xRead - Globus and Chronic Cough (April 2024)

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Altman and Irwin

Systemic Disease and other

Flexible laryngoscopy Stroboscopy Serology Biopsy Steroid injection

Rhinologic

Neurologic

RAST Allergy skin testing Nasal endoscopy Sinus CT

MRI brain Modified barium swallow Laryngeal EMG Laryngeal function studies Botox injection Vocal fold injection Medialization laryngoplasty

Immunotherapy FESS sinuplasty

Chronic Cough

Tumor

Pulmonary

CT neck CT chest MRI Ultrasound

PFTs Methacholine challenge Chest X-ray Chest CT Bronchoscopy Airway fluoroscopy

FNA PET Laryngoscopy & biopsy

Esophageal Barium esophagogram TNE EGD Manometry 24-hour pH/impedance Gastric emptying

VATS thoracotomy

Surgery Radiation therapy Chemotherapy Rehabilitation

CP myotomy Zenker’s diverticulotomy

Figure 2. Diagnostic and therapeutic procedures associated with different cough-related disease states and anatomic sites. CP, cricopharyngeus; CT, computed tomography; EGD, esophagogastroduodenoscopy; EMG, electromyography; FESS, functional endoscopic sinus surgery; FNA, fine needle aspiration; MRI, magnetic resonance imaging; PET, positron emission tomography; PFT, pulmonary function testing; RAST, radioabsorbentimmunoassay;TNE, transnasal esophagoscopy;VATS, video-assisted thoracoscopic surgery.

outcomes of different algorithm steps through critical pathways should improve value in health care. 8 Therein lies an additional role for the otolaryngologist to master partnerships in the care of patients with chronic cough. Conclusion There are many opportunities for the otolaryngologist to develop a more prominent role in caring for patients with chronic cough. The very large number of patients with cough not treated by otolaryngologists suggests an unmet need. Otolaryngologists are ideally suited to help with understand ing the interrelation of aerodigestive diseases in these patients. Finally, many bridges need to be built between otolaryngol ogy, pulmonology, and gastroenterology toward true inte grated practice units. Otolaryngologists have a responsibility

to demonstrate leadership in these collaborations and to remain active in championing patient care.

Author Contributions Kenneth W. Altman , conception and preparation; Richard S. Irwin , conception and preparation. Disclosures Competing interests: None. Sponsorships: None. Funding source: None. References 1. Madison JM, Irwin RS. Cough: a worldwide problem. Otolaryn gol Clin North Am . 2010;43:1-13.