Airway Hypersensitivity, Reflux, and Phonation Contribute to Chronic Cough

BACKGROUND & AIMS

Although chronic cough is common, its etiology is often elusive, making patient management a challenge. Gastroesophageal reflux and airway hypersensitivity can cause chronic cough. We explored the relationship between reflux, phonation, and cough in patients with idiopathic chronic cough.

METHODS

We performed a blinded, cross-sectional study of nonsmoking patients with chronic cough (duration, >8 weeks) refractory to reflux treatment referred to the Digestive Disease Center at Vanderbilt University. All underwent 24-hour acoustic recording concurrently and temporally synchronized with ambulatory pH-impedance monitoring. Cough, phonation, and pH-impedance events were recorded. We evaluated the temporal relationship between cough and phonation or reflux events using Poisson and logistic regression.

RESULTS

Seventeen patients met the inclusion criteria (88% female; 100% white; median age, 63 years [interquartile age range, 52-66 years]; mean body mass index, 30.6 [interquartile range, 27.9-34.0]); there were 2048 analyzable coughing events. The probability of subsequent coughing increased with higher burdens of preceding cough, reflux, or phonation. Within the first 15 minutes after a cough event, the cough event itself was the main trigger of subsequent cough events. After this period, de novo coughing occurred with increases of 1.46-fold in association with reflux alone (95% confidence interval, 1.17-1.82; P < .001) and 1.71-fold in association with the combination of phonation and reflux events.

CONCLUSIONS

Antecedent phonation and reflux increased the rate of cough events in patients with idiopathic chronic cough. Reflux events were more strongly associated with increased rate of coughing. Our findings support the concept that airway hypersensitivity is a cause of chronic cough, and that the vocal folds may be an effector in chronic cough ClinicalTrials.gov number: NCT01263626.

Middle ear meningiomas: a case series reviewing the clinical presentation, radiologic features, and contemporary management of a rare temporal bone pathology

Meningiomas are the most common extra-axial intracranial neoplasm and frequently develop in the parasagittal region. Rarely, meningiomas may involve the middle ear and mastoid, resulting from contiguous spread of adjacent intracranial tumor, or less commonly as an isolated primary tumor of the middle ear. Patients with primary middle ear meningiomas (MEMs) often present with non-specific otologic complaints including hearing loss, otorrhea and otalgia thereby mimicking common chronic otitis media, while secondary lesions more frequently manifest sensorineural hearing loss, cranial neuropathy and other neurologic symptoms from the associated intracranial component. The radiological appearance of MEMs often overlaps with other tumors of the temporal bone. Therefore, a correct diagnosis cannot always be made prior to surgical biopsy. While gross total resection with preservation of existing neurological function is possible with smaller lesions, complete tumor removal may be extremely morbid with more extensive or adherent MEMs. In such cases, aggressive subtotal resection with close radiologic follow-up should be considered. Given the rarity of the studied condition, the literature addressing MEMs is sparse. The current study reviews ten additional cases of MEMs, highlighting the clinicopathologic and radiological features that distinguish meningiomas from other middle ear and mastoid pathology.

Allelopathic polyacetylenes fromCentaurea repens (Russian knapweed)

The allelopathic weed Russian knapweed (Centaurea repens) was found to contain polyacetylenes VIII-XIV in the roots. Dose vs. response of the root length elongation against lettuce, alfalfa, barnyard grass, and red millet showed IX to be active. Closely related isomers were not active. Examination of the soil surrounding the Russian knapweed roots revealed the presence of IX in sufficient concentration to have an appreciable effect on the surrounding plant community.

Changes in mRNA levels for brain-derived neurotrophic factor after wheel running in rats selectively bred for high- and low-aerobic capacity

We evaluated levels of exercise-induced brain-derived neurotrophic factor (BDNF) messenger RNA (mRNA) within the hippocampal formation in rats selectively bred for 1) high intrinsic (i.e., untrained) aerobic capacity (High Capacity Runners, HCR), 2) low intrinsic aerobic capacity (Low Capacity Runners, LCR), and 3) unselected Sprague-Dawley (SD) rats with or without free access to running wheels for 3 weeks. The specific aim of the study was to determine whether a dose-response relationship exists between cumulative running distance and levels of BDNF mRNA. No additional treatments or behavioral manipulations were used. HCR, LCR, and SD rats were grouped by strain and randomly assigned to sedentary or activity (voluntary access to activity wheel) conditions. Animals were killed after 21 days of exposure to the assigned conditions. Daily running distances (mean ± standard deviation meters/day) during week three were: HCR (4726 ± 3220), SD (2293 ± 3461), LCR (672 ± 323). Regardless of strain, levels of BDNF mRNA in CA1 were elevated in wheel runners compared to sedentary rats and this difference persisted after adjustment for age (p=0.040). BDNF mRNA was not affected by intrinsic aerobic capacity and was not related to total running distance. The results support that BDNF mRNA expression is increased by unlimited access to activity wheel running for 3 weeks but is not dependent upon accumulated running distance.

The treatment of pleomorphic adenomas by formal parotidectomy

We reviewed 100 patients who underwent formal parotidectomy. Seventy-two were new patients in whom a parotid lump proved to be a pleomorphic adenoma. Twenty-eight were patients in whom a tumour had recurred after treatment for pleomorphic adenoma by local excision (with or without irradiation) elsewhere. After a follow-up of 1--15 years (median 4 years), there were no recurrences in the primary group but 5 recurrences among the secondary cases. Permanent facial nerve damage was not seen in the primary group, but 11 patients undergoing secondary parotidectomy were left with some permanent facial weakness. Malignant change occurred in 4 patients in the secondary group.