The scope of this Practice Portal page is aerodigestive disorders that affect feeding, swallowing, voice, and/or respiration in children and adults.
Structural abnormalities and complex medical conditions of the aerodigestive tract that affect feeding, swallowing, voice, and/or laryngeal airway function are also discussed to varying degrees in ASHA's Practice Portal pages on Dysphagia (Adult), Dysphagia (Pediatric) – Feeding and Swallowing, Cleft Lip and Palate, Head and Neck Cancer, Voice Disorders, and Tracheostomy and Ventilator Dependence.
The aerodigestive tract consists of the organs and tissues of the respiratory tract and the upper part of the digestive tract (Andrews, 2006). The aerodigestive tract includes the
Breathing and swallowing functions take place in the aerodigestive tract. Both tasks elicit a complex, coordinated biomechanical sequence of events designed to protect the airway during eating and drinking, while maintaining sufficient airflow for phonation (Coyle, 2010; Jadcherla, 2012; Robbins, 2011).
The aerodigestive anatomy and physiology of infants is different from that of adults (see figure below). These differences include the following:
Aerodigestive disorders are conditions or diseases of the aerodigestive tract—including the airway (pharynx and larynx), pulmonary tract (trachea, bronchi, and lungs), and upper digestive tract (esophagus)—that may affect respiratory and swallowing functions. Aerodigestive disorders, or the management of them (e.g. surgery, intubation), may result in voice, feeding, and/or swallowing problems as well as laryngeal airway problems—the term used in this Practice Portal page to refer to paradoxical vocal fold movement (PVFM) and chronic cough.
Aerodigestive disorders may be congenital, developmental, or acquired. They are not mutually exclusive—individuals may have more than one disorder (Jadcherla, 2012). In children, some aerodigestive disorders may resolve with maturity or with behavioral management, but others may require medical and/or surgical intervention.
Examples of common aerodigestive disorders (grouped by anatomical location) include, but are not limited to, the following:
Airway (Pharynx and Larynx)
See Aerodigestive Disorders of the Airway (Pharynx and Larynx) [PDF].
Pulmonary Tract (Trachea, Bronchi, and Lungs)
See Aerodigestive Disorders of the Pulmonary Tract (Trachea, Bronchi, and Lungs) [PDF].
Upper Digestive Tract (Esophagus)
See Aerodigestive Disorders of the Upper Digestive Tract (Esophagus) [PDF].
For detailed information about these and other aerodigestive disorders, see, for example, Andrews (2006), Ashland and Hersh (2009), Coyle (2010), Dinwiddie (2004), Jadcherla (2012), Matsuo and Palmer (2008), and Morris et al. (2006).
Aerodigestive disorders can cause secondary problems in feeding, swallowing, voice, and/or laryngeal airway function. SLPs play a role in the screening, assessment, diagnosis, and treatment of these secondary problems and often work collaboratively with other professionals in providing services to individuals with aerodigestive disorders.
Paradoxical vocal fold movement, or PVFM, is the intermittent, episodic adduction of the vocal folds during inspiration. During episodes, the vocal folds adduct partially or fully and restrict the passage of air to the lungs. PVFM can occur in isolation, or it can co-occur with other conditions, including pulmonary disorders (e.g., asthma), laryngeal abnormalities, and cardiac pathology (Reitz et al., 2014). About 29%–40% of those with PVFM also have asthma (Gurevich-Uvena et al., 2010). SLPs are involved in the diagnosis and direct behavioral management of PVFM.
Chronic cough is most commonly defined as a cough lasting more than 8 weeks in adults and more than 4 weeks in children (Asilsoy et al., 2008; Morice, 2004). Chronic cough may be termed “somatic cough syndrome” in the absence of a known cause or “tic cough” when it is accompanied by core clinical features of tics (e.g., suppressibility, distractibility, suggestibility, variability, and presence of a warning sensation; Vertigan, 2017). SLP intervention is an effective treatment for chronic cough (Gibson & Vertigan, 2009; Petty & Dailey, 2009) and addresses the management of cough regardless of the initiating cause.
The incidence of a disorder or condition refers to the number of new cases identified in a specified time period. Prevalence refers to the number of individuals who are living with the disorder or condition in a given time period.
