Managing Chronic Refractory Cough with Nerve Block Injections (Podcast)

Chronic cough lasting four months or more affects approximately 12% of adults. Until recently, there have only been a couple of treatments, including behavioral therapy and neuromodulators. Now there’s another option – superior laryngeal nerve blocks.

“It’s a third treatment modality that offers this chance at benefit to a group of patients who don’t improve with any of the other therapies we expect to possibly work,” says William Tierney, MD, a physician in Cleveland Clinic’s Department of Otolaryngology-Head and Neck Surgery. “So, it’s really been a powerful tool in our quiver to add to this challenging problem.” 

In a recent episode of Cleveland Clinic’s Head and Neck Innovations podcast, Dr. Tierney discusses bilateral superior laryngeal nerve block for chronic refractory cough, which Cleveland Clinic began offering in 2019. He covers:

• Common causes of cough and chronic cough
• Who makes a good candidate for the nerve block and how it is administered
• Possible challenges and side effects of bilateral superior laryngeal nerve block
• Results of a study Dr. Tierney and colleagues recently published in The Laryngoscope
• Future studies and clinical applications for bilateral superior laryngeal nerve block

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: How do you incorporate this into the current practices in managing refractory chronic cough? And what advice or considerations would you give to our listeners who might be healthcare professionals who would be interested in trying to incorporate this into their practice?

Dr. Tierney: It's been a game changer in my cough practice, just that I'm able to offer this. We've had those other two options, but many people don't want to do neuromodulators because one of the common side effects is drowsiness, and that bothers a lot of people. There's also a “do not operate heavy machinery” warning on most of these drugs. And so, people who drive a truck or have to worry about things like operating an automobile may not be interested in that.

And if they aren't [interested in neuromodulators] and didn't want to do [cough suppression behavioral] therapy, we were kind of stuck before. But now we have this at least trial that we can give people, which is quick and you can do it the same day you see them. That gets you some answers.

I will tell both our patients and other healthcare providers who are wondering if a superior laryngeal nerve block might be appropriate for a specific situation that I only jump to this after we've proven that the common causes of cough are not the source. Because you certainly don't want to mask something more sinister or another disease process.

So, most patients end up getting an evaluation with pulmonary. Some people also need to see a gastroenterologist. Everyone should be worked up by a generalist just to make sure we're not missing something obvious. And then the laryngology group or a comprehensive otolaryngologist needs to look for those things like sinonasal disease, allergy. Sometimes there's a role for allergy testing as well. But all those boxes need to be checked before we jump to this procedural intervention.