Vocal Fold Augmentation For Refractory Chronic Cough When Phonation Is A Trigger

Objectives: Refractory chronic cough (RCC) is a cough lasting longer than 8 weeks that has not been found on testing for or not responded to traditional empiric trials for asthma, upper airway cough syndrome and/or gastroesophageal reflux disease. Many patients with RCC present with concomitant glottic insufficiency from presbyphonia, unilateral vocal fold paresis or vocal fold scar. In a subset of these patients, phonation, including speaking and laughing, can be a regular trigger for their cough. This study hypothesizes that vocal fold augmentation will improve cough symptoms when both glottic insufficiency and phonation triggers are present in patients with RCC.

Methods: Retrospective Review. Patients who underwent diagnostic carboxymethylcellulose (CMC) injection augmentations via an office-based, per-oral approach for non-paralytic glottic insufficiency (atrophy and unilateral paresis) between 2019 – present were identified through a proprietary intake questionnaire database. Subjects were included if they also reported talking or laughing as a regular trigger for their RCC. Subject demographics, diagnoses, and volume/sidedness of CMC injected will be reported. Pre- and post-injection subjective improvement (yes or no) will be the primary outcome measure; Voice handicap index-10 (VHI), Reflux symptom index (RSI) and Cough Severity index (CSI) at 2- 4 weeks will be reported where available.

Results: Pre- and post-subjective outcome, VHI, CSI and RSI are collected automatically with every intake survey completed at all patient visits during the time period, and analysis is forthcoming. The expected number of subjects presented will likely grow before the Symposium.

Conclusion: Injection augmentation for RCC in the setting of phonatory triggers in patients with non-paralytic etiologies of glottic insufficiency is a novel application and sparsely found in the laryngology literature. Pre/post patient outcomes after CMC gel augmentation for RCC in a phonatory triggered patient population will be presented.