Chronic Cough, Cough Hypersensitivity Syndrome and the Vagus Nerve

Ross Hauser, MD

We will often be contacted by someone who will describe their current health situation in this way:

I have been experiencing neck pain and stiffness. I have a numbing, tingling sensation from my scalp through my hands. My ear is always filled, I have tenderness and burning pain burning sensation on one side of my head.

I also suffer from severe coughing and sneezing coupled with sinus drainage. I have come to believe that these issues are being caused by my neck issues. After an MRI revealed bulging discs in my neck, I have had various therapies and treatments, some of which provided temporary relief.

This has been going on for many years and it is worsening. The coughing and neck pain prevents me from sleeping. I take large amounts of cough suppressants to stop the coughing so I can sleep. I have seen doctors, ENTs, and neurosurgeons. They all suggest I have severe allergies and prescribe antihistamines, sinus medications, and antibiotics. They hardly work if at all.

In the many people, we see with chronic neck pain and a list of “mysterious ailments” cough is among the prevalent ones. But what is causing the cough? Cough can be caused by many, many health challenges. In this article, we will focus on unresolved cough caused by dysfunction of the vagus nerve as it travels and becomes compressed in the cervical spine.

Hundreds, or even thousands, of daily cough episodes

Chronic cough can be disabling, as it can involve dozens to hundreds, or even thousands, of daily cough episodes with recurrent sensory disturbances from a trickle to a severe “something is stuck in my throat” feeling. It can also be described as a dry patch, intense sandpaper feeling, or crumb in the throat. Episodes can occur spontaneously or be brought on by something as simple as a laugh, hug, talking, or exposure to cold or warm air. Left untreated, neuropathic cough can profoundly affect a person’s quality of life. While the dozens to hundreds of brief coughing episodes each day can annoy and frustrate, most people also experience at least a few more severe, potentially humiliating episodes each day, lasting from 10 seconds to several minutes, and can be associated with rhinorrhea, otorrhea, retching, vomiting, laryngospasm, near-syncope, and urinary incontinence.

Chronic cough represents a syndrome by itself, regardless of the underlying condition

These are just a few of the recent medical papers published on chronic cough. In these papers, doctors have recognized that the cough is not a response to a specific disease, such as asthma, but has taken on a characteristic of itself. To make a play on words, the cough is a problem of cough and doctors should focus on the cough as a primary, not a secondary condition.

June 2019: “Chronic cough represents a public health problem with a high degree of morbidity; It represents a syndrome by itself, regardless of the underlying condition. Recent evidence suggests an abnormal and altered neurophysiologic process.” (1)

July 2020: “Over the past decade, there has been a major shift in how we approach this problem, driven by a better appreciation of the clinical manifestation of chronic cough and an improved understanding of the associated neurobiology. “Cough hypersensitivity syndrome” has been proposed as a new diagnostic term for chronic cough, encompassing different phenotypes of the condition. Accumulating evidence suggests that this new concept is clinically relevant.” (2)

Chronic cough patients do indeed report more frequent and severe autonomic symptoms it’s a problem of vagal pathology

A July 2021 paper (3) makes this observation: “Chronic cough patients do indeed report more frequent and severe autonomic symptoms than healthy volunteers, indicating that this population may suffer from dysautonomia. At present, it remains unclear whether this occurs as a result of the cough or whether both the cough and dysfunction are part of some wider vagal pathology.”

An explanation of the vagus nerve network and how dysfunction in this network can cause cough.

The caption of this illustration reads:

Lung sensory nerve pathways from lungs to the brain.

A. The vagus nerves sensory neurons from the jugular and nodose ganglia go directly to the lung tissue.

B. The vagus sensory neurons from the lungs reach the respiratory center in the brainstem medulla.

C. The vagus sensory information for the lungs is then interpreted by the higher cognitive centers in the brain, which causes voluntary and involuntary motor responses such as coughing and sneezing.