The following aerodigestive disorders provide a sample of conditions that can cause feeding, swallowing, voice, and/or laryngeal airway problems that may involve treatment by a speech-language pathologist (SLP). Some problems may be symptomatic or indicative of an aerodigestive disorder but do not involve treatment by an SLP. For example, dysphagia symptoms in individuals with esophageal dysmotility may resolve following medical and/or surgical intervention.
Airway Disorders
Pulmonary Tract Disorders
Upper Digestive Tract Disorders
Voice and swallowing problems commonly occur as a result of structural or physiologic changes to the aerodigestive tract secondary to surgery or radiation therapy. For example, the majority of individuals (70.5%) who received a lung transplant and subsequent swallowing evaluation showed laryngeal penetration or aspiration (Atkins et al., 2010). Following an esophagectomy, the incidence of vocal fold paralysis/paresis was estimated to be 1.96% of individuals, with 35% of those individuals receiving speech-language pathology services (Crowson et al., 2018). For more information, visit ASHA's Practice Portal pages on Head and Neck Cancer, Dysphagia (Adult), and Voice Disorders.
Signs are observations made by a third party (e.g., clinician or family member). For example, observations of coughing when someone swallows may be a sign of aspiration, and observations of changes in someone's vocal pitch may be a sign that the vocal folds are swollen or inflamed.
Symptoms are a person's own perception of changes in their swallowing, voice, breathing, or desire to eat or drink. Symptoms are usually described in terms of severity, location, frequency, and duration. For example, a person may notice that, recently, they have been coughing a great deal following exercise.
Signs and symptoms of aerodigestive disorders can vary depending on the specific disorder and the severity of the condition causing the disorder.
The following signs and symptoms are grouped by the function that can be affected:
Feeding and Swallowing
Voice
Respiration
Paradoxical Vocal Fold Movement (PVFM)
Chronic Cough
For more detailed information about the signs and symptoms of aerodigestive disorders, see, for example, Andrews (2006), Ashland and Hersh (2009), Coyle (2010), Dinwiddie (2004), Ibrahim et al. (2007), Jadcherla (2012), Matsuo and Palmer (2008), Morice (2004), and Morris et al. (2006).
There are many ways to categorize the causes of aerodigestive disorders, given the overlap of structures and functions involved.
This Practice Portal page uses the following categories:
Congenital
Structural/Anatomical
Functional
Other Medical Conditions
Paradoxical Vocal Fold Movement (PVFM)
The exact cause of PVFM is not known, although PVFM may be related to laryngeal hyperresponsiveness.
PVFM may be triggered by
Chronic Cough
For detailed information about the causes of aerodigestive disorders, see, for example, Andrews (2006), Ashland and Hersh (2009), Coyle (2010), Dinwiddie (2004), Ibrahim et al. (2007), Jadcherla (2012), Matsuo and Palmer (2008), Morice (2004), Morris et al. (2006), and Reitz et al. (2014).
Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of feeding, swallowing, voice, and laryngeal airway problems related to aerodigestive disorders. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. See ASHA's Scope of Practice in Speech-Language Pathology (ASHA, 2016).
Appropriate roles for SLPs include, but are not limited to, the following:
As indicated in the ASHA Code of Ethics (ASHA, 2023), SLPs who serve this population should be specifically educated and appropriately trained to do so. This includes maintaining and documenting the highest level of competence in the areas of practice and ensuring referral of patients to the most qualified practitioner in each area of practice in which the SLP is not highly qualified.
See the Assessment section of ASHA's Evidence Maps on Voice Disorders, Dysphagia (Adult), and Pediatric Feeding and Swallowing for pertinent scientific evidence, expert opinion, and client/caregiver perspectives.
Assessment and treatment of aerodigestive disorders may require use of appropriate personal protective equipment.
Most aerodigestive disorders are identified by a physician on the basis of physical examination and one or more of the following:
Assessment of impairments caused by aerodigestive disorders often requires a multidisciplinary approach involving the speech-language pathologist (SLP) and other medical, surgical, and rehabilitation specialists. In collaboration with other health care specialists, the SLP provides expertise on feeding, swallowing, voice, and laryngeal airway problems related to aerodigestive disorders.
