背景:神经源性咳嗽(NC)被认为与下咽和喉的感觉神经病变有关。定义为咳嗽持续超过8周的标准治疗难治性,当其他常见病因(哮喘,胃食管反流病(GERD),药物副作用)被排除。它影响了大约11%的美国人,并可能对生活质量产生负面影响。
方法:在机构审查委员会批准后,我们评估了2018年至2023年在亚利桑那大学三级喉科中心就诊的成年患者的医疗记录.如果患者咳嗽持续>8周,他们要么对之前的质子泵抑制剂和哮喘治疗没有反应,要么排除了GERD和哮喘.这些患者接受了逐步升级的治疗,其中包括有或没有咳嗽抑制疗法的神经调质,喉上神经(SLN)阻滞,和喉部肉毒毒素注射.主要结果是患者报告的咳嗽症状改善,评分为1-5:1=无反应,2=轻度改善,3=适度改善,4=显著改进,5=完整的分辨率。
结果:共纳入56例患者。平均(SD)年龄为64.6(14.8)岁,66%是女性。总的来说,42例患者(75.0%)对治疗有反应。在响应者中,7人(16.7%)经历了轻度改善,14人(33.3%)经历了中度改善,17人(40.5%)经历了显著改善,4人(9.5%)咳嗽完全缓解。33例患者(58.9%)仅接受神经调质±咳嗽抑制疗法治疗;27平均反应等级为3.0(SD=1.2)。11例患者(19.6%)药物治疗失败,接受了SLN阻滞,没有随后的肉毒杆菌治疗;7例反应,平均反应等级为2.5(SD=1.4)。9名患者(16.1%)未通过所有先前的治疗,并接受了喉肉毒杆菌毒素注射;6名患者的平均反应等级为2.4(SD=1.3)。其余3例患者仅接受咳嗽抑制治疗,2响应,平均响应评分为3.3(SD=1.7)。
结论:神经源性咳嗽可以通过逐步多模式方法有效治疗,包括神经调质,咳嗽抑制疗法,SLN块,和喉部肉毒毒素注射.
BACKGROUND: Neurogenic cough (NC) is thought to be related to sensory neuropathy in the hypopharynx and larynx. Defined as a cough persisting longer than 8 weeks refractory to standard therapy, it is a diagnosis of exclusion when other common etiologies (asthma, gastroesophageal reflux disease (GERD), medication side effects) are ruled out. It affects roughly 11 % of Americans and can negatively impact quality of life.
METHODS: Following institutional review board approval, we evaluated the medical records of adult patients seen at the University of Arizona\'s tertiary laryngology center from 2018 to 2023. Patients were included if their cough persisted for >8 weeks, and they either did not respond to prior proton pump inhibitor and asthma therapy or had GERD and asthma ruled out. These patients underwent a progressive escalation of therapy, which included
neuromodulators with or without cough suppression therapy, superior laryngeal nerve (SLN) block, and laryngeal botulinum toxin injections. The primary outcome was patient-reported improvement in cough symptoms rated on a 1-5 scale: 1 = no response, 2 = mild improvement, 3 = moderate improvement, 4 = significant improvement, 5 = complete resolution.
RESULTS: A total of 56 patients were included. Mean (SD) age was 64.6 (14.8) years, and 66 % were female. Overall, 42 patients (75.0 %) responded to treatment. Among responders, 7 (16.7 %) experienced mild improvement, 14 (33.3 %) experienced moderate improvement, 17 (40.5 %) experienced significant improvement, and 4 (9.5 %) experienced complete resolution of their cough. 33 patients (58.9 %) were managed exclusively with
neuromodulators ± cough suppression therapy; 27 responded, with an average response rating of 3.0 (SD = 1.2). 11 patients (19.6 %) failed medical therapy and underwent SLN block without subsequent botox treatment; 7 responded, with an average response rating of 2.5 (SD = 1.4). 9 patients (16.1 %) failed all previous therapies and underwent laryngeal botulinum toxin injections; 6 responded with an average response rating of 2.4 (SD = 1.3). The remaining 3 patients underwent cough suppression therapy alone, with 2 responding and an average response rating of 3.3 (SD = 1.7).
CONCLUSIONS: Neurogenic cough can be effectively treated with a stepwise multimodal approach, including
neuromodulators, cough suppression therapy, SLN block, and laryngeal botulinum toxin injections.