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Longitudinal Follow-up for Patients with Chronic Neurogenic Cough Treated with Superior Laryngeal Nerve Block

On-Demand Content—Best of Scientific Oral Presentation

 

Vaninder K. Dhillon, MD

A new study indicates that patients who undergo superior laryngeal nerve blocks demonstrate efficacy over 10-12 months after last injection without further need for intervention or neuromodulators.

Vaninder K. Dhillon, MD, of Johns Hopkins University in the National Capital Region in Bethesda, Maryland, completed a retrospective review of 35 patients who underwent serial in-office superior laryngeal nerve blocks with longitudinal follow-up over 10-12 months. The results demonstrated that overall 90% of the patients required no further intervention in the follow-up period.

“The use of sensory nerve block is still novel as an alternative treatment for patients with chronic neurogenic cough,” said Dr. Dhillon. “It has not been studied as long as neuromodulators and cough suppression therapy, but it is promising. This [study] is exciting because this small cohort demonstrated a significant improvement in cough scores and long-term efficacy in terms of treating neurogenic cough—which, for some, had occurred for decades.”

Superior laryngeal nerve block, said Dr. Dhillon, is a combined steroid/lidocaine injection to the superior laryngeal nerve, a sensory branch of the larger vagus nerve, which is cranial nerve X.

“By blocking the superior laryngeal nerve, the goal is to decrease the sensory input to the larynx so that the cough reflex is subdued or suppressed and allows for improved control for patients with a diagnosis of chronic neurogenic cough,” she said.

“The benefit of a superior laryngeal nerve block is to ‘block’ or desensitize the superior laryngeal nerve, which provides sensation to the larynx. Patients with chronic neurogenic cough have what’s known as hypersensitive larynx or hypersensitive triggers that include the cough reflex.”

There’s not sufficient data to indicate that superior laryngeal nerve blocks are superior to neuromodulators. However for patients who are unable to take neuromodulators and don’t want the risk of associated side effects, a superior laryngeal nerve block may be the way to go.

“In my practice I typically recommend standard of care with trial of neuromodulators and cough suppression therapy for all my patients,” said Dr. Dhillon. “I always discuss this treatment as an alternative treatment and if the first two are not successful or the patient does not desire the side effects of neuromodulators, I recommend the block. There is an important consent process because even with superior laryngeal nerve block, there is no guarantee that the block works, nor that it improves an individual’s chronic neurogenic cough… I feel like for those who have been refractory to neuromodulators and cough suppression therapy, superior laryngeal nerve blocks work and offer relief that would not otherwise be explored.”

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