Below the illustration are explanatory notes.

In my article Vagus nerve compression in the neck: Symptoms and treatments, I write that the vagus nerves (there are two, left side and ride side) are the nerves of life. They keep us alive by their innervation of the internal organs of the body and their interactions with the brain, spinal cord, cranial nerves, upper cervical spinal nerves, and sympathetic nervous system.

When there is a dysfunction of the vagus nerve, for the purpose of this article this dysfunction is being caused by cervical spine instability that can occur from C0-C7 (I call this cervicovagopathy. Cervico – a structural problem in the neck is causing “vago” vagus nerve “pathy” or disease or illness), there can be an incredible number of symptoms and conditions caused by disruption of and interference of the vagus nerve signals. One of these symptoms and conditions is uncontrollable cough and a cough that does not respond to treatment. In this article, I will present information that this type of cough can be the result of vagal nerve compression.

I will also invite you to continue reading through the companion articles:

Cervical degenerative dysstructure

In the image below I want to give an illustration of how the vagus nerve function and cough control mechanisms described in the upper illustration can be altered and then become dysfunctional. The caption of the illustration below reads: Cervical degenerative dysstructure: The progressive nature of cervical instability that leads to a breakdown of the cervical curve resulting in destructive forces (compression, grinding, and impingement of blood vessels and nerves) being placed on vital neurovascular structures including the cervical spinal cord and vagus nerves.

To the left we see:

This all occurs because of damage to the cervical spine ligaments that hold the bones in proper alignment.

Treatment for loss of natural neck curve structure is directed to improve the structural integrity of the cervical spine and the symptoms and conditions it causes, including breathing and swallowing problems and cough. Treatment modalities can include dynamic (chiropractic) orthoneurological adjustments for the vertebral subluxations (malrotations), curve correction to restore lordosis, and Prolotherapy to repair injured ligaments. The diagnostic tests used to discover cervical instability and resultant pathophysiology can also be used to monitor progress during treatment. These treatment options are discussed below.

The role of the vagus nerve in chronic cough

The vagus nerve can be mysterious. The problems of vagal nerve dysfunction or low vagal tone can equally be mysterious. In February 2022, doctors at Harvard medical school wrote in the journal Neuron (4).

“The vagus nerve is an indispensable body-brain connection that controls vital aspects of autonomic physiology like breathing, heart rate, blood pressure, and gut motility, reflexes like coughing and swallowing, and survival behaviors like feeding, drinking, and sickness responses. Classical physiological studies and recent molecular/genetic approaches have revealed a tremendous diversity of vagal sensory neuron types that innervate different internal organs, with many cell types remaining poorly understood.”

Although afferent nerves (those which bring messages back from the lungs to the central nervous system) within the vagus innervate virtually all visceral organs, nearly 20% terminate with the airways and lungs. Thus, vagal sensory neurons constitute the major afferent supply to the airways and lungs. 

To demonstrate the complexity of the vagus nerve and cough let’s look at a 2020 case history (5). Here doctors at New York Medical College and The Institute for Voice and Swallowing Disorders, Phelps Hospital, Sleepy Hollow, NY wrote about a patient with Oto (ear), Tricho (hair), Tussia (cough) and noted that the otolaryngology community has seen an enormous increase in the number of office visits for chronic cough. Here are three cases they encountered:

“Chronic cough is a frequently encountered condition with multiple etiologies. In patients with neurogenic chronic cough, peripheral laryngopharyngeal hypersensitivity of the vagus nerve stimulates the cough reflex. We present three cases of “Oto-tricho-tussia,” describing hair within the ear canal stimulating Arnold’s branch (skin of the ear canal) of the vagus nerve and triggering the urge-to-cough. All three patients experienced significant improvement or complete resolution of their cough symptoms after removal of the hair resting on their tympanic membrane and external auditory canal. We encourage ear canal examination and promotion of proper ear cleaning habits as this is an easily treatable consideration for the cause of chronic cough.”

