Arnold's nerve cough reflex: evidence for chronic cough as a sensory vagal neuropathy.
Arnold's nerve ear-cough reflex is recognised to occur uncommonly in patients with chronic cough. In these patients, mechanical stimulation of the external auditory meatus can activate the auricular branch of the vagus nerve (Arnold's nerve) and evoke reflex cough. This is an example of hypersensitivity of vagal afferent nerves, and there is now an increasing recognition that many cases of refractory or idiopathic cough may be due to a sensory neuropathy of the vagus nerve. We present two cases where the cause of refractory chronic cough was due to sensory neuropathy associated with ear-cough reflex hypersensitivity. In both cases, the cough as well as the Arnold's nerve reflex hypersensitivity were successfully treated with gabapentin, a treatment that has previously been shown to be effective in the treatment of cough due to sensory laryngeal neuropathy (SLN).
1 Priority Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia ; 2 Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, New Lambton, NSW 2305, Australia ; 3 Division of Asthma, Allergy and Lung Biology, King's College London, Denmark Hill, London SE5 9RS, UK.
Nicole M
NM
Ryan
1 Priority Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia ; 2 Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, New Lambton, NSW 2305, Australia ; 3 Division of Asthma, Allergy and Lung Biology, King's College London, Denmark Hill, London SE5 9RS, UK.
Peter G
PG
Gibson
1 Priority Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia ; 2 Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, New Lambton, NSW 2305, Australia ; 3 Division of Asthma, Allergy and Lung Biology, King's College London, Denmark Hill, London SE5 9RS, UK.
Surinder S
SS
Birring
Arnold’s ear-cough reflex; Gabapentin; refractory chronic cough; sensory vagal neuropathy