Pregabalin Shows Promise as Treatment Option for Laryngeal Sensory Neuropathy

Treatment with the antiepileptic drug pregabalin (Lyrica) appears to relieve symptoms among patients with laryngeal sensory neuropathy, researchers reported at the 88th annual meeting of the American Broncho-Esophagological Association.

Of the 12 patients in the study, 10 improved with pregabalin, said David L. Sycamore, MD, a resident in otolaryngology at Indiana University School of Medicine in Indianapolis, in his oral report at the meeting, held in conjunction with the Combined Spring Otolaryngology Spring Meeting.

Treatment with pregabalin appears to be an effective option for laryngeal sensory neuropathy, Dr. Sycamore said. Future prospective studies are needed to compare outcomes between pregabalin and other established treatments.

Researchers reviewed hospital records for patients who were treated for laryngeal sensory neuropathy from February 2006 through October 2007, and, after receiving approval from the Indiana University School of Medicine institutional review board, performed a retrospective study based on a patient chart review, Dr. Sycamore said in discussing his results. The study included all patients who presented to the Indiana University Clinic for Voice, Swallowing, and Airway Disorders who were diagnosed with laryngeal sensory neuropathy suggested by history and examination, and patients who received empiric treatment with pregabalin.

Pregabalin as Treatment for Neuropathy

This study introduces pregabalin as an alternative treatment for this disorder, Dr. Sycamore said.

Pregabalin is a gamma analog that binds to the calcium channel in the central nervous system, which, in turn, inhibits the releases of certain neurotransmitters. The medication is currently indicated for treatment of partial seizures, postherpetic neuralgia, and diabetic peripheral neuropathy. There have been no previous studies investigating pregabalin use in laryngeal sensory neuropathy, he said.

Dr. Sycamore noted that neuropathy can affect any part of the body. It can involve motor function, sensory function, or both, he said. Motor impairments can involve dysfunction or lack of function. Sensory problems can manifest as insensitivity, paresthesia, or pain.

Some examples of neuropathy that are common to the head and neck region are Bell’s palsy, idiopathic vocal fold paralysis, trigeminal/glossopharyngeal neuralgia, and laryngeal sensory neuropathy. The etiologies of neuropathy are variable and include viral/autoimmune, ischemic, and traumatic causes.

He acknowledged that treatment of laryngeal sensory neuropathy is a difficult problem because of challenges in diagnosing the complaint-usually globus sensation or the feeling that there is a lump in the throat, despite the lack of a mass. He said patients often complain of a cough or a need for throat-clearing despite being free of colds or infections.

Diagnosis and Treatment of Laryngeal Sensory Neuropathy

He said that history of onset is an important part of diagnosing laryngeal sensory neuropathy. It typically presents as an acute onset that the patient can clearly remember, he said. Frequently the patient will describe a laterality of symptoms, such as a globus sensation. Typical symptoms include globus sensation, chronic cough, odynophonia, and odynophagia. Exam findings are often lacking in this diagnosis, though at times you may find vocal cord hypomobility or paresis. These findings may support the diagnosis, but can also result from other causes. There is no proven objective testing for diagnosing laryngeal sensory neuropathy at this time. Because of this, a diagnosis of laryngeal sensory neuropathy is primarily based on history.