Treatment of Chronic Laryngitis With Amitriptyline

Study Overview
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Brief Summary
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This randomized, double-blind, placebo-controlled trial will compare the effectiveness of amitriptyline versus placebo (inactive medication) in treating chronic laryngitis.

Detailed Description
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Chronic laryngitis commonly manifests through symptoms including cough, hoarseness, throat clearing, foreign body sensation, throat pain, sensation of excessive phlegm, and difficulty swallowing. A significant minority also present with GERD, rhinosinusitis-induced post-nasal drainage, direct allergic effect, and smoking issues. Amitriptyline is commonly used for mental/mood problems, but is also prescribed to treat chronic laryngitis because some investigators suggest a neuropathic etiology for idiopathic chronic laryngitis. No trials have compared any treatment for chronic laryngitis to placebo and it is unknown if currently used therapies for chronic laryngitis are effective. At the baseline visit, subjects will be assigned at random to amitriptyline or placebo, which they will take for 4 weeks each. Subjects will be seen in the clinic at baseline and after 10 weeks. Improvement will be measured using standardized symptom scales, and a self-reported subjective improvement percentage.

Official Title
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Double-blind Placebo Controlled Trial of the Treatment of Chronic Laryngitis With Amitriptyline

Conditions
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Laryngeal Diseases

Intervention / Treatment
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* Drug: Amitriptyline
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Must be age 18 or older and able to consent for themselves Must have had structural pathology such as tumor previously ruled out using flexible laryngoscopy Must be able to speak and read the English language Must have failed a 2 month or longer trial of a proton pump inhibitor for the treatment of gastro-esophageal reflux Women under 55 years of age who may become pregnant must have a negative pregnancy test and agree to barrier or hormonal methods of contraception during the study Potential subject and their physician have agreed that amitriptyline will be part of their regular care plan Exclusion Criteria: Active untreated environmental allergies Smoking within past 5 years Current upper respiratory infections Use of narcotics (e.g. oxycodone, methadone) within the past week Hypersensitivity to amitriptyline History of amitriptyline use or of other tricyclic antidepressant - including pregabalin, gabapentin, baclofen, or other gamma-aminobutyric acid (GABA)analogues or inhibitors - for any medical condition (not limited to chronic laryngitis) within the past 12 months. Use of any other monoamine oxidase inhibitors (MAOIs) other than amitriptyline within the past 4 weeks (selegiline, phenelzine, tranylcypromine, isocarboxazid, rasagiline, phenelzine sulfate, selegiline hydrochloride, rasagiline mesylate, tranylcypromine sulfate) History of urinary retention History of an acute episode of a major depressive disorder within the past 12 months For women 18-55 years of age without history of menopause: currently nursing or pregnant, plans to become pregnant, or unwillingness to utilize contraception (barrier or hormonal methods) Currently participating in another clinical trial that could interfere with the efficacy of, or participation in, this study. Current untreated diagnosis of gastroesophageal reflux (GERD)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: amitriptyline<br>Subjects in this arm will receive pills composed of amitriptyline and Avicel (cellulose filler) | Drug: Amitriptyline<br>* Subjects in this arm will receive pills composed of amitriptyline and Avicel (cellulose filler)<br>* Other names: Elavil;|
| Placebo Comparator: placebo<br>Subjects in this arm will receive pills composed only of Avicel (cellulose filler) | Other: Placebo<br>* Subjects in this arm will receive pills composed only of Avicel (cellulose filler)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Score on Reflux Symptom Index (RSI) | The Reflux Symptom Index (RSI) is a validated questionnaire consisting of 9 statements to be ranked on a scale of 0-5 (0=no problem, 5=severe problem). RSI scores can range from 0 to 45, with higher scores correlated with more reflux symptoms. | baseline, 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the Score on the Voice Handicap Index-10 (VHI-10) | The Voice Handicap Index-10 (VHI-10) is a 10-question scale rated from 0-4 that addresses effects on quality of life from voice disorders (0=never, 1=almost never, 2=sometimes, 3=almost always, 4=always). VHI-10 scores can range from 0 to 40, with lower scores correlated with a higher quality of life related to voice disorders. | baseline, 8 weeks | 
| Change in the Score on the Cough Severity Index (CSI) | The Cough Severity Index is a validated 10 item questionnaire to quantify a patient's symptoms associated with upper airway chronic cough. The 4 point Likert scale for each of the 10 items is 0 to 4 where 0 = Never, 1 = Almost never, 2 = Sometimes, 3 = Almost always, 4 = Always. Scores can range from 0 to 40 and higher scores reflect more coughing. | baseline, 8 weeks | 
| Change in Throat Pain or Burning | Participants will be asked to rate the severity of their throat pain or burning on a scale from 0 (no problem) to 5 (severe). Higher scores are correlated with more throat pain/burning. | baseline, 8 weeks | 
| Change in Pain When Swallowing | Participants were asked to rate their pain when swallowing on a scale of 0=none to 5= severe pain. | baseline, 8 weeks | 
| Subjective Improvement of Laryngitis Symptoms | Patients will subjectively rate improvement of symptoms on an ordinal 10-point scale where 0=no improvement and 10=significant improvement. | 8 weeks | 
| Number of Participants Who Dropped Out of the Study Due to Side Effects | The number of patients who report they did not continue with study participation due to side effects, will be obtained from study logs. | 8 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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laryngeal sensory neuropathy, chronic laryngeal neuropathy