Most of the vagal afferent nerves innervating the respiratory tract are deciphering what is potentially harmful to the lungs. In health, afferent vagal nerves assist in the fine-tuning of lung function, and perhaps more importantly, provide a critical defense mechanism aimed at keeping the airspaces sterile. In respiratory pathology, the vagal sensory system can become dysregulated, which can lead to autonomic reflexes (bronchospasm, secretions), urge to cough, and dyspnea (labored breathing) that are out of balance and exaggerated with respect to the activating sensory stimulus. This connection would appear to be especially obvious for those disorders that involve inflammation, including rhinitis, bronchitis, asthma, and chronic obstructive pulmonary disease.

Vagal afferent and efferent nerves (nerves that send messages from the brain down the vagus network) are involved in many of the pathologies and symptoms that involve the respiratory tree. Airway vagal sensory receptors are biosensors that detect the lung inflammatory process through various mediators and cytokines, even as it relates to COVID-19 infection.

The anti-inflammatory aspects of the vagus nerve

The anti-inflammatory aspects of the vagus nerve on lung inflammation were most recently discussed in an animal study published January 2022 in the journal Biomedicines. (6)

“Vagus nerve stimulation (VNS) is considered a potential method for anti-inflammation due to the involvement of the Vagus nerve in the cholinergic anti-inflammatory pathway. (This is the part of the nervous system that helps control and regulate inflammation) formation of a connection between the central nervous system and peripheral immune cells that help relieve inflammation.” What the researchers were trying to confirm was whether vagus nerve stimulation could help with inflammation problems. In acute inflammation, the researchers suggested that vagus nerve stimulation could bring down inflammation including that of the lungs.

Let’s try to take a poorly understood mechanism and try to make it a little better understood. We are going to examine the illustration below. It is of a neuroimmune unit. As its name implies it is part of a system of nerves and inflammation response.

Next, we will explore an understanding of first, airway inflammation that leads to the production of mediators that overtly activate vagal nociceptors in the respiratory tract. Second, inflammatory processes can change the excitability of the afferent nerve terminals such that other activating stimuli are more efficacious in evoking high-frequency vagal afferent nerve discharge.

The neuroimmune unit

This is adapted from a paper published in the journal Nature Reviews. Neurology. (7)

The diagram depicts the proposed constituents of the neuroimmune unit (NIU) and its age-dependent dysfunctional activation. (More simply the diagram shows a neuroimmune unit and how a task can be “messed up” by age-dependent dysfunctional activation. That is neurodegenerative problems making the task dysfunctional.) One of the reasons for presenting this information on this level is to help present a case to people whose doctors have told them that they can find nothing wrong with them and that the next consultation perhaps should be psychiatric in nature.

The diagram depicts the proposed constituents of the neuroimmune unit

What does all this neuroimmune unit discussion mean when it comes to vagus nerve dysfunction and cough?

The symptoms of the most common respiratory diseases (respiratory tract viral infections, rhinitis, bronchitis, asthma, chronic obstructive pulmonary disease, and chronic cough) are a consequence of alterations in the nervous system. Such symptoms include reflex mucus secretions, painful oropharynx (the back part of your tongue, tonsils, soft palate, and the walls of the throat), excessive sneezing, coughing, reflex bronchospasm, sensations of dyspnea, and urge to cough. It is likely that in some cases the symptoms of these airway diseases are secondary to inappropriate activity within the afferent nervous system. Specifically, there is dysregulation of the vagus nerve, and the lung sensors are dysfunctional. As discussed in a 2016 paper published in the journal Physiological Reviews, (8) and more recently in a May 2021 paper in the International Journal of Molecular Sciences (9) In this paper researchers noted that doctors’ awareness of the role of neurological and neuro-immunological processes in the development of symptoms, the progression, and the outcome of these chronic obstructive respiratory diseases, is growing.

