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Neurogenic Cough

November 4th, 2020

Neurogenic cough is a relatively new diagnosis and can be very challenging to diagnose and treat. Often, these patients have seen numerous physicians with little improvement in their symptoms. There are multiple terminologies for this disorder:

  • Neurogenic Cough

  • Sensory neuropathic cough

  • Irritable larynx syndrome or hypersensitive larynx

  • Cough hypersensitivity syndrome

However it is termed, this type of cough can be very annoying. It is often described as a “tickle” in the throat that will not resolve. Often, the cough is worse during the day but does not occur much once the patient falls asleep. This is quite opposite of a true infectious cough which tends to keep us up all night coughing.

Some other common features of neurogenic cough include:

  1. Irritation in the throat or upper chest or lower throat.  These patients tend to clear their throat a lot.

  2. Cough triggered by non-tussive stimulus i.e. talking, laughing, singing

  3. Increased cough sensitivity to inhaled stimuli and number of triggers.  Cough can be caused by certain scents or perfumes

  4. Coughing spasms that are difficult to control.  These can lead to other problems such as incontinence or even abdominal wall hernias.

Common triggers for this type of cough include:

  • Mechanical activation: singing, talking, laughing, or deep breath
  • Changes in temperature: cold air, turning on the A/C in the car, or drinking cold liquids
  • Odors: aerosols, scents, or that annoying perfume isle at the store
  • Positions or activities: lying flat, eating, or exercising

This type of cough is often a diagnosis of exclusion and patients have generally tried multiple other treatments such has inhalers, allergy medications, or even reflux medications. Usually an ENT evaluation is needed to make sure there is no other cause of the cough. This is often achieved by using a scope to evaluate the throat. If neurogenic cough is determined to be a possible cause of your cough, treatment often uses atypical medications not commonly used for treating cough. These medications are often neuromodulators, or medications designed to reduce the “tickle in the throat.” Finding the right medication and dose can often take some time. As a general rule, 50% of patients can achieve good resolution of the cough. About 40% are much improved but still cough from time to time. Unfortunately, there are about 10% of patients for whom the cough never resolves. We are still working on ways to help these patients.

By Andrew Celmer, M.D. - MMC Comprehensive ENT Specialists

Posted by Murfreesboro Medical Clinic | Topic: ENT  | Category: ENT
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