Chronic cough as a sign of laryngeal sensory neuropathy: diagnosis and treatment.
Chronic cough is often attributed to reflux, postnasal drip, or asthma. We present 28 patients who had chronic cough or throat-clearing as a manifestation of sensory neuropathy involving the superior or recurrent laryngeal nerve. They had been identified as having sudden-onset cough, laryngospasm, or throat-clearing after viral illness, surgery, or an unknown trigger. Cough and laryngospasm were the most common complaints. Seventy-one percent of the patients had concomitant superior laryngeal nerve or recurrent laryngeal nerve motor neuropathy documented by laryngeal electromyography or videostroboscopy. After a negative workup for reflux, asthma, or postnasal drip, these patients were treated with gabapentin at 100 to 900 mg/d. Symptomatic relief was achieved in 68% of the patients. Sensory neuropathy of the recurrent laryngeal nerve or superior laryngeal nerve should be considered in the workup for chronic cough or larynx irritability. Symptomatic management of patients with cough and laryngospasm due to a suspected sensory neuropathy may include the use of antiseizure medications such as gabapentin.
Lee
Bryant
B
Department of Otolaryngology-Head and Neck Surgery, The Grabscheid Voice Center, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.
Woo
Peak
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D003371:Cough / Q000188:drug therapy* / Q000209:etiology*; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000188:drug therapy / Q000209:etiology; D004576:Electromyography; D005260:Female; D000077206:Gabapentin; D006801:Humans; D061224:Laryngeal Nerve Injuries; D007823:Laryngeal Nerves / Q000503:physiopathology; D007826:Laryngismus / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D049489:Stroboscopy; D014741:Video Recording; D014826:Vocal Cord Paralysis / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin