Brianna K Crawley1, Thomas Murry2, Lucian Sulica2. 1. Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Health, Loma Linda, California. Electronic address: bcrawley@llu.edu. 2. Department of Otolaryngology - Head and Neck Surgery, Parker Institute for the Voice, New York, New York.
Abstract
OBJECTIVES/HYPOTHESIS: Chronic cough (CC) is a pervasive and expensive health problem in the United States. Almost as diverse as its etiologies are the available therapeutic options. When vocal fold paresis and CC coincide, injection augmentation may provide an alternative to standard medical and behavioral treatments for CC. Our objective was to assess the effect of injection augmentation in a selected group of patients with CC who had failed multiple medical and behavioral treatments. STUDY DESIGN: The study design is a retrospective case review. METHODS: Our study group included six subjects (1 male and 5 females; aged 24-84 y) who presented for laryngologic evaluation with a chief complaint of CC unresponsive to conventional medical and behavioral management. The cough severity index (CSI), reflux symptom index (RSI), dyspnea severity index (DSI), and voice handicap index-10 (VHI-10), as well as subjective evaluation were assessed before and after the injection augmentation of the vocal folds was undertaken. RESULTS: Five of six patients reported subjective improvement in cough. CSI scores improved in all six (average change 7.3, range 2-13). RSI and DSI scores also improved significantly after injection, whereas VHI-10 scores did not significantly change. One patient reported transient hoarseness after injection that completely resolved. One patient received injection augmentation three times, as the material resorbed and symptoms returned. CONCLUSIONS: Injection augmentation effected relief from CC in a select group of patients with CC refractory to previous medical and/or behavioral treatments. This intervention is a novel option for such patients and offers an alternative approach to medical treatment.
OBJECTIVES/HYPOTHESIS: Chronic cough (CC) is a pervasive and expensive health problem in the United States. Almost as diverse as its etiologies are the available therapeutic options. When vocal fold paresis and CC coincide, injection augmentation may provide an alternative to standard medical and behavioral treatments for CC. Our objective was to assess the effect of injection augmentation in a selected group of patients with CC who had failed multiple medical and behavioral treatments. STUDY DESIGN: The study design is a retrospective case review. METHODS: Our study group included six subjects (1 male and 5 females; aged 24-84 y) who presented for laryngologic evaluation with a chief complaint of CC unresponsive to conventional medical and behavioral management. The cough severity index (CSI), reflux symptom index (RSI), dyspnea severity index (DSI), and voice handicap index-10 (VHI-10), as well as subjective evaluation were assessed before and after the injection augmentation of the vocal folds was undertaken. RESULTS: Five of six patients reported subjective improvement in cough. CSI scores improved in all six (average change 7.3, range 2-13). RSI and DSI scores also improved significantly after injection, whereas VHI-10 scores did not significantly change. One patient reported transient hoarseness after injection that completely resolved. One patient received injection augmentation three times, as the material resorbed and symptoms returned. CONCLUSIONS: Injection augmentation effected relief from CC in a select group of patients with CC refractory to previous medical and/or behavioral treatments. This intervention is a novel option for such patients and offers an alternative approach to medical treatment.