Management of Chronic Cough and Laryngeal Hypersensitivity Disorders (2023 AMW)
2023 AAO-HNSF Annual Meeting & OTO Experience
Orbital infections are common complications of acute rhinosinusitis (ARS) in children. These infections can progress intracranially which can lead to meningitis and brain abscesses. A large proportion of these patients respond well to oral or intravenous antibiotics. Depending on the severity of the infection, these patients can be treated as outpatient, while others require admission to the hospital for systemic antibiotics. Some studies have suggested benefit for concomitant use of corticosteroid. Surgical drainage is indicated when medical treatment fails. This panel seeks to gain insight to the most recent evidence-based treatment of complications of ARS with emphasis on the role of the otolaryngologists in the medical and surgical treatment decisions.
Credits
CME:1.0, MOC:1.0
Description
The focus of this presentation is on the diagnosis and management options for chronic refractory or non-specific cough and other related disorders such as inducible laryngeal obstruction (ILO), paradoxical vocal fold motion (PVFM), and irritable larynx. SIGNIFICANCEChronic cough is defined as any cough that persists for eight weeks or longer. The cough can persist for years, be debilitating for patients and have a significant negative effect on quality of life. Cough is estimated to affect between 7% and 9% of the global population and has been reported as the reason for 10% to 38% of referrals to a specialist at an average health care expenditure of over $3200 (USD) per patient per year. RELEVANCEIf the cough is refractory and a gastroenterologist and a pulmonologist have failed to identify a specific cause, patients are often referred to an otolaryngologist. This spectrum of symptoms may be secondary to abnormal neurogenic laryngeal hypersensitivity (NLH). Understanding the signs and symptoms of this disorder leads to improved accuracy in diagnosis. Cough frequency recordings and patient reported sensitivity measures are helpful to assess disease severity and response to intervention. There are many reported treatment options all with variable success rates. While neuromodulating medications and trigger point injections are helpful in reducing symptom severity, they are associated with ongoing cost and symptom relapse on cessation of treatment. Behavioral interventions based in cognitive approaches, on the other hand, have been shown to provide quick, significant, and permanent severity reduction or relief in over 80% of patients.