Persistent cough and laryngeal neuropathy

Abstract

Persistent cough is a common symptom for medical consultation, it is of multifactorial origin and involves different specialties such as pneumology, gastroenterology and otorhi- nolaryngology. The most frequent causes are postnasal drip, cough variant asthma and gas- troesophageal/pharyngolaryngeal reflux. Once these causes are discarded the vagus nerve sensory disorder becomes of importance, it is a relatively new entity also known as laryngeal sensitive neuropathy. In the laryngeal neuropathy, an injury in the afferent neuronal pathway of the cough reflex produces laryngeal hypersensitivity in which normally ignored stimulus (i.e. do not cause cough) start to trigger the reflex. The clinical features of the cough and the rule out of the most frequent causes allow the diagnosis. The objective of the treatment is to modulate the altered neuronal pathways based on 3 pillars: education regarding the pathology, behavioral recommendations (vocal hygiene, cough reduction strategies) and drugs among which proton pump inhibitors, mucolytics and neuromodulators are used.