These collaborations may be a part of an established aerodigestive disorders team or may occur as a result of informed, targeted referrals within or outside the SLP's area of expertise. See ASHA's resources on interprofessional education/interprofessional practice [IPE/IPP] and collaboration and teaming.
A multidisciplinary approach may include
A core multidisciplinary team may include one or more of the following professionals:
Depending on the age of the individual and the specific concerns, other team members may include the following:
See Boesch et al. (2018) and Piccione and Boesch (2018).
Person- and family-centered care is a collaborative approach grounded in a mutually beneficial partnership among individuals, families, and clinicians. Each party is equally important in the relationship, and each party must respect the knowledge, skills, and experiences that the others bring to the process. This approach incorporates individual and family preferences and priorities and offers a range of services, including
See ASHA's resource on person- and family-centered care.
An SLP may be the first to see an individual who is experiencing voice or swallowing problems. These individuals may or may not have an underlying aerodigestive disorder. The purpose of screening is to identify individuals who require further assessment by an SLP or referral for other professional services. Screening may uncover findings that suggest underlying medical problems. See information about screening in the Assessment section of ASHA's Practice Portal pages on Voice Disorders, Dysphagia (Adult), and Pediatric Feeding and Swallowing.
It is important for SLPs to
SLPs screen for the following observed and reported changes:
SLPs also look for signs of neurologic conditions (e.g., abnormal sensorimotor function) that can affect voice, swallowing, or respiration, or that signal an underlying medical condition.
If screening results indicate feeding, swallowing, or respiratory difficulties that suggest an underlying disease process, referral is made to an appropriate medical professional.
Aerodigestive disorders may involve the interaction of multiple systems, including laryngeal, pulmonary, phonatory, digestive, and sensorimotor. Individuals may present with multiple complaints and varied symptoms. A thorough case history and sign/symptom assessment—gathered by members of a multidisciplinary team that includes an SLP—facilitate assessment and differential diagnosis.
Consistent with the World Health Organization's International Classification of Functioning, Disability and Health framework (ASHA, 2016a; World Health Organization, 2001), comprehensive assessment is conducted to identify and describe
See ASHA's resources titled Person-Centered Focus on Function: Voice [PDF], Person-Centered Focus on Function: Adult Swallowing [PDF], and Person-Centered Focus on Function: Pediatric Feeding and Swallowing [PDF] for examples of handouts featuring assessment data consistent with the International Classification of Functioning, Disability and Health framework.
Consider factors related to the anatomy and physiology of the aerodigestive tract and the age of the client.
Assess under varied conditions, including while at rest, during light activities such as walking, in challenging conditions such as aerobic activities, or during patient-identified trigger activities.
See the Assessment section of ASHA's Practice Portal page on Voice Disorders for detailed information.
See the Assessment section of ASHA's Practice Portal pages on Dysphagia (Adult) and Pediatric Feeding and Swallowing for detailed information.
SLPs conduct assessments in a manner that is sensitive to the individual's cultural background, religious beliefs, dietary beliefs/practices/habits, history of disordered eating behaviors, and preferences for medical intervention. Cultural, religious, and individual beliefs about food and eating practices may affect an individual's comfort level or willingness to participate in assessment. Some eating habits that appear to be a sign or symptom of an aerodigestive disorder (e.g., avoiding certain foods or refusing to eat in front of others) may, in fact, be related to cultural differences in meal habits or may be symptoms of an eating disorder (National Eating Disorders Association, n.d.).
Individual beliefs and preferences are considered when providing education and recommendations. Ethnographic interviewing strategies can help in gathering useful information (Westby et al., 2003). Collaboration with other professionals (e.g., cultural broker, mental health provider, registered dietitian, etc.) may be beneficial. See ASHA's Practice Portal pages on Cultural Responsiveness and Collaborating With Interpreters, Transliterators, and Translators for more information.
When completing videofluoroscopic swallow assessments, SLPs need to consider the potential impact of the barium concentration and viscosity of the test stimuli for all individuals. This is particularly important for infants and young children with aerodigestive disorders.
Using the appropriate weight per volume of barium concentrate reduces residual coating, which may affect the diagnosis or interpretation of the study. Viscosity of test fluids should approximate the customary or recommended fluid consistency as closely as possible (Cichero et al., 2011; Dodrill & Gosa, 2015). Use of a standardized flow test ensures that the tested consistency matches the defined consistency.
