Exploring Longitudinal Trends and Patterns in Chronic Cough

Podcast Transcript

Paul Bryson: Welcome to Head and Neck Innovations, a Cleveland Clinic podcast for medical professionals exploring the latest innovations, discoveries, and surgical advances in otolaryngology-head and neck surgery.

Thanks for joining us for another episode of Head and Neck Innovations. I'm your host, Paul Bryson, Director of the Cleveland Clinic Voice Center. You can follow me on X, formerly Twitter, @PaulCBryson, and you can get the latest updates from Cleveland Clinic Otolaryngology-Head and Neck Surgery by following @CleClinicHNI on X. That's @CleClinicHNI. You can also find us on LinkedIn at Cleveland Clinic Otolaryngology - Head and Neck Surgery, and Instagram at Cleveland Clinic Otolaryngology.

Today I'm happy to report upon a recent paper that our group participated in regarding the topic of chronic refractory cough, and a recent publication that we were a part of in the journal called Otolaryngology-Head and Neck Surgery that was just published in February, talking about the concept of our otolaryngologists seeing more cough, and this looked at longitudinal trends and patterns. Dor the listeners here on this podcast out today, chronic refractory cough is a topic that can really touch multiple specialties. This includes otolaryngology, pulmonology, gastroenterology, and even allergy and immunology. And so one of the things our group of collaborators looked at was whether otolaryngologists were seeing more chronic cough patients.

And what we found in this is that otolaryngologists made up more than 84% of surgical specialist visits for chronic cough. And we looked at this over a long period of time, from 2005 to 2019. And what we thought when we looked at this was that we were seeing more patients in our practices, but what this database research supported was that otolaryngologists are indeed increasingly called upon to evaluate and consider treatment for chronic coughing. And what we also figured was that identifying patient groups with limited access really underscores the need for enhanced education and collaboration, not just with otolaryngologists, but with our other multidisciplinary teams.

Here at Cleveland Clinic, when patients with chronic refractory coughing seek care, there's a lot of pathways into the system. It could be an otolaryngologist, but it could also be a pulmonologist, and we actually have a special chronic cough team within pulmonology that helps evaluate these patients. But depending on the constellation of symptoms that patients may experience, we also work collaboratively with allergy and immunology as well as with gastroenterology. Some of the biggest difficulties with this include quality of life. Chronic coughing can be very socially and occupationally disruptive. We're emerging from a global pandemic where coughing was sort of a signifier, potentially of illness, and sometimes chronic refractory cough can occur after a bad upper respiratory infection.

This can be garden variety colds and upper respiratory infections, but certainly can be a thing that patients experience after COVID, after influenza, after respiratory syncytial virus. So chronic coughing can really be a part of many common things that people might experience. And the treatment and evaluation will really kind of rely on the history. But oftentimes, patients will be recommended to get chest imaging to make sure we're not missing something in the chest, pulmonary function testing, very important to evaluate for common conditions like asthma or reactive airway disease. Then finally, we want to know if there's a swallowing component to chronic cough, in which instance we might interface with gastroenterology to look at reflux, to look at other esophageal and pharyngeal issues with swallowing.

So it's really a common complaint, sometimes with complex solutions. And we really try to have an approach that looks at these treatments. Sometimes treatment can be as simple as over-the-counter cough suppressants. Other times we engage with speech-language pathology to have cough suppression behavioral treatments. And then additionally, some of the common things used to treat asthma, steroids, inhalers, and things like that. Within otolaryngology, we have a keen eye for laryngeal problems. We have a keen eye for sinonasal complaints, making sure we're not seeing chronic sinusitis or other things that might cause post-nasal drainage that can trigger coughing.

As we get out into sort of treatments that would be off-label, but after other treatments have failed, we look at neuromodulator medicines that might treat the chronic cough like a peripheral neuropathy. We also look at some new and emerging treatments such as Botox or superior laryngeal nerve blockade, and superior laryngeal nerve blockade is a treatment that our group here at Cleveland Clinic has written about and is being adopted more broadly across the country for patients that are suffering with this. So I'd encourage people to look around, be aware of the team that might be available to help them with refractory cough. And I would say

For more information on chronic refractory cough, please visit ClevelandClinic.org, and to speak with a specialist or submit a referral, please call 216.444.8500. That's 216.444.8500. Thanks very much for tuning in for another episode of Head and Neck Innovations.

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