal cord to the rest of the body.

The condition causes persistent hoarseness, coughing, throat clearing, and discomfort. However, due to symptoms being nonspecific, doctors can find it challenging to diagnose the condition. As a result, people may instead receive a misdiagnosis of reflux, asthma, allergies, or chronic laryngitis.

This article examines laryngeal sensory neuropathy, including the causes, treatment, and outlook.

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Doctors do not fully understand the causes of laryngeal sensory neuropathy. However, many believe that viral infections, such as the common cold, can damage the laryngeal nerves, which then causes hypersensitivity in the cough reflex.

Other potential causes include metabolic abnormalities and nerve trauma during surgery or medical procedures, such as intubation or airway endoscopy.

Once the nerves become overly sensitive, certain stimuli can trigger symptoms. These may include:

  • allergies and environmental irritants
  • gastric reflux
  • other viruses
  • changing humidity levels
  • consumption of acidic or spicy foods

Certain individuals are more prone to laryngeal sensory neuropathy. For example, an older 2014 study, which investigated the prevalence of this neuropathy type in people with type 2 diabetes, found that 42% of those with diabetes had the condition compared with 13.9% of the control group. This increased prevalence in individuals with diabetes could potentially be due to metabolic abnormalities.

Generally, peripheral neuropathy affects one-third to one-half of people living with diabetes.

Additionally, people with goiter — an enlarged thyroid gland that causes neck swelling — due to thyroid disease have an increased risk of laryngeal sensory neuropathy.

The primary symptom of laryngeal sensory neuropathy is a chronic cough that is often dry and unproductive, meaning it does not produce mucus. It tends to appear or worsen after exposure to a trigger. The individual may also feel a sensation of tickling, itching, or burning in the throat that may worsen at night or when lying down.

Other symptoms may include:

  • hoarseness or changes in voice quality
  • a constant need to clear the throat
  • difficulty swallowing or a feeling of something stuck in the throat
  • pain or discomfort in the throat or neck
  • breathing difficulties or shortness of breath

Doctors may find diagnosing laryngeal sensory neuropathy challenging, as the symptoms are similar to other conditions affecting the throat and airways. Healthcare professionals will often begin by taking a thorough medical history to see if the symptoms may trigger due to inappropriate stimuli or sensations in the throat.

They also perform a physical examination of the throat and larynx to look for signs of inflammation, swelling, or structural abnormalities.

To rule out other conditions, blood tests and imaging tests may be useful. Blood tests can show if a person has infections or immune system problems, while imaging tests can assess the chest and throat.

Depending on their findings, a person may require a referral to a laryngologist, a specialist in larynx and throat conditions. A laryngologist may order various tests to help support their diagnosis, including:

  • Laryngoscopy: This involves passing a thin, flexible tube housing a light and camera through the mouth to view the larynx. The doctor can assess the movement of the vocal cords and look for any signs of irritation or damage to the laryngeal nerves.
  • Laryngeal electromyography (EMG): This test measures the electrical activity of laryngeal muscles.
  • Provocative testing: This involves exposing the larynx to various irritants or stimuli to see if the individual’s symptoms worsen.
  • Acid reflux testing: Tests, such as pH impedance monitoring, look at the laryngeal pH levels, which can indicate acid reflux.

While there is no cure for laryngeal sensory neuropathy, treatments may help reduce and manage symptoms.

As with other sensory neuropathies, people with the condition may find that neuromodulator agents ease their symptoms. These medications include gabapentin (Neurontin) or low dose tricyclic antidepressants such as amitriptyline (Elavil). Neuromodulator agents can specifically target the nerves in the larynx and help reduce their hypersensitivity.

Therapeutic nerve blocks may also be beneficial. Some experts believe that the internal branch of the superior laryngeal nerve may be the cause of neuropathy. Therefore, if the predominant symptom is cough, blocking the nerve of this branch may be an option to alleviate symptoms. A doctor can perform this as an in-office treatment if other treatments are ineffective.

The outlook of laryngeal sensory neuropathy can vary depending on the severity of the condition and the individual’s response to treatment. In some cases, it becomes a chronic and persistent condition that affects a person’s quality of life, particularly if medical interventions cannot ease symptoms.

Some may find that over time, their symptoms may be intermittent and recur or worsen even with treatment. Therefore, a person should work closely with a team of healthcare professionals to develop an individualized treatment plan considering their specific symptoms, medical history, and overall health.

With appropriate treatment and ongoing monitoring, many people with laryngeal sensory neuropathy can experience improvements in symptoms and overall well-being.

Laryngeal sensory neuropathy is a condition affecting the larynx and throat. It causes the nerves in the larynx to become hypersensitive, leading to various symptoms such as hoarseness, chronic coughing, and throat pain.

Diagnosis typically relies on a thorough medical history, physical examination, and tests such as laryngoscopy and laryngeal EMG. Treatment involves medications that alter the activity of the laryngeal nerves. Examples of these medications include gabapentin (Neurontin) and tricyclic antidepressants (Elavil).

Many people with laryngeal sensory neuropathy may experience significant improvement in their symptoms and overall well-being with appropriate treatment and symptom management.