Potential interventions and treatment recommendations (positioning, utensils, bottle and nipple types, textures and liquid viscosity, and compensatory strategies) should be assessed during the examination. See the Assessment section of ASHA's Practice Portal pages on Dysphagia (Adult) and Pediatric Feeding and Swallowing for more details.
Differential diagnosis of PVFM involves a multidisciplinary approach (Koufman & Block, 2008). Team members may include pulmonologists, allergists, otolaryngologists, gastroenterologists, cardiologists, psychologists, and SLPs (Altman et al., 2000). The SLP is an important member of the team and plays an essential role in diagnosis. They obtain a detailed case history, assess breathing patterns, perform a skilled fiberoptic laryngoscopy, and synthesize test information from all other team members (Reitz et al., 2014).
The SLP gathers the following case history information:
Assessment activities may include the following:
Note: It may be possible to have an asymptomatic larynx and still meet the criteria for PVFM (Olin et al., 2014).
The SLP helps in the differential diagnosis of chronic cough by gathering a detailed case history, performing fiberoptic laryngoscopy, and assessing voice.
For patients presenting with chronic cough, the SLP gathers information about
Assessment activities may include
See the Treatment section of ASHA's Evidence Maps on Voice Disorders, Dysphagia (Adult), and Pediatric Feeding and Swallowing for pertinent scientific evidence, expert opinion, and client/caregiver perspectives.
Decisions about goals and treatment options are made in partnership with the person, their family/caregiver, and other caregiving professionals. As part of a multidisciplinary team (see the Assessment section above), the speech-language pathologist (SLP) may be involved in assessing the individual's response to medical treatment and in implementing both indirect and direct strategies during or following medical treatment. See ASHA's resources on interprofessional education/interprofessional practice [IPE/IPP] and person- and family-centered care.
Comprehensive multidisciplinary treatment of aerodigestive disorders may include
Medical management decisions in aerodigestive disorders balance airway needs for breathing with optimal preservation of vocal quality and swallowing integrity (Dinwiddie, 2004). Approaches vary from “wait and watch” to complex surgical interventions.
Examples of medical approaches by appropriate medical professionals include, but are not limited to, the following:
Dietary, compensatory, and environmental management may include the following:
SLPs provide direct or restorative treatment to address functional voice problems (including respiratory support for voicing) and feeding and swallowing problems. SLPs also provide direct treatment for laryngeal airway problems, including paradoxical vocal fold movement (PVFM), and chronic cough.
The nature, scope, and duration of SLP management depend on
See ASHA's Practice Portal pages on Voice Disorders, Dysphagia (Adult), and Pediatric Feeding and Swallowing for specific treatment options and techniques related to these disorders.
See ASHA's resources titled Person-Centered Focus on Function: Voice [PDF], Person-Centered Focus on Function: Adult Swallowing [PDF], and Person-Centered Focus on Function: Pediatric Feeding and Swallowing [PDF] for examples of handouts featuring assessment data consistent with the International Classification of Functioning, Disability and Health framework.
Treatment selection depends on the child's age, cognitive and physical abilities, and specific swallowing and feeding problems. Treatment options—including postural and positioning techniques, maneuvers, and feeding strategies—are discussed in detail in the Pediatric Feeding and Swallowing Practice Portal page.
Infants and young children with aerodigestive disorders may benefit from alterations of liquid viscosity to improve airway protection during swallowing and/or to reduce the impact of reflux when tube feeding. This may include the use of natural foods or commercial dietary thickening agents to increase liquid viscosity. When making such recommendations, SLPs should consult with the medical team and be aware of the possible impact of thickening agents on nutritional status and overall health. For example, the addition of a thickener may alter the nutritional composition of the formula or breast milk. This may require the child to ingest more volume in order to obtain the necessary nutrients, or it may provide more than the recommended calories or the amount of certain nutrients (e.g., more than the recommended iron, if rice cereal is the thickening agent).
In addition, children with a history of necrotizing enterocolitis are advised to avoid gel-based thickeners containing the agent xanthan gum. Food allergies must also be considered when thickening agents are being considered.
