Laryngeal dysfunction as a cause of chronic refractory cough (CRC) and episodic dyspnea is often missed, which results in unnecessary testing and delays in diagnosis. Understanding laryngeal roles in breathing and airway protection can help to appreciate the propensity to laryngeal dysfunction with aging, chronic lung disease, and sleep apnea. The human larynx is a complex muscular structure that is responsible for multiple roles of breathing, vocalization, coughing, and swallowing. To undertake these activities, the larynx has a high density of sensory and motor innervation. In addition to common embryological origins with the pharynx and esophagus, with which many laryngeal activities are shared, somatomotor and autonomic pathways regulate emotional, cognitive, and complex motor sequence-planning activities within the larynx. Due to its unique location, the larynx is susceptible to infectious and gastroesophageal reflux-related insults. Couple this with key roles in regulation of airflow and mediation of airway protective reflexes, it is not surprising that neuropathic abnormalities and muscle dysfunction frequently develop. The expression of laryngeal dysfunction as hypersensitivity to mechanical, thermal, chemical, and other stimuli leads to exaggerated airway protective reflexes (laryngeal adductor reflex and cough reflex) manifesting as dyspnea and cough. Pulmonologists should incorporate assessment of laryngeal dysfunction during evaluation of CRC and dyspnea. Recognition of laryngeal hypersensitivity in patient with CRC can identify patients who may benefit from cough suppression therapies. Similarly, timely identification of inducible laryngeal obstruction may not only resolve episodic dyspnea but lessen the need for unnecessary testing and treatments.

中文翻译：

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表现为慢性难治性咳嗽和呼吸困难的喉功能障碍：呼吸系统健康和疾病中的喉生理学

喉功能障碍是慢性难治性咳嗽 (CRC) 和阵发性呼吸困难的原因之一，经常被忽视，从而导致不必要的检查和诊断延误。了解喉部在呼吸和气道保护中的作用有助于了解衰老、慢性肺病和睡眠呼吸暂停导致喉部功能障碍的倾向。人类的喉部是一个复杂的肌肉结构，负责呼吸、发声、咳嗽和吞咽等多种功能。为了进行这些活动，喉部具有高密度的感觉和运动神经支配。除了与咽和食管共同的胚胎学起源（许多喉部活动与之共享）之外，躯体运动和自主神经通路还调节喉内的情绪、认知和复杂的运动序列规划活动。由于其独特的位置，喉部很容易受到感染和胃食管反流相关的损害。再加上气流调节和气道保护反射调节的关键作用，神经性异常和肌肉功能障碍频繁发生也就不足为奇了。喉功能障碍表现为对机械、热、化学和其他刺激过敏，导致气道保护性反射（喉内收肌反射和咳嗽反射）过度，表现为呼吸困难和咳嗽。肺科医生应在评估 CRC 和呼吸困难时纳入对喉功能障碍的评估。识别 CRC 患者的喉部过敏症可以识别出可能受益于咳嗽抑制治疗的患者。同样，及时识别诱发性喉阻塞不仅可以解决阵发性呼吸困难，还可以减少不必要的检查和治疗的需要。