Laryngeal Cryotherapy