Precaution
The U.S. Food and Drug Administration (FDA) has cautioned consumers about using commercial, gum-based thickeners for infants from birth to 1 year of age, especially when using the product to thicken breast milk. SLPs should be aware of these cautions and consult, as appropriate, with their facility to develop guidelines for using thickened liquids with infants. See FDA consumer cautions (FDA, 2017).
See also the Treatment section of ASHA's Evidence Map on Pediatric Feeding and Swallowing. Use keywords “Diet Modifications” and “Early Intervention.”
The goal of treatment is to establish consistent vocal fold abduction during the breathing cycle to maintain a patent airway. This reduces anxiety and affirms that breathing is consistently achievable, even in the presence of environmental or activity-related triggers.
Behavioral management by an SLP is the preferred treatment approach to PVFM (Reitz et al., 2014). Other disciplines may also be involved in treatment (e.g., medical intervention to treat reflux or allergy triggers, when present).
SLPs may implement the following procedures with most individuals with PVFM. Procedures are individualized based on triggers or other factors (Mathers-Schmidt, 2001; Sandage & Zelazny, 2004) and include the following:
Once the individual has identified their most effective breathing technique, the SLP may introduce challenges (triggers) while using the technique. These include the following:
See Reitz et al. (2014), Blager (2006), and Murry et al. (2006) for intervention details.
The goal of treatment is to help the individual manage their cough by identifying triggers, using strategies to suppress the cough, reducing laryngeal irritation, and using healthy vocal hygiene behaviors (Vertigan, Theodoros et al., 2007). Speech-language services should be coordinated with medical management of the underlying cause; services should be implemented after ruling out or addressing other contributing factors (Murry et al., 2006).
Treatment activities include the following:
The SLP typically introduces strategies without the presence of triggers to establish functional behaviors and to determine the person's most consistent response. The SLP may then introduce stimulants such as strong odors, increased activity levels, or other identified triggers to help the individual use the strategies before the “need” to cough. Treatment ends when the person can manage cough across a variety of contexts and in the presence of triggers.
See Blager et al. (1988), Petty and Dailey (2009), Soni et al. (2017), Vertigan (2017), and Vertigan, Theodoros et al. (2007).
Providing appropriate procedure codes for evaluation and treatment is an important aspect of successfully billing for services. Payer policies often outline specific coverage guidelines and list relevant Current Procedural Terminology (CPT; American Medical Association, 2018) codes from the International Classification of Diseases and Related Health Problems (10th Revision, Clinical Modification; World Health Organization, 2015).
Although individuals with PFVM or chronic cough may not present with dysphonia, respiratory and laryngeal function are substrates of the speech system. SLPs use diagnostic and procedure codes for assessment and treatment of voice to represent these services. Payer policies regarding the coverage of PVFM and chronic cough vary. SLPs working with private insurance should verify coverage on the basis of each individual.
For more information about coding, see the following ASHA resources:
New CPT Evaluation Codes for SLPs
Medicare CPT Coding Rules for Speech-Language Pathology Services
Coding for Reimbursement Frequently Asked Questions: Speech-Language Pathology
In addition to determining the type of treatment that is optimal for individuals with feeding, swallowing, voice, and laryngeal airway problems related to aerodigestive disorders, SLPs consider other service delivery variables—including format, provider, dosage, timing, and setting—that may affect treatment outcomes.
The list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.
Altman, K. W., Mirza, N., Ruiz, C., & Sataloff, R. T. (2000). Paradoxical vocal fold motion: Presentation and treatment options. Journal of Voice, 14(1), 99–103.
American Medical Association. (2018). CPT/Current Procedural Terminology (Professional Edition).
American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology [Scope of practice]. www.asha.org/policy/
American Speech-Language-Hearing Association. (2023). Code of ethics [Ethics]. www.asha.org/policy/
Andrews, M. L. (2006). Manual of voice treatment: Pediatrics through geriatrics (3rd ed.). Thomson Delmar Learning.
Ashland, J. E., & Hersh, C. J. (2009). Pediatric swallowing disorders: The speech-language pathologist's perspective. In K. Haver, M. Brigger, S. Hardy, & C. J. Hartnick (Eds.), Pediatric aerodigestive disorders (pp. 377–400). Plural.
