Exploring Longitudinal Trends and Patterns in Chronic Cough (Podcast)

Chronic refractory cough can have a profound effect on a patient’s quality of life, but management of the condition can also be challenging for providers due to its complex nature and causes.

In a recent episode of Head & Neck Innovations, Paul Bryson, MD, MBA, Director of the Cleveland Clinic Voice Center and Section Head of Laryngology, discusses key findings from a longitudinal study that revealed that otolaryngologists are the primary surgical specialists consulted for chronic cough.

“Chronic refractory cough is a topic that can really touch multiple specialties,” says Dr. Bryson. “This includes otolaryngology, pulmonology, gastroenterology, and even allergy and immunology. One of the things our group of collaborators looked at was whether otolaryngologists were seeing more chronic cough patients.”

Dr. Bryson explains that the group found that otolaryngologists made up more than 84% of surgical specialist visits for chronic cough. Furthermore, they also found that more specialists are referring to their patients with chronic cough to otolaryngologists for evaluation and treatment.

“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,” says Dr. Bryson.

In addition to the research findings, the episode also covers:

• Tips for identifying the cause of a patient’s chronic cough.
• The multidisciplinary approach to chronic cough care at Cleveland Clinic.
• Established and emerging treatments for chronic cough.
• Collaborating with gastroenterologists when there may be a swallowing component involved with the cough.

Click the podcast player above to listen to the episode now, or read on for a short, edited excerpt. Check out more Head and Neck Innovations episodes at clevelandclinic.org/podcasts/head-and-neck-innovations or wherever you get your podcasts.

Excerpt from the podcast

Podcast host Paul Bryson, MD, MBA: [Chronic cough] is really a common complaint, sometimes with complex solutions. We really try to have an approach that looks at these treatments. Sometimes a 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. Additionally, [we’ll use] 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 into treatments that would be off-label, 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. 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 who are suffering from this. So I'd encourage people to look around, and be aware of the team that might be available to help them with refractory cough.