Co-articulated consonant consonant such as is doubly or secondarily articulated. In some English dialects, for example, is a labialized velar that could be transcribed as , but the Japanese is closer to a true labial-velar, . It is common usage to restrict the letter to the former. The glottis controls phonation, and works simultaneously with many consonants. It is not normally considered an articulator, and an ejective such as , with simultaneous closure of the velum and glottis, is not normally considered to be a co-articulated consonant. Co-articulated consonant Co-articulated consonants or complex consonants are consonants produced with two simultaneous places of
Vocal cord dysfunction of the larynx (voice box). The glottic closure reflex (or laryngeal adductor reflex) serves to protect the airway, and it is possible that this reflex becomes hyperactive in some individuals, resulting in the paradoxical vocal fold closure seen in VCD. Two major causes of laryngeal inflammation and hyperresponsiveness are gastroesophageal reflux disease (GERD) and postnasal drip (associated with rhinosinusitis, allergic or nonallergic rhinitis, or a viral upper respiratory tract infection (URI)). Rhinosinusitis is very common among patients with VCD and for many patients, VCD symptoms are ameliorated when the rhinosinusitis is treated. GERD is also common among VCD patients, but