Bilateral internal superior laryngeal nerve injections for unexplained chronic cough

Andrew Jay Bowen; Ariel Roitman; Sydney Ring; David O Francis; Ruth J Davis; Timothy McCulloch; Seth H Dailey

doi:10.1016/j.amjoto.2024.104568

Bilateral internal superior laryngeal nerve injections for unexplained chronic cough

Am J Otolaryngol. 2024 Dec 19;46(1):104568. doi: 10.1016/j.amjoto.2024.104568. Online ahead of print.

Authors

Andrew Jay Bowen¹, Ariel Roitman², Sydney Ring³, David O Francis³, Ruth J Davis³, Timothy McCulloch³, Seth H Dailey⁴

Affiliations

¹ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America. Electronic address: andrewbowen77@gmail.com.
² Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America; Technion- Israel Institute of Technology, The Bruce Rappaport Faculty of Medicine, Haifa, Israel.
³ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America.
⁴ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America. Electronic address: dailey@surgery.wisc.edu.

PMID: 39740535
DOI: 10.1016/j.amjoto.2024.104568

Abstract

Objective: Internal Superior laryngeal nerve (iSLN) injections with steroids and anesthetic for Unexplained Chronic Cough (UCC) was initially described as a unilateral injection. This study reports the safety profile and patient-reported outcomes of concurrent bilateral iSLN injections for UCC.

Study design: Retrospective chart review.

Setting: Tertiary center.

Methods: A chart review from 2018 to 2023 was performed for patients with UCC who underwent bilateral iSLN injections. Demographics, clinical history, and physical exam findings were recorded, along with any post-injection complications. The primary outcome was patient-reported percent improvement in cough symptoms. Nonparametric statistical analyses were performed to examine whether treatment effectiveness differed based on (a) duration of cough, (b) whether an upper respiratory illness (URI) preceded the start of the cough, (c) had undergone prior speech therapy or (d) neuromodulator treatment for cough, (e) laterality of symptoms, and (f) demonstrated abnormal flexible laryngoscopy/stroboscopy findings.

Results: 12 UCC patients underwent a median of 2 injections (Interquartile Range (IQR): 1-5.5 injections) for a total of 42 injections). There were no aspiration events and only 3 self-limited minor complications. 75 % of patients reported improvement with at least one of their injections with a median percentage response of 73 % (IQR: 26-89 %) and a reported median duration of response of 2.2 months (IQR: 1.2-3.2 months). Nonparametric testing revealed greater responses to injection in patients with abnormal flexible laryngoscopy/stroboscopic findings with their initial injection (p ≤0.02).

Conclusion: Bilateral concurrent iSLN injections are a safe and effective way of treating UCC that may require fewer visits to effectively treat UCC.

Keywords: Chronic cough; Irritable larynx syndrome; Laryngeal hypersensitivity syndrome; Refractory chronic cough; Superior laryngeal nerve.