Sensory Neuropathic Cough
There are patients with a chronic dry cough lasting longer than 6 months that seem to defy all explanation and resist all of the usual standard treatments. Some patients have coughed for more than ten years resulting in frustration not only in the terms of treatment, but diagnosis. Medications are reviewed, as some are known to cause cough as a side effect (such as ACE inhibitors). Patients are often told their cold is due to reflux, allergy, asthma, virus, etc. and undergo numerous tests such as a pulmonary function test, a chest x-ray, an upper endoscopy, an esophagram, CT scans, MRI scans, etc. Proposed treatments with antibiotics, proton pump inhibitors, allergy medications, cough suppressants, steroid inhalers, etc. are not successful. Eventually, some are told it’s all in their head or the cough is idiopathic.
A typical patient with the chronic cough is described as follows:
-Started during or after recovering from a viral laryngitis
-Dry cough
-Cough occurs due to no perceivable reason, maybe only a “tickle”
-Cough may occur several times per hour to as often as several times a minute
-Must be distinguished from whooping cough (severe attacks of a choking cough that lasts 1-2 minutes often with near vomiting and appearance of suffocation)
-Cough does not seem to get better with time (months or even years)
-All diagnostic studies have come back normal
-Endoscopy of the throat and voice box is normal (to ensure there is no anatomic reason for the cough such as an elongated uvula or large tonsils)
If this description sounds like you, you may have a chronic cough due to laryngeal sensory neuropathy (also called sensory neuropathic cough and vagal neuropathy). Essentially, this means that the nerve that provides sensation to the voice box and is responsible for triggering the cough reflex has been injured, usually by a virus. When this happens, the nerve becomes hyper-sensitive.
Normally, the nerve recovers its normal level of sensitivity and the cough resolves. However, in some patients, the nerve does not recover and a persistent chronic cough results. In this scenario, the best medications are those that “calm” down the nerve. For a given patient, one medication may work better than the other, which may not work at all. Trial and error is unfortunately necessary. With careful guidance with these medications, the cough significantly improves and even completely resolves.
It is becoming recognized that voice therapy under guidance from a qualified speech-language pathologist, is beneficial for patients with neurogenic chronic cough. Through self-awareness exercises and therapy, patients are often able to decrease laryngeal sensory hyper-responsiveness leading to cough decrease. The therapy includes behavior modification, cough suppression behavior and vocal hygiene training.
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This is exactly what I have got. Seems to be a combination of post nasal drip and reflux. I have had various medications but none work. The cough comes to a head often, where I take a short supply of steroids and it clears it away after a week., but it reappears again shortly after.
ReplyOh my goodness. I think this is me! Luckily, mildly. I think! And I’ve had it all my life and I’m in my late 70s and otherwise very fit and healthy. Need to investigate – but maybe goodbye to asthma medication!! Unfortunately in the UK. but plan to investigate.
ReplyI’ve had a chronic cough for about seven years. It started with an upper respiratory infection and never stopped. It starts with a tickle in my throat and seems to be very random. I’ve had to stop singing in choirs and sometimes have to leave meetings or presentations where quiet is needed. Fisherman’s Friend cough drops seem to help. I’ve been evaluated by ENT, allergist, pulmonary doctors. Nothing. I’m 73 and think I will never be cured.
ReplyThe description above describes my wife, Judy exactly. She has had the above described daily cough for over 20 years. Over the years she has been thru every imaginable test for reflux, allergies, etc. numerous times with the same results – not the cause for her constant cough. We are still hoping to find a path for some relief from this daily constant cough. Please contact us if you may have some potential for a course of treatment that may help. Any relief would certainly lead to an enhanced quality of life for her. Thanking you in advance for any response.
Marvin & Judy Oliver
ReplyHopeful
I think I’ve just ‘accidentally’ found something that works for me. I’ve had a persistent cough for years (coughing multiple times throughout the day and night) and was prescribed a drug called Lyrica for nerve pain in my hip…it’s only been a week so I’m not 100% but I have hardly coughed at all since starting this. Apparently some ENTs are prescribing it now as a treatment for persistent cough. Could be worth a try?
