Hypotussia in Head and Neck Cancer Survivors With Radiation-Associated Dysphagia: A Conceptual Model

Purpose: Radiation-associated dysphagia (RAD) due to head and neck cancer (HNC) and the associated silent aspiration is likely related, in part, to hypotussia , or downregulated cough. Although the negative impact of RAD may be exacerbated for HNC survivors with concomitant hypotussia , cough dysfunction remains an underemphasized area of clinical practice. Emerging evidence supports the need for improved assessment and management of cough in HNC survivors, particularly given the impact of cough dysfunction with uncompensated aspiration on respiratory compromise, feeding tube dependence, and quality of life in other clinical populations with dysphagia. The purpose of this tutorial was to increase knowledge on central and peripheral underpinnings of cough dysfunction, as it pertains to HNC patients and survivors, through a conceptual model. Conclusions: A conceptual model—iterative in nature—integrates both foundational and contemporary evidence on cough function and dysfunction in HNC patients and survivors for clinicians to leverage. By expanding the speech-language pathologists' clinical arsenal to include expertise in both swallow and cough dysfunction, HNC practitioners may be able to more effectively address the continuum of airway protective dysfunction for HNC survivors.