Asilsoy, S., Bayram, E., Agin, H., Apa, H., Can, D., Gulle, S., & Altinoz, S. (2008). Evaluation of chronic cough in children. Chest,134(6), 1122–1128.
Atkins, B. Z., Petersen, R. P., Daneshmand, M. A., Turek, J. W., Lin, S. S., & Davis, R. D., Jr. (2010). Impact of oropharyngeal dysphagia on long-term outcomes of lung transplantation. The Annals of Thoracic Surgery, 90(5), 1622–1628.
Blager, F. B. (2006). Vocal cord dysfunction. Perspectives on Voice and Voice Disorders, 16(1), 7–10.
Blager, F. B., Gay, M. L., & Wood, R. P. (1988). Voice therapy techniques adapted to treatment of habit cough: A pilot study. Journal of Communication Disorders, 21(5), 393–400.
Boesch, R. P., Balakrishnan, K., Acra, S., Benscoter, D. T., Cofer, S. A., Collaco, J. M., Dahl, J. P., Daines, C. L., DeAlarcon, A., DeBoer, E. M., Deterding, R. R., Friedlander, J. A., Gold, B. D., Grothe, R. M., Hart, C. K., Kazachkov, M., Lefton-Greif, M. A., Miller, C. K., Moore, P. E., . . . Wood, R. E. (2018). Structure and functions of pediatric aerodigestive programs: A consensus statement. Pediatrics, 141(3), e20171701.
Brugman, S. M. (2003). The many faces of vocal cord dysfunction: What 36 years of literature tell us. American Journal of Respiratory and Critical Care Medicine, 167(7), A588.
Ciccolella, D. E., Brennan, K. J., Borbely, B., & Criner, G. J. (1997). Identification of vocal cord dysfunction (VCD) and other diagnoses in patients admitted to an inner city university hospital asthma center. American Journal of Respiratory and Critical Care Medicine, 155(4), A82.
Cichero, J., Nicholson, T., & Dodrill, P. (2011). Liquid barium is not representative of infant formula: Characterisation of rheological and material properties. Dysphagia, 26(3), 264–271.
Connor, M. J., Springford, L. R., Kapetanakis, V. V., & Giuliani, S. (2015). Esophageal atresia and transitional care—step 1: A systematic review and meta-analysis of the literature to define the prevalence of chronic long-term problems. The American Journal of Surgery, 209(4), 747–759.
Coppens, C. H., van den Engel-Hoek, L., Scharbatke, H., de Groot, S. A. F., & Draaisma, J. M. T. (2016). Dysphagia in children with repaired oesophageal atresia. European Journal of Pediatrics, 175(9), 1209–1217.
Coyle, J. L. (2010). Ventilation, respiration, pulmonary diseases, and swallowing. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 19(4), 91–97.
Croft, J. B., Wheaton, A. G., Liu, Y., Xu, F., Lu, H., Matthews, K. A., Cunningham, T. J., Wang, Y., & Holt, J. B. (2018). Urban-rural county and state differences in chronic obstructive pulmonary disease—United States, 2015. Morbidity and Mortality Weekly Report, 67(7), 205–211.
Crowson, M. G., Tong, B. C., Lee, H.-J., Song, Y., Harpole, D. H., Jones, H. N., & Cohen, S. (2018). Prevalence and resource utilization for vocal fold paralysis/paresis after esophagectomy. The Laryngoscope, 128(12), 2815–2822.
Dietrich, M., Verdolini Abbott, K., Gartner-Schmidt, J., & Rosen, C. A. (2008). The frequency of perceived stress, anxiety, and depression in patients with common pathologies affecting voice. Journal of Voice, 22(4), 472–488.
Dinwiddie, R. (2004). Congenital upper airway obstruction. Pediatric Respiratory Reviews, 5(1), 17–24.
Dodrill, P., & Gosa, M. M. (2015). Pediatric dysphagia: Physiology, assessment, and management. Annals of Nutrition & Metabolism, 66(Suppl. 5), 24–31.
Ghannouchi, I., Speyer, R., Doma, K., Cordier, R., & Verin, E. (2016). Swallowing function and chronic respiratory diseases: Systematic review. Respiratory Medicine, 117, 54–64.
