Chronic cough is defined as any cough that persists for eight weeks or longer in adults, and it ranks as one of the most common reasons for visiting a physician. For many patients, it can interrupt their sleep, social life, family life, work, and general wellbeing. In severe cases, it may cause pain, muscle strain, voice changes/dysphonia, vomiting and intermittent urinary incontinence. At the Grabscheid Voice and Swallowing Center of Mount Sinai, our interdisciplinary team of speech language pathologists (SLPs) and physicians evaluate patients after gastroenterology and pulmonary workups have been completed and the etiology has not been identified. Our SLP’s have developed a novel cognitive behavioral therapy (CBT)-like treatment to help significantly reduce or, in many cases, eviscerate chronic cough from their lifestyle.
Causes and Symptoms of Chronic Cough
Common causes of chronic cough include pulmonary diseases such as asthma, COPD, and chronic bronchitis (viral or bacterial); gastrointestinal disturbances such as reflux disease and esophageal dysmotility syndromes; postnasal drip; allergies; and select cardiac medications (i.e. ACE inhibitors). While some patients may be able to rule out some of these common causes, they might have comorbidities/coexisting diagnoses that warrant behavioral intervention for chronic cough. Additionally, some patients may experience psychological effects as a result of this pervasive interruption to their life.
At Mount Sinai, we distinguish chronic cough as one of the symptomatic subsets under the umbrella diagnosis of neurogenic laryngeal hypersensitivity (NLH). This refers to a hypersensitive or hyper-reactive larynx/throat. We believe that NLH is similar to other hypersensitivity disorders such as neuropathic pain and fibromyalgia. The other symptoms or subsets of NLH that may work in concert with chronic cough or independently are throat clearing, globus sensation (sensation of something in the throat), muscle tension dysphonia, vocal cord dysfunction (also known as paradoxical vocal cord motion), shortness of breath, and laryngospasm. Symptoms of chronic cough include muscle pain or tightness in the neck, nonproductive throat clearing or coughing, sensation of postnasal drip, globus sensation, difficulty breathing, and change of voice quality.
About Mount Sinai’s Unique Approach to Treating Chronic Cough
Patients who come to the Grabscheid Voice and Swallowing Center may have experienced cough for months to years. They have typically exhausted their visits to primary care physicians, pulmonologists, gastroenterologists, and allergists without a distinct diagnosis, explanation of their ongoing symptoms, or an effective treatment. When they arrive, they are understandably frustrated and discouraged. However, our specialized team not only gives hope to our patients, but also provides sound solutions for identifying triggers and teaching techniques that resolve this issue – often with lifelong success.
When patients first meet with our team this is the frequently the first time their unique symptoms are explained. We obtain a detailed history, help identify triggers, educate patients on the basic anatomy and physiology of voice and respiration, and define NLH as it relates to their specific condition. Through individualized work with our SLP clinicians, patients are given functional, alternate behaviors and suppression techniques that immediately address their chronic symptoms on their first visit. The goal is for patients to leave that same day with a sound treatment plan and the ability to demonstrate these techniques with success. Subsequent sessions focus on assessing progress, modifying behaviors, and exposing triggers to facilitate desensitization.
Medications for Chronic Cough
Our philosophy at the Grabscheid Voice and Swallowing Center is to first treat chronic cough with behavioral intervention. This approach through cognitive behavioral-like therapies is highly effective in the majority of our patients. However, some patients are unable to maintain these therapeutic techniques. For example, this can occur if patients are too far from our hospital or are treating more coexisting medical conditions such as degenerative neurological disorders or cancer). In these instances, prescribed medications, ones that are similar and effective in other neurogenic hypersensitivity disorders, may be given to this small percentage of patients to manage symptoms of their chronic cough.
Chronic Cough Research at Mount Sinai
For nearly a decade, Mount Sinai physicians and SLPs at the Grabscheid Voice and Swallowing Center have been researching chronic cough. Data from our retrospective review has shown that chronic cough/NLH affects approximately 70 percent females versus 30 percent males. As part of this study, patients completed a symptom questionnaire before and after treatment; results showed an 87.5 percent improvement after only three or four sessions.
In addition to researching the etiology of chronic cough, our researchers are in the process of establishing a standardized protocol and defining nomenclature for this diagnosis. We are also training other clinicians at the Mount Sinai Health System to disseminate this novel approach. Our experts realize this is a disruption to patients’ lives and our goal is to redefine direct treatment and eradicate chronic cough once and for all.