Procedural Therapies Demonstrate Effectiveness in Improving the Lives of Patients with Neurogenic Cough

by Linda Kossoff •

How do procedural therapies compare to other established pharmacologic and nonpharmacologic methods in treating patients with neurogenic cough (NC)?

BOTTOM LINE

Procedural therapy should be considered as a neurogenic cough treatment, particularly in patients refractory to, or intolerant of, the side effects of medical therapy.

BACKGROUND: Affecting approximately 11% of Americans, NC is characterized by reflexive coughing episodes triggered by innocuous stimuli such as laughing. Although gabapentin is considered the gold standard therapy for NC, prescribing practices among otolaryngologists vary. Procedural treatments such as speech therapy (ST), superior laryngeal nerve (SLN) block, botulinum toxin (BTX), and vocal fold augmentation are also options.

STUDY DESIGN: Systematic review and meta-analysis.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Washington University in St. Louis, St. Louis, Mo.

SYNOPSIS: Researchers compared adults with NC receiving any pharmacologic or nonpharmacologic treatment with adults with NC receiving any other relevant interventions, or treated as single cohorts, assessed with cough-specific quality of life outcomes, in all study designs and case series with > cases. A total of 51 manuscripts were used. Of the 2,408 patients included in the review, 77% received medical therapy (neuromodulating drugs, tricyclic antidepressants [TCAs], inhaled corticosteroids, opioids), 19% ST, 1% both medical and speech therapy, and 3% procedural therapy. Medical therapy, ST, and procedural therapy were compared by analyzing cough-specific, patient-reported outcome measures and the proportion of patients reporting improvement. Medical therapy, especially gabapentin, TCAs, and P2X3-inhibitors, led to improvement in cough and cough-specific quality of life, while ST was consistently favorable as well. For procedural therapy, SLN block showed improvement in cough-specific QoL compared to vocal fold augmentation and laryngeal BTX injection. Almost all studies lacked longterm follow-up. Study limitations included lack of direct comparisons between different cough interventions.

CITATION: Wamkpah NS, Peterson AM, Lee JJ, et al. Curbing the cough: multi-modal treatments for neurogenic cough: a systematic review and meta-analysis. Laryngoscope. 2022;132:107-123.