Gibson, P. G., & Vertigan, A. E. (2009). Speech pathology for chronic cough: A new approach. Pulmonary Pharmacology & Therapeutics, 22(2), 159–162.
Gurevich-Uvena, J., Parker, J. M., Fitzpatrick, T. M., Makashay, M. J., Perello, M. M., Blair, E. A., & Solomon, N. P. (2010). Medical comorbidities for paradoxical vocal fold motion (vocal cord dysfunction) in the military population. Journal of Voice, 24(6), 728–731.
Ibrahim, W. H., Gheriani, H. A., Almohamed, A. A., & Raza, T. (2007). Paradoxical vocal cord motion disorder: Past, present and future. Postgraduate Medical Journal, 83(977), 164–172.
Jadcherla, S. (2012). Pathophysiology of aerodigestive pulmonary disorders in the neonate. Clinics in Perinatology,39(3), 639–654.
Jain, S., Bandi, V., Zimmerman, J., Hanania, N., & Guntupalli, K. (1999). Incidence of vocal cord dysfunction in patients presenting to emergency room with acute asthma exacerbation. Chest, 116(4), 243S.
Katz, P. O., Gerson, L. B., & Vela, M. F. (2013). Guidelines for the diagnosis and management of gastroesophageal reflux disease. The American Journal of Gastroenterology, 108(3), 308–328.
Koufman, J. A., & Block, C. (2008). Differential diagnosis of paradoxical vocal fold movement. American Journal of Speech-Language Pathology, 17(4), 327–334.
Kusak, B., Cichocka-Jarosz, E., Jedynak-Wasowicz, U., & Lis, G. (2017). Types of laryngomalacia in children: Interrelationship between clinical course and comorbid conditions. European Archives of Oto-Rhino-Laryngology, 274(3), 1577–1583.
Leboulanger, N., & Garabédian, E.-N. (2011). Laryngo-tracheo-oesophageal clefts. Orphanet Journal of Rare Diseases, 6(1), 81.
Logemann, J. A. (1998). Evaluation and treatment of swallowing disorders (2nd ed.). Pro-Ed.
Mansoor, E., & Cooper, G. S. (2016). The 2010–2015 prevalence of eosinophilic esophagitis in the USA: A population-based study. Digestive Diseases & Sciences, 61(10), 2928–2934.
Maradey-Romero, C., Prakash, R., Lewis, S., Perzynski, A., & Fass, R. (2015). The 2011–2014 prevalence of eosinophilic oesophagitis in the elderly amongst 10 million patients in the United States. Alimentary Pharmacology and Therapeutics, 41(10), 1016–1022.
Mathers-Schmidt, B. A. (2001). Paradoxical vocal fold motion: A tutorial on a complex disorder and the speech-language pathologist's role. American Journal of Speech-Language Pathology, 10(2), 111–125.
Matsuo, K., & Palmer, J. B. (2008). Anatomy and physiology of feeding and swallowing: Normal and abnormal. Physical Medicine and Rehabilitation Clinics of North America, 19(4), 691–707.
Morice, A. H. (2004). The diagnosis and management of chronic cough. European Respiratory Journal, 24(3), 481–492.
Morris, M. J., Allan, P. F., & Perkins, P. J. (2006). Vocal cord dysfunction: Etiologies and treatment. Clinical Pulmonary Medicine, 13(2), 73–86.
Murry, T., Tabaee, A., Owczarzak, V., & Aviv, J. E. (2006). Respiratory retraining therapy and management of laryngopharyngeal reflux in the treatment of patients with cough and paradoxical vocal fold movement disorder. Annals of Otology, Rhinology & Laryngology, 115(10), 754–758.
National Eating Disorders Association. (n.d). Warning signs and symptoms: Common symptoms of an eating disorder. https://www.nationaleatingdisorders.org/warning-signs-and-symptoms
Olin, J. T., Clary, M. S., Connors, D., Abbott, J., Brugman, S., Deng, Y., Chen, X., & Courey, M. (2014). Glottic configuration in patients with exercise‐induced stridor: A new paradigm. The Laryngoscope, 124(11), 2568–2573.
