Management of Chronic Cough and Laryngeal Hypersensitivity Disorders

PROGRAM DESCRIPTION: FOCUS

The focus of this presentation is on the diagnosis and management options for chronic refractory or non-specific cough and other related disorders such as inducible laryngeal obstruction (ILO), paradoxical vocal fold motion (PVFM), and irritable larynx.

SIGNIFICANCE
Chronic cough is defined as any cough that persists for eight weeks or longer. The cough can persist for years, be debilitating for patients and have a significant negative effect on quality of life. Cough is estimated to affect between 7% and 9% of the global population and has been reported as the reason for 10% to 38% of referrals to a specialist at an average health care expenditure of over $3200 (USD) per patient per year.

RELEVANCE
If the cough is refractory and a gastroenterologist and a pulmonologist have failed to identify a specific cause, patients are often referred to an otolaryngologist. This spectrum of symptoms may be secondary to abnormal neurogenic laryngeal hypersensitivity (NLH). Understanding the signs and symptoms of this disorder leads to improved accuracy in diagnosis. Cough frequency recordings and patient reported sensitivity measures are helpful to assess disease severity and response to intervention. There are many reported treatment options all with variable success rates. While neuromodulating medications and trigger point injections are helpful in reducing symptom severity, they are associated with ongoing cost and symptom relapse on cessation of treatment. Behavioral interventions based in cognitive approaches, on the other hand, have been shown to provide quick, significant, and permanent severity reduction or relief in over 80% of patients. Key points in identification of patients appropriate for this intervention a

OUTCOME OBJECTIVE 1: Understand the otolaryngologic causes of chronic cough

OUTCOME OBJECTIVE 2: Recognize the diagnosis of neurogenic laryngeal hypersensitivity (NLH)

OUTCOME OBJECTIVE 3: Understand the role of behavioral intervention in the treatment of NLH and implement an appropriate treatment plan

BACKGROUND STATEMENT: Chronic cough patients present similarly to those with ILO, irritable larynx and PVFM. The spectrum of symptoms all respond to cognitive behavioral-like therapy. Uniting them under “neurogenic laryngeal hypersensitivity” provides a framework for improved understanding and management.