Challenging Cough Cases: A New Frontier in Otolaryngology

Abstract

Program Description: Both acute and chronic cough are responsible for a significant portion of all ambulatory medical visits annually (about 3%), over-the-counter self-medication expenses in excess of $3.6 billion in the United States, and impaired quality of life. According to 2007 data, there were more than 27 million visits to all physicians for cough, but that same year otolaryngologists saw a total of only 17 million visits for all diagnoses. This suggests a large unmet need for otolaryngologists to participate in the care of these patients. The diagnosis of cough can be simple or profoundly challenging, and it may be a sentinel indicator of severe underlying disease. The list of diseases that may induce cough is growing, along with an appreciation of their interrelations. For example, the Unified Airway concept supports our long-held observation that the upper and lower airway diseases are closely related. There is also a spectrum of overlapping asthmatic, non-asthmatic, and suppurative pulmonary disease. Gastroesophageal reflux (both distal and proximal LaryngoPharyngeal Reflux), along with neurologic reflexes and aspiration are similarly important. And the complex interplay of neurologic reflexes for cough in the brainstem may result in paradoxical vocal fold motion and disordered breathing. Otolaryngologists are playing an increasingly important role in the multidisciplinary evaluation of these challenging patients, and mastering many procedures associated with cough patients. The spectrum of medical specialists also includes pulmonology and chest physicians, allergy and immunology, gastroenterology, neurology, cardiology, infectious disease, speech and swallowing pathologists, as well as psychiatry. This miniseminar will involve the use of case presentations, panel discussion and audience participation to emphasize evidence-based practice and “state-of-the-art.” Controversial areas will include the inter-relatedness of the disease, the role of speech therapy in disordered breathing, and the importance of early diagnosis in value-based healthcare.

Educational Objectives: 1) Learn the spectrum of common and uncommon causes of chronic cough. 2) Understand evidence-based treatment guidelines in the evaluation and treatment of these patients. 3) Be prepared to participate in interdisciplinary discussion of these patients at their home institution.