Standardized Behavioral Treatment Improves Chronic Cough

Varelas, Eleni A; Hwang, Chaewon; Brown, Sarah; Chang, Jung-Jung; Sataluri, Medha; Kirke, Diana N.; Courey, Mark S.; Goldberg, Leanne

doi:10.1016/j.jvoice.2022.11.017

Cited by 5 publications

(1 citation statement)

References 17 publications

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“…While this option does not have the side effects of medication therapy, studies cite short-lived results and have inconclusive findings with regards to its efficacy. 12 In addition to medical treatments and cough modulating therapy, 1,13 iSLN nerve blockade has been successful in improving presumed laryngeal hypersensitivity cough symptomatology. 8,14 In 2018, Simpson et al 14 demonstrated significant improvement in cough in a cohort of 23 patients treated with iSLN blockade using a combination of local anesthetic and corticosteroid.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Medical Comorbidities on Cough Improvement Following Superior Laryngeal Block

Shah,

Wilkins,

Malik

et al. 2024

Ann Otol Rhinol Laryngol

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Introduction: Chronic refractory cough is defined as cough lasting greater than 8 weeks and with an unclear etiology. Blockade of the internal branch superior laryngeal nerve (iSLN) has been shown to be safe and effective in the treatment of chronic cough. It remains unknown, however, if underlying comorbidities impact patient response to iSLN blockade. Methods: A total of 44 patients aged 18 years and older were seen at our institution’s Laryngology clinics between 2019 and 2022 and treated with iSLN blockade. Patient demographics, comorbidities, and pre- and post-treatment cough severity index (CSI) scores were collected from electronic medical records. Two-tailed independent T tests were used to compare CSI scores between groups with and without 4 underlying comorbidities: GERD, pulmonary history, smoking history, and evidence of vocal fold paresis or asymmetry on stroboscopy. Results: Patients with a history of GERD or smoking and those with evidence of glottic insufficiency had similar improvements in CSI compared to those who did not (22.5 ± 26.4 vs 45.0 ± 47.1, P = .36; 32.7 ± 27.8 vs 29.0 ± 38, P = .85; 41.3 ± 18.8 vs 27.2 ± 37.7, P = .195). Patients with underlying pulmonary conditions had a significantly reduced response to iSLN blockade than did patients without underlying disease (9.85 ± 15.0 vs 47.4 ± 38.1, P = .028). Conclusion: Underlying lung pathology may contribute to decreased iSLN blockade efficacy in the treatment of chronic refractory cough from laryngeal hypersensitivity and its treatment is likely necessary for optimal symptom reduction. Characterizing patient comorbidity profiles can help guide patient counseling on expected treatment efficacy.

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Section: Introductionmentioning

confidence: 99%

The Impact of Medical Comorbidities on Cough Improvement Following Superior Laryngeal Block

Shah,

Wilkins,

Malik

et al. 2024

Ann Otol Rhinol Laryngol

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Laryngeal Vibrotactile Stimulation Is Feasible, Acceptable To People With Unexplained Chronic Cough

Misono,

Shen,

Sombrio

et al. 2024

The Laryngoscope

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ObjectivesUnexplained chronic cough (UCC) is common and has significant impacts on quality of life. Ongoing cough can sensitize the larynx, increasing the urge to cough and perpetuating the cycle of chronic cough. Vibrotactile stimulation (VTS) of the larynx is a noninvasive stimulation technique that can modulate laryngeal somatosensory and motor activity. Study objectives were to assess feasibility and acceptability of VTS use by people with UCC. Secondarily, changes in cough‐related quality of life measures were assessed.MethodsAdults with UCC recorded cough measures at baseline and after completing 2 weeks of daily VTS. Feasibility and acceptability were assessed through participant‐reported device use and structured feedback. Cough‐related quality of life measures were the Leicester Cough Questionnaire (LCQ) and the Newcastle Laryngeal Hypersensitivity Questionnaire (NLHQ).ResultsNineteen adults participated, with mean age 67 years and cough duration 130 months. Notably, 93% of planned VTS sessions were logged, 94% of participants found the device comfortable to wear, 89% found it easy to operate and 79% would recommend it to others. Pre‐post LCQ change achieved a minimal important difference (MID) (mean 1.3 [SD 2.4, p = 0.015]). NLHQ scores improved, but did not reach an MID.ConclusionsLaryngeal VTS use was feasible and acceptable for use by patients with UCC and was associated with a meaningful improvement in cough‐related quality of life. Future studies will include VTS dose refinement and the inclusion of a comparison arm to further assess the potential for laryngeal VTS as a novel treatment modality for UCC.Level of Evidence4 Laryngoscope, 2024

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Refractory Chronic Cough: A State‐of‐the‐Art Review for Otolaryngologists

Lilly,

Carroll,

Pietsch

et al. 2024

Otolaryngol.--head neck surg.

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ObjectivePatients with refractory chronic cough (RCC) are being seen in increasing numbers within otolaryngology clinics. Identifying the next steps in the evaluation and management of cough in patients who have had first‐line treatment for gastroesophageal reflux, sinonasal disease, pulmonary disease, and angiotensin‐converting enzyme inhibitor‐related cough is paramount. This state‐of‐the‐art review focuses on emerging treatments for RCC from an otolaryngology perspective.Data SourcesPubmed.Review MethodsThe available literature on chronic cough, with a focus on RCC, emerging paradigms concerning pathophysiology, and evolving treatment approaches was reviewed and summarized.ConclusionsGuided by a more detailed understanding of refractory cough physiology, a myriad of new treatment options have been developed to treat RCC. These are primarily aimed at disrupting what is thought to be a hypersensitive cough reflex, whether by a dampening of its sensory inputs or an alteration in motor activity, and are inclusive of neuromodulator treatments, superior laryngeal nerve blockade, vocal fold augmentation, botulinum toxin injection, topical capsaicin, and potentially the eventual use of P2X3 antagonists. Improved laryngopharyngeal reflux diagnosis and management, as well as the potential benefit of behavioral cough suppression therapy, are also discussed.Implications for PracticeThe literature supporting each of these strategies is growing—and as more patients with RCC seek otolaryngology care, knowledge of these various approaches may improve the overall treatment of this condition.

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Standardized Behavioral Treatment Improves Chronic Cough

Cited by 5 publications

References 17 publications

The Impact of Medical Comorbidities on Cough Improvement Following Superior Laryngeal Block

The Impact of Medical Comorbidities on Cough Improvement Following Superior Laryngeal Block

Laryngeal Vibrotactile Stimulation Is Feasible, Acceptable To People With Unexplained Chronic Cough

Refractory Chronic Cough: A State‐of‐the‐Art Review for Otolaryngologists

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