ph.d., SLP (Australia)
Published on October 17, 2016
Pleased to post an interview with Dr. Anne Vertigan, a prominent Australian Speech-Language Pathologist who has completed important work on chronic cough and paradoxical vocal fold motion (PVFM). She has recently published a groundbreaking book on diagnosis and treatment of these debilitating disorders.
TVF: Where do you currently practice/teach?
AV: John Hunter Hospital in Newcastle Australia.
TVF: Where did you complete your medical training?
AV: Latrobe University in Melbourne.
TVF: How/why did you come to choose medical Speech-Language Pathology?
AV: I was always interested in the helping professions. I became interested in behaviour modification in my teenage years and wanted a job where I could combine teaching and medical work.
TVF: What comes to your mind as one of the most pressing issues in contemporary laryngeal disorders?
AV: It would be helpful to know more about the role of the larynx in laryngeal hypersensitivity disorders such as chronic cough and paradoxical vocal fold movement. While it is an international issue it is more significant in countries with less ready access to ENT assessment.
TVF: Most people not involved in medical field do not know that Speech-Language Pathologists provide treatment for chronic coughing and PVFM with no known cause. How did this come about as a sub-specialty for SLPs?
AV: The initial studies e.g. those by Dr Florence Blager, used techniques adapted from the treatment of hyperfunctional voice disorders for the treatment of cough and PVFM. Subsequent studies built on this early research and demonstrated effective results.
TVF: What is your research interest?
AV: I am interested in the role of laryngeal imaging in patients with chronic cough and PVFM and also the characterisation of laryngeal disorders in asthma.
TVF: How do you hope your research will be applied in the clinical field?
AV: I hope this research will provide more evidence to support speech-language pathologists in their treatment of patients with laryngeal hypersensitivity disorders. I also hope it will guide who should be referred for speech-language pathology intervention and who is not an ideal candidate.
TVF: What is the best way for the general public to understand laryngeal hypersensitivity and laryngeal hyperresponsiveness (LHR)?
AV: It can be helpful for patients to understand that their sensation is not always reality. For example the perception of the urge to cough does not necessarily mean that a cough is needed or helpful. We aim to teach our patients that their cough and breath holding etc can be a response to an external trigger but that it is possible to learn to control their responses. We aim to help patients internalise their responses to external triggers rather than view them as something uncontrollable that is happening to them.
TVF: You have recently authored a very important book. Thank you very much as it will help so many people. Can you tell us about this new book?
AV: Our new text book is designed to assist speech-language pathologists provide treatment for patients with chronic cough and related laryngeal disorders. While many speech-language pathologists are experienced in this field, there is a need to provide further education so that the therapy can be delivered in a more standardised manner by a greater number of therapists.
TVF: In your opinion, what are some of the most important advances made in the field of laryngology and voice rehabilitation in the recent years?
AV: Understanding the principles of motor learning is very important. If we want patients to change their behaviour and learn new techniques we need to do more than describe a set of exercises and expect patients to implement them. We need to ensure that they are practicing accurately and frequently and structure our therapy accordingly.
AV: When patients are referred for speech pathology treatment of chronic cough without necessary medical intervention.
TVF: Which vocal myth would you like to dispel?
AV: I would like to challenge the notion that it is harmful to suppress a cough. Occasionally it is……. But in the case of laryngeal hyperresponsiveness, the cough is usually a response to irritation rather than needing to clear anything from the airway.
TVF: What is your most memorable case?
AV: I had a patient who worked very hard in therapy and was diligent with her practice and showed great improvement. It suddenly occurred to me half way through the session that patients often get better if they practice!
TVF: As a SLP scientist, what keeps you on your toes?
AV: The patients who don’t get better - we often need to develop new strategies or investigate further.
TVF: What do you think the next steps are in growing the field of laryngology and voice rehabilitation (including LHR)?
AV: Laryngeal imaging and understand the mechanics behind why treatments work. At present we have hypothesis but the underlying physiology needs further research.
TVF: Who have been your most important/influential mentors?
AV: Dr Peter Gibson has been very influential – always asking the right questions to push the field further.
TVF: What is your advice in mentoring future laryngologists and voice specialists?
AV: Keep asking questions. Work out what you don’t know and what is currently unclear in the literature.
TVF: What advice would you like to give to the general populace about voice care in terms of laryngeal hypersensitivity?
AV: Hydration is very important and often poor in patients with chronic cough. I would also ask patients with cough occurring with an upper respiratory tract infection whether they need to cough or are coughing deliberately in response to irritation.
TVF: What can laryngologists learn from voice pathologists and voice scientists, and vice versa?
AV: I think we each bring one part of the puzzle regarding voice function and need to understand the components in order to see the big picture.
TVF: What sparks “joy” for you as a person?
AV: Work – research and crunching statistics.
AV: Outside of work – watching my son kicking a winning goal at soccer and my daughter playing the saxophone.