(A704) Assessing the Utility of Laryngoscopy in Patients with Isolated Neurogenic Cough

Introduction: Laryngoscopy is routinely performed by otolaryngologists in the evaluation of chronic cough. However, the laryngeal hypersensitivity underlying neurogenic cough likely does not produce observable findings on laryngoscopy. This study examines the frequency of positive laryngoscopic findings in neurogenic cough patients in a single author’s cohort compared to perceived rates of positive findings in community practices.

Methods: A retrospective chart review was conducted on patients evaluated for neurogenic cough at the University of Arizona tertiary laryngology center between 2018 and 2024. This study included patients with a cough persisting longer than eight weeks that did not respond to proton pump inhibitor therapy or asthma treatment. Data collected included patient demographics, diagnostic evaluations, laryngoscopy findings, initiated therapies, and outcomes. Additionally, a survey was distributed to otolaryngology providers attending a regional CME conference to assess the frequency of laryngoscopy use and the perceived prevalence of positive findings in chronic cough patients.

Results: The first arm of the study included a total of 56 patients in the senior author’s cohort. Only 2 of 56 neurogenic cough patients (3.6%) demonstrated motion impairment or ulcerative changes on laryngoscopy. Patients were treated with neuromodulators, superior laryngeal nerve blocks, and laryngeal botox injections in a step-up fashion. Overall, 75% of patients responded to treatment. The second arm of the study included a total of 40 otolaryngology providers completing the survey. All respondents (100%) reported “almost always” performing laryngoscopy for isolated chronic cough, however, findings did not change their management.

Conclusions: The low frequency of positive findings on laryngoscopy in neurogenic cough patients, combined with survey data indicating routine use despite findings not changing management, calls into question the necessity of laryngoscopy in the diagnostic evaluation of isolated neurogenic cough.