The neuro-alarm and cough

The stretch-sensitive and nociceptor vagal sensor neurons in the bronchopulmonary tree reside almost exclusively in the vagal nodose ganglion, which again sits right in front of the atlas (C1). When activated, these stretch-sensitive and nociceptors (mainly C-fibers) provide an alarm of sorts and initiate defensive reflexes, including apnea, cough, bronchospasm, and secretions in an effort to rid the perceived danger. In many cases, this system becomes dysregulated such that the response to the perceived danger is out of balance with the response.

There is where the connection between cervical spine instability, the vagus nerve, and cough is made. Let’s look at a paper published in the journal Multidisciplinary Respiratory Medicine (10) and review some of its learning points:

Above we see the mechanism of cough stimulus through the nervous system, to the brain, and back that creates the cough. But there is more.

The stretch-sensitive and nociceptor (painful) vagal sensor neurons

The stretch-sensitive and nociceptor (painful) vagal sensor neurons in the bronchopulmonary tree reside almost exclusively in the vagal nodose ganglion, which again sits right in front of the atlas (C1). Let’s explain this. The Vagus nerve has many stretch-sensitive and nociceptor vagal sensor neurons. If you overeat you have overstretched the walls of your stomach and you have stomach pain. It’s the vagus nerve that makes this determination and it was the stretch-sensitive action that tried to get you to stop overeating.

When activated, these stretch-sensitive and nociceptors (mainly C-fibers) provide an alarm of sorts and initiate defensive reflexes, including apnea, cough, bronchospasm, and secretions in an effort to rid the perceived danger. In many cases, this system becomes dysregulated such that the response to the perceived danger is out of balance with the response. When you are “out of breath” the vagus nerve senses that your lungs are stretched out from the gasping of air and slows your breathing.

The stretch-sensitive and nociceptor vagal sensor neurons in the bronchopulmonary tree reside almost exclusively in the vagal nodose ganglion, which again sits right in front of the atlas (C1). When activated, these stretch-sensitive and nociceptors (mainly C-fibers) provide an alarm of sorts and initiate defensive reflexes, including apnea, cough, bronchospasm, and secretions in an effort to rid the perceived danger. In many cases, this system becomes dysregulated such that the response to the perceived danger is out of balance with the response.

In the three panels vertical below we see the vital neurovascular structures that surround, pass through, and weave themselves through the C1-C2 atlantoaxial joint.

In panel A we are facing the face and neck. In blue we see the internal jugular vein that helps drain blood and fluid from the brain and head. We see the vertebral, external, and internal carotid arteries that bring blood to the brain and head. Behind these structures in yellow are the right side and left side vagus nerves.

In panel B we see a side view of the components and structure of the nervous system. The vagal nodose ganglion sits right in front of the atlas (C1).

In panel C we see from behind and to the side – the various cranial nerves including the vagus nerve.

Cervical spine instability can produce respiratory symptoms, including chronic cough, by many different mechanisms.

Cervical spine instability can produce respiratory symptoms, including chronic cough, by many different mechanisms. Cough can be a critically important and potentially life-saving reflex, but it can also be pathological and nonproductive. Historically speaking, pathological coughing is considered to be a relatively benign consequence of some underlying primary disorder, such as postnasal drip, asthma, respiratory tract viral infection, or gastrointestinal reflux disorder. Chronic cough is normally a consequence of the “3 Rs”—reactive airways, rhinosinusitis, or reflux disease—but what about the person suffering from an idiopathic chronic cough that occurs 50-100 times per hour most of their waking lives? Activation of certain vagal afferent nerves in the respiratory tract can lead to the conscious sensations of dyspnea and urge to cough. Could it be that they have a hypersensitive cough reflex pathway as their primary disorder? This was discussed in a 2017 paper in the journal Allergy, Asthma & Immunology Research (11)

“The cough reflex is a vital protective mechanism against aspiration. It relies on a complex vagally mediated neuronal pathway which is still only partially understood. In some disease states, both acutely as in a viral respiratory tract infection and chronically, a state of hypersensitivity is created. This leads to excessive coughing, which is both distressing and disadvantageous. Our understanding of the mechanism of cough hypersensitivity and the realization that this represents a distinct clinical condition has advanced the field enormously over the past decades.”