Perkner, J. J., Fennelly, K. P., Balkissoon, R., Bartelson, B. B., Ruttenber, A. J., Wood, R. P., II, & Newman, L. S. (1998). Irritant-associated vocal cord dysfunction. Journal of Occupational and Environmental Medicine, 40(2), 136–143.
Petty, B. E., & Dailey, S. H. (2009). The collaborative medical and behavioral management of chronic cough. Perspectives on Voice and Voice Disorders, 19(2), 49–57.
Piccione, J., & Boesch, R. P. (2018). The multidisciplinary approach to pediatric aerodigestive disorders. Current Problems in Pediatric and Adolescent Health Care, 48(3), 66–70.
Poelmans, J., & Tack, J. (2005). Extraoesophageal manifestations of gastro-oesophageal reflux. Gut, 54(10), 1492–1499.
Reitz, J. R., Gorman, S., & Kegyes, J. (2014). Behavioral management of paradoxical vocal fold motion. Perspectives on Voice and Voice Disorders, 24(2), 64–70.
Robbins, J. (2011). Upper aerodigestive tract neurofunctional mechanisms: Lifelong evolution and exercise. Head & Neck, 33(S1), S30–S36.
Rundell, K. W., & Spiering B. A. (2003). Inspiratory stridor in elite athletes. Chest,123(2), 468–474.
Sandage, M. J., & Zelazny, S. K. (2004). Paradoxical vocal fold motion in children and adolescents. Language, Speech, and Hearing Services in Schools, 35(4), 353–362.
Shaheen, N. J., Mukkada, V., Eichinger, C. S., Schofield, H., Todorova, L., & Falk, G. W. (2018). Natural history of eosinophilic esophagitis: A systematic review of epidemiology and disease course. Diseases of the Esophagus, 31(8), doy015.
Simons, J. P., Greenberg, L. L., Mehta, D. K., Fabio, A., Maguire, R. C., & Mandell, D. L. (2016). Laryngomalacia and swallowing function in children. The Laryngoscope, 126(2),478–484.
Soni, R. S., Ebersole, B., & Jamal, N. (2017). Treatment of chronic cough: Single-institution experience utilizing behavioral therapy. Otolaryngology—Head & Neck Surgery, 156(1), 103–108.
Soon, I. S., Butzner, J. D., Kaplan, G. G., & deBruyn, J. C. C. (2013). Incidence and prevalence of eosinophilic esophagitis in children. Journal of Pediatric Gastroenterology and Nutrition, 57(1), 72–80.
Taylor, A. C. F., Breen, K. J., Auldist, A., Catto-Smith, A., Clarnette, T., Crameri, J., Taylor, R., Nagarajah, S., Brady, J., & Stokes, K. (2007). Gastroesophageal reflux and related pathology in adults who were born with esophageal atresia: A long-term follow-up study. Clinical Gastroenterology and Hepatology, 5(6),702–706.
U.S. Food and Drug Administration. (2017). FDA expands caution about SimplyThick.
Velayutham, P., Irace, A. L., Kawai, K., Dodrill, P., Perez, J., Londahl, M., Mundy, L., Dombrowski, N. D., & Rahbar, R. (2017). Silent aspiration: Who is at risk? The Laryngoscope, 128(8),1952–1957.
Vertigan, A. E. (2017). Somatic cough syndrome or psychogenic cough—what is the difference? Journal of Thoracic Disease, 9(3), 831–838.
Vertigan, A. E., Gibson, P. G., Theodoros, D. G., & Winkworth, A. L. (2007). A review of voice and upper airway function in chronic cough and paradoxical vocal cord movement. Current Opinion in Allergy and Clinical Immunology, 7(1), 37–42.
Vertigan, A. E., Theodoros, D. G., Winkworth, A. L., & Gibson, P. G. (2007). Chronic cough: A tutorial for speech-language pathologists. Journal of Medical Speech-Language Pathology, 15(3),189–206.
Westby, C., Burda, A., & Mehta, Z. (2003, April). Asking the right questions in the right ways: Strategies for ethnographic interviewing. The ASHA Leader, 8(8), 4–17.
World Health Organization. (2001). International Classification of Functioning, Disability and Health.
World Health Organization. (2015). International Classification of Diseases (10th rev., clinical modification).
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