ReplyPlease don’t give up. Read this doctor’s book, The Chronic Cough Enigma, and check out her information here. There is a cure! https://jamiekoufman.com/the-chronic-cough-enigma/ It can either be silent reflux, a neurogenic cough, or both. This doc has a 2 week plan to try if it’s reflux or both. A neurogenic cough can be treated with amitriptyline. I wish Judy healing!
ReplyI have had a neurogenic cough for over 30 years. It has greatly affected my life. There is a fairly recent procedure that appears to offer good results. Superior Laryngeal Nerve Block. A combo of lidocaine and steroids are injected into the over active nerve. I could find only a few major hospitals that offer this.
ReplyPlease let me know where you got this treatment. I have had this cough for over 15 years now. I am 63 and I just cant see how my body can take it much longer. As a result of the cough I have costochondritis most of the time. I am fit and active. I have been tested for everything. It is embarrassing, annoying and disruptive to my life. I have stress incontinence and of course that is affected by coughing. At least 4-5 times a week I cough so hard that I wretch and vomit. Any information that you can give me may help.
Thank you
ReplyJust been put on Endep 10 amitriptyline hydrochloride 10mg. My wonderful Dr said it’s an old fashioned anti depressants not used much now for depression but it’s calmed my cough noticeably. I do believe after many tests and medication it’s a neuropathic cough triggered by viral infection 5 yrs ago. We need to have the tests to rule things out but I can say this medication has helped me.
ReplyTry Tremadol it works for me.
ReplyYes, I discovered Tramadol works like a charm! Was given it for post surgery pain. Problem is it’s an opiate and habit forming, so really not an option for anyone.
ReplyThis sounds like me too Katharine. Please don’t give up. Read this doctor’s book, The Chronic Cough Enigma, and check out her information here. There is a cure! https://jamiekoufman.com/the-chronic-cough-enigma/ It can either be silent reflux, a neurogenic cough, or both. This doc has a 2 week plan to try if it’s reflux or both. A neurogenic cough can be treated with amitriptyline. I wish you healing!
ReplySadly, I have those exact symptoms. Mine started after being prescribed an Ace Inhibitor. I am so very angry as this cough affects my entire life.
ReplyAce inhibitors can produce cough. Had one for several years.Ramipril was the problem.Had to replace it. Seemed to help.
ReplyI tested positive for Covid on February 2 of this year and progressively worse double pneumonia. I was ultimately intubated, life flighted to a larger facility and spent 9 days on a ventilator, some days in ICU and after 18 days was released to a rehab facility for a month. I also did 7 weeks rehab at my home. I am thankful to have recovered to where I am off oxygen, have increasing strength and am looking forward to being able to resume some of the activities I did before Covid (I am 76 and very blessed to be alive! Praising the Lord for His healing hand. )
ReplyWith that said, I am unable to shake the cough that sounds exactly like what you describe. I cough every day multiple times but there are the severe episodes where I can’t breathe, wretch and gag with tears running down my face. I’ve tried meds that put me to sleep, gabapentin, cough drops, reflux meds, had an endoscopy that shows inflammation but no damage. Yesterday I had two such episodes the one before bed was set off by the taste of the toothpaste when I brushed my teeth. Our medical facilities here are somewhat limited and travel is still a bit difficult for me. I plan to show this site to my Dr and hope he is receptive to it.
My prayers go with anyone who struggles with this!
Barbara so glad that you recovered from covid! Did you ever find relief for your cough with your doctor? Thank you.
ReplyNot yet. I went to a throat specialist in TN when we visited our daughters in November. He prescribed nortryptilene. I took it for several weeks but was unable to sleep nights. I didn’t notice any relief, in fact it seems worse now than before. I see my Dr the end of this month to let him know. I’ve also tried many natural remedies. Hoping others are experiencing some relief.
ReplyI think this cough has been lingering for a long time but exacerbated after I had COVID for a second time in July ’22. Not sure where to turn next. Find a specialist in Virginia to help me get some treatment. I have an extreme allergist response to all hot and spicy foods and pepper and like someone else, toothpaste triggers an event. Hoping for relief soon and searching for medical attention now.
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