Cough is due to the activation of sensory receptors in the larynx and lower respiratory tract, sending impulses to the brainstem.

Cough is due to the activation of sensory receptors in the larynx and lower respiratory tract, sending impulses to the brainstem. The vagal receptors that go through the nodose ganglion end in the medullary region of the solitary tract nucleus and adjoining area postrema (left and right side paired structure in the medulla oblongata in the brainstem), and neurons derived from the jugular vagal ganglia preferentially end in the trigeminal nucleus.

Simply, nerve impulses from the larynx and lower respiratory tract make their way to the brain through the vagal receptors.

The cough center is located in the upper brainstem and pons (the part of the brainstem that links the medulla oblongata and the thalamus. The thalamus is a relay station for motor and sensory signals to the cerebral cortex.)

There are obvious connections to the trigeminal nerve, the nausea center (area postrema), and the respiratory tree (the tree branch-like structure supplying air to the lungs). The impulses from the cough center travel via the vagus, phrenic, and spinal motor nerves to the diaphragm, abdominal wall, laryngeal, and respiratory muscles. By phrenic and other spinal motor nerves, the nucleus retroambigualis (nucleus retroambigualis) refers to a group of neurons in the medulla oblongata at the caudal (bottom) end of the nucleus ambiguus (where motor nerves are that control the ipsilateral muscles of the soft palate, pharynx, larynx and upper esophagus. They provide the innervation for swallowing and speaking) sends impulses to the inspiratory and expiratory muscles, and the nucleus ambiguus send them by the laryngeal branches of the vagus nerve to the larynx. The vagal afferent pathways for cough are from receptors in and under the epithelium of the airways, including the upper airways to the terminal bronchioles and the lung parenchyma. These receptors are rapidly adapting with thin, myelinated fibers in the vagus nerves, which can be directly stimulated by various chemical and mechanical stimuli.

In brief, the nerve messaging relay that creates cough or “thinks” you need to cough goes through a complex but direct highway from stimuli to brain and back. Any disruption in this messaging can create a cough with a message that “loops” and keeps repeating.

“A cough with a message that “loops” and keeps repeating “

In the image below the caption reads “Retroverted (backward) dens (the dens or odontoid process, is a bone originating from the C2 that connects to the C1 and enables head rotation) indenting backward on the brainstem. (Above we discussed the KYPHOTIC neck. Cervical spine instability has become so severe, the curve of the neck has reversed itself and is now backward.)

In this image, this person’s dens in the neutral position (what should be normal head posture) is tipped backward (the arrow depicts this in the image) causing a kinking on the brainstem.

In this section, we will discuss treatments for cervical spine instability. In this image, I suggest that the ultimate cause of this person’s problems is upper cervical instability and the combination of cervical curve correction and ailment adjustments and Prolotherapy will help normalize the dens position and take pressure off of the brainstem.

Convention treatments

If chronic cough persists even after treatment of the underlying disease, or if the chronic cough is not attributable to any cause, then a symptomatic approach with neuromodulators may be considered, with gabapentin as the first choice, and opioids or macrolides as alternatives. (12) The use of neuromodulators, such as amitriptyline, gabapentin, baclofen, and pregabalin, has recently been identified as a promising treatment modality for chronic idiopathic cough patients. (13)

If these treatments failed or did not provide satisfactory results, nerve blocks may be suggested.

