xRead - Globus and Chronic Cough (April 2024)

Clinical Review & Education

JAMA Otolaryngology–Head & Neck Surgery | Review

Otolaryngologic Management of Chronic Cough in School-aged Children AReview

Aimee A. Kennedy, MD; Samantha Anne, MD; Catherine K. Hart, MD, MS

Author Audio Interview

IMPORTANCE The causes of pediatric chronic cough are numerous and span across several medical subspecialties. In addition to the vast array of underlying causes, there are also several different ways to approach and evaluate chronic cough. Given the frequency with which children present to otolaryngology clinics with this problem, a review of common otolaryngologic causes and an algorithm for evaluation and treatment can be beneficial. OBSERVATIONS The primary 3 causes of pediatric chronic cough presenting to an otolaryngologist include infectious causes, reflux, and airway hyperreactivity. In these cases and other instances of specific cough, treatment should be directed at the underlying cause—which may include supportive care, antibiotics, antireflux medication, bronchodilators, inhaled steroids, or other intervention. Patients with nonspecific cough should be treated according to pediatric-specific cough algorithms. CONCLUSIONS AND RELEVANCE Appropriate workup and treatment of chronic cough can lead to higher cure rates, shorter cough duration, and improved quality of life for both patients and caregivers. A systematic approach using cough algorithms can help otolaryngologists effectively manage this common yet complex problem.

Author Affiliations: Author affiliations are listed at the end of this article. Corresponding Author: Catherine K. Hart, MD, MS, Division of Pediatric Otolaryngology–Head and Neck Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 2018, Cincinnati, OH 45229 (catherine.hart @cchmc.org).

JAMA Otolaryngol Head Neck Surg . 2020;146(11):1059-1064. doi:10.1001/jamaoto.2020.2945 Published online October 1, 2020.

P ediatric chronic cough, defined as a daily cough lasting lon ger than 4 weeks, 1 will affect up to 10% of school-aged children 2 and is a frequent cause for referral to an otolar yngologist. The underlying causes are numerous and often require a multidisciplinary approach involving a combination of pediatri cians, pulmonologists, gastroenterologists, behavioral specialists, al lergists/immunologists, and otolaryngologists. This presenting com plaint is commonly encountered in both primary and subspecialty clinics and is associated with significant negative effects on quality of life for both patients and their caregivers. 3 Given the broad im pact of this symptom, a structured approach to the evaluation and management of pediatric chronic cough is essential. The common causes of pediatric chronic cough differ from those in adults, thus making it important to use pediatric-specific cough algorithms dur ing the initial workup and treatment. 4 Use of these tools has been shown to lead to earlier diagnosis and improved outcomes. 5,6 The causes of pediatric cough can be characterized by dura tion (acute vs chronic) and cough characteristics (dry vs wet) and quality (description of sound). It is also helpful to consider the pres ence of specific cough “pointers,” which are key symptoms that point to a diagnosis. An important tenet in addressing pediatric chronic cough is that treatments should target a specific cause as opposed to starting empirical therapies in the absence of symptoms, such as those for gastroesophageal reflux disease (GERD) or allergies. 7 Inthe search for an underlying cause of chronic cough, there are many unique diagnostic and therapeutic tools available to the otolaryn gologist that create an important role for the specialty as part of the

multidisciplinary care team. This review will detail the most fre quent causes of chronic cough in school-aged children seen in oto laryngology practices and outline treatment protocols to assist in management of chronic cough.

Common Otolaryngologic Causes of Chronic Cough

The differential diagnosis for chronic cough is extensive, and the causes in patients presenting to an otolaryngologist differ from those seen in a primary care practice. 8 Previous studies have shown that the most common causes of cough from an otolaryngologic per spective were related to infection/upper airway cough syndrome, GERD, or airway hyperreactivity. 9,10 It is worth noting that the most common causes of cough vary by age, and the differential diagno sis will be different in infants compared with school-aged children. This review focuses primarily on cough in school-aged children. Upper Airway Cough Syndrome Many conditions and lifestyle factors can increase nasal inflamma tion and mucus production, including allergic rhinitis, nonallergic rhi nitis, nonallergic rhinitis with eosinophilia, infectious rhinitis, acute and chronic rhinosinusitis, allergic fungal sinusitis, chemical rhini tis, rhinitis medicamentosa, and consumption of dairy products. 11 While the underlying causes among the varying forms of rhinitis may differ, the common result is a variable degree of nasal obstruction

(Reprinted) JAMA Otolaryngology–Head & Neck Surgery November 2020 Volume 146, Number 11 1059

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