Management of Recurrent Laryngeal Sensory Neuropathic Symptoms

Abstract

Patients with suspected neuropathy of the recurrent laryngeal nerve frequently respond to neuromodulator therapy. The addition of reflux precautions and acid suppression therapy is helpful in cases of chronic and recurrent laryngospasm. Patients with evidence of motor neuropathy appear to have better outcomes with neuromodulator therapy.

An update and systematic review on drug therapies for the treatment of refractory chronic cough

“…No baseline characteristics comparison between groups. High risk of selection bias (patients where randomized by chart numbers and presence of nasal allergies).Norris & Schweinfurth, 2010 [87]Retrospective case series10^ Amitriptyline used as the first-line neuromodulator, n  = 5 (median dose 25 mg/day, maximum dose 100 mg/day). Patients with nonresponse or intolerable side effects to amitriptyline were prescribed gabapentin, n  = 3 (median dose 300 mg/tid).…”

A review on the efficacy and safety of gabapentin in the treatment of chronic cough

“…Patients prescribed a lower dose of amitriptyline or those taking gabapentin did not complain of fatigue. No severe side effects were reported, and no patients experienced permanent side effects after discontinuation of the medication [43].…”

“…A retrospective case series performed by Norris & Schweinfurth [43] in 2010 studied 12 patients with recurrent laryngeal nerve sensory neuropathic symptoms. The patients had been previously referred to a tertiary academic setting with either CC or vocal fold synkinesis between 2004 and 2009.…”

“…Studies specific to gabapentin treatment of refractory CC included the studies presented above [17,18,20,43]; therefore no further comment is required of this review. Likewise a journal club review by Mackenzie in Thorax, 2014 [47] summarizes the randomized controlled trial findings by Ryan et al [20].…”

Gabapentin in chronic cough

“…Five articles investigated the role of gabapentin [17,22,[28][29][30] in the treatment of cough, one article focused on pregabalin treatment of cough [23] and a further three articles included both pregabalin and gabapentin treatment trials [31][32][33]. The trial design consisted of case reports, case series, and a randomised controlled trial.…”