xRead Articles - October 2022
Fig. 6. Forest plot of the meta-analysis of the proportion of patients with at least one adverse event (AE) for active treatment groups only, strat i fi ed by intervention type. The medical therapy category is ordered in clusters by drug class: neuromodulating drugs, tricyclic antidepressants, opioids, inhaled corticosteroids, macrolide antibiotic, combination-drug regimens, alternative medicine, and lastly investigational drugs. Effect sizes (ES) closer to 0 indicate a lower proportion of patients with at least 1 AE and is considered to favor treatment. BTX = botulinum toxin; PPI = proton pump inhibitor; PSALTI = physiotherapy, speech and language therapy intervention; SLN = superior laryngeal nerve; SPT = speech pathology treatment; VF = vocal fold. [Color fi gure can be viewed in the online issue, which is available at www.laryngoscope.com.]
before clinical use of these investigational drugs. ST had no reported AEs, bolstering its use as an adjunct to medi cal therapy by the CHEST panel. 5 Among the procedural therapies, bilateral thyroarytenoid BTX injection was associated with the most harm and the least bene fi t. Vocal fold augmentation, associated with a low AE rate in this meta-analysis, presents an indirect way of suppressing cough by decreasing glottic insuf fi ciency. Patients are less likely to use increased glottic pressure to produce a strong voice, thereby avoiding phonotrauma that would hypersensitize nerves around the arytenoid mucosa and induce cough. 13 AEs for SLN block were low,
non-serious, and temporary. On average, about two injec tions were needed, but follow-up was not standard ized. 11,46 Without controlled trials of SLN block, we cannot readily advocate for its superiority or non inferiority over commonly used medical treatments. Future research in developing an optimal treatment plan for NC involves understanding its pathophysiology, clinical presentation, accurate diagnosis, and appropriate end-point assessment of therapy. Historically, NC was diagnosed and treated via an anatomic – diagnostic proto col (ADP): systematically eliminating common causes for cough (i.e., re fl ux, asthma) by targeting different body
Laryngoscope 132: January 2022
Wamkpah et al.: Multimodal Treatments for Neurogenic Cough
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