Abstract Introduction Chronic refractory cough (CRC) is defined as a cough that persists longer than eight weeks and remains unresponsive to treatment of common underlying conditions such as asthma, gastroesophageal reflux disease (GERD), or upper airway cough syndrome. For a subset of patients, no clear etiology is identified even after thorough evaluation, and their persistent cough is increasingly attributed to what is known as cough hypersensitivity syndrome. Case 52-year-old female with a history of asthma, GERD, and obstructive sleep apnea presented to the pulmonary clinic with a chronic, non-productive cough of insidious onset, persisting for two years. The cough occurred throughout the day and was not associated with identifiable environmental or behavioral triggers. The patient reported a sensation of throat tightness, immediately preceding coughing episodes. The severity and frequency of the cough significantly impaired her quality of life, including frequent interruptions at work. Initial evaluation included spirometry, which revealed no abnormalities, and a computed tomography scan of the chest, which revealed a small, stable pulmonary nodule. Despite adherence to guideline-directed therapy for asthma, including the use of maintenance inhalers, there was no clinical improvement. Evaluation by gastroenterology led to a trial of proton pump inhibitor therapy for presumed GERD-related cough, which also failed to alleviate symptoms. Given the refractory nature of her cough, the patient was referred to an otolaryngologist for further evaluation. Flexible fiberoptic laryngoscopy revealed findings consistent with chronic neurosensory laryngeal dysfunction. Based on this, the patient underwent a superior laryngeal nerve (SLN) block targeting the internal branch of the nerve. Following the procedure, she reported marked improvement in both the frequency and severity of her cough, with substantial improvement in functional status and quality of life. Discussion In cases where no clear etiology is identified despite thorough evaluation, the cough is considered idiopathic and is often attributed to cough reflex hypersensitivity, a condition involving both peripheral and central neural sensitization. Patients often experience an exaggerated urge to cough in response to minimal stimuli, significantly impairing quality of life. Diagnosis requires exclusion of treatable causes through comprehensive clinical assessment, imaging, and therapeutic trials. When conventional therapies fail, treatment options shift toward neuromodulators such as gabapentin or pregabalin, behavioral interventions like speech therapy, and, more recently, procedural approaches. Superior laryngeal nerve (SLN) block is a promising intervention, particularly in patients with suspected laryngeal hypersensitivity, as it targets the internal branch of the SLN responsible for sensory input from the larynx. This abstract is funded by: None
Yosry et al. (Fri,) studied this question.