An August 2018 paper in the journal Laryngoscope (14) reported that in patients where neurogenic cough is believed to be resulting from a sensory neuropathy involving the internal branch of the superior laryngeal nerve, localized blockade or nerve block of the internal branch of the superior laryngeal nerve may be beneficial to the patient. A 2021 paper in the American Academy of Otolaryngology’s journal OTO Open (15) suggested that patients who underwent in-office superior laryngeal nerve block with lidocaine and steroids for chronic neurogenic cough could see beneficial results for up to ten months.

Botox

A November 2021 paper in the Journal of Clinical Medicine (16) suggesting Laryngeal sensory dysfunction as being a disorder of the vagal sensory pathways with symptoms of chronic refractory cough and abnormal throat sensation could be helped with Onabotulinum toxin Type A injection (Botox).

What are we seeing in this image?

A Digital Motion X-Ray or DMX is a tool we use to help understand a patient’s neck instability and how we may be able to help the patients with our treatments. In the illustration below a patient who suffered from upper cervical instability demonstrated hypermobility of the C1-C2.

A Digital Motion X-Ray or DMX is a tool we use to help understand a patient' neck instability and how we may be able to help the patients with our treatments. In the illustration below a patient who suffered from upper cervical instability demonstrated hypermobility of the C1-C2. This hypermobility can result in common symptoms of neck pain, headaches, dizziness, vertigo, tinnitus, concentration difficulties, anxiety and other symptoms common in TMJ/TMD patients.

Repairing the ligaments and curve for a long-term fix

The goal of our treatment is to repair and strengthen the cervical ligaments and get your head back in alignment with the shoulders in a normal posture.

What are we seeing in this image?

In this illustration, we see the before and after of neck curve corrections. Ligament laxity or looseness or damage, whether the cause is from trauma, genetic as in cases of Ehlers-Danlos syndrome, ultimately causes a kyphotic force on the cervical spine, stretching the posterior ligament complex of the neck. As can be seen in the x-rays of this image, patients with a whiplash injury, Joint Hypermobility Syndrome, and Ehlers-Danlos syndrome can have their cervical curve restored with Prolotherapy Injections and the use of head and chest weights.

In this illustration we see the before an after of neck curve corrections. Ligament laxity or looseness or damage, whether the cause is from trauma, genetic as in cases of Ehlers-Danlos syndrome, ultimately causes a kyphotic force on the cervical spine, stretching the posterior ligament complex of the neck. As can be seen in the x-rays of this image, patients with a whiplash injury, Joint Hypermobility Syndrome, and Ehlers-Danlos syndrome can have their cervical curve restored with Prolotherapy Injections and the use of head and chest weights, documented below.

In this video, a demonstration of treatment is given

Prolotherapy is referred to as a regenerative injection technique (RIT) because it is based on the premise that the regenerative healing process can rebuild and repair damaged soft tissue structures. It is a simple injection treatment that addresses very complex issues.

This video jumps to 1:05 where the actual treatment begins.

This patient is having C1-C2 areas treated. Ross Hauser, MD, is giving the injections.

Treating cervical ligaments with Prolotherapy  – published research from Caring Medical

Prolotherapy is an injection technique that stimulates the repair of unstable, torn or damaged ligaments. When the cervical ligaments are unstable, they allow for excessive movement of the vertebrae, which can stress tendons, atrophy muscles, pinch on nerves, such as the vagus nerve,  and cause other symptoms associated with cervical instability including problems of digestion among others.

In 2014, we published a comprehensive review of the problems related to weakened damaged cervical neck ligaments in The Open Orthopaedics Journal. (4) We are honored that this research has been used in at least 6 other medical research papers by different authors exploring our treatments and findings and cited, according to Google Scholar, in more than 40 articles.

In our clinical and research observations, we have documented that Prolotherapy can offer answers for sufferers of cervical instability, as it treats the problem at its source. Prolotherapy to the various structures of the neck eliminates the instability and the sympathetic symptoms without many of the short-term and long-term risks of cervical fusion.

Summary and contact us. Can we help you? How do I know if I’m a good candidate?

We hope you found this article informative and it helped answer many of the questions you may have surrounding Chronic Sinusitis and Eustachian Tube Dysfunction in your complicated neck pain case. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.

Please visit the Hauser Neck Center Patient Candidate Form

References

1 Sacre-Hazouri JA, Sacre L. Chronic cough. Cough reflex hypersensitivity syndrome. Revista alergia México. 2019 Jun;66(2):217-31. [Google Scholar]
2 Song WJ, An J, McGarvey L. Recent progress in the management of chronic cough. The Korean Journal of Internal Medicine. 2020 Jul;35(4):811. [Google Scholar]
3 Dockry RJ, Farrelly CL, Mitchell J, Corfield DR, Smith JA. Chronic cough is associated with increased reporting of autonomic symptoms. ERJ Open Research. 2021 Jul 1;7(3). [Google Scholar]
4 Prescott SL, Liberles SD. Internal senses of the vagus nerve. Neuron. 2022 Jan 19. [Google Scholar]
5 Castro RA, Zalvan CH, Berzofsky C. Oto-tricho-tussia: An Unexpected Cause of Cough. Case Reports in Otolaryngology. 2020 Mar 31;2020. [Google Scholar]
6 Go YY, Ju WM, Lee CM, Chae SW, Song JJ. Different Transcutaneous Auricular Vagus Nerve Stimulation Parameters Modulate the Anti-Inflammatory Effects on Lipopolysaccharide-Induced Acute Inflammation in Mice. Biomedicines. 2022 Feb;10(2):247. [Google Scholar]
7 De Virgiliis F, Di Giovanni S. Lung innervation in the eye of a cytokine storm: neuroimmune interactions and COVID-19. Nature Reviews Neurology. 2020 Nov;16(11):645-52. [Google Scholar]
8 Mazzone SB, Undem BJ. Vagal afferent innervation of the airways in health and disease. Physiological reviews. 2016 Jul;96(3):975-1024. [Google Scholar]
9 Camp B, Stegemann-Koniszewski S, Schreiber J. Infection-Associated Mechanisms of Neuro-Inflammation and Neuro-Immune Crosstalk in Chronic Respiratory Diseases. International Journal of Molecular Sciences. 2021 Jan;22(11):5699. [Google Scholar]
10 Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F. Anatomy and neuro-pathophysiology of the cough reflex arc. Multidisciplinary respiratory medicine. 2012 Dec;7(1):1-5. [Google Scholar]
11 Song WJ, Morice AH. Cough hypersensitivity syndrome: a few more steps forward. Allergy, asthma & immunology research. 2017 Sep 1;9(5):394-402. [Google Scholar]
12 Visca D, Beghè B, Fabbri LM, Papi A, Spanevello A. Management of chronic refractory cough in adults. European Journal of Internal Medicine. 2020 Nov 1;81:15-21. [Google Scholar]
13 Cohen SM, Misono S. Use of specific neuromodulators in the treatment of chronic, idiopathic cough: a systematic review. Otolaryngology–Head and Neck Surgery. 2013 Mar;148(3):374-82. [Google Scholar]
14 Simpson CB, Tibbetts KM, Loochtan MJ, Dominguez LM. Treatment of chronic neurogenic cough with in‐office superior laryngeal nerve block. The Laryngoscope. 2018 Aug;128(8):1898-903. [Google Scholar]
15 Dhillon VK. Longitudinal Follow-up of Superior Laryngeal Nerve Block for Chronic Neurogenic Cough. OTO open. 2021 Feb;5(1):2473974X21994468. [Google Scholar]
16 Novakovic D, Sheth M, Stewart T, Sandham K, Madill C, Chacon A, Nguyen DD. Supraglottic Botulinum Toxin Improves Symptoms in Patients with Laryngeal Sensory Dysfunction Manifesting as Abnormal Throat Sensation and/or Chronic Refractory Cough. Journal of Clinical Medicine. 2021 Jan;10(23):5486. [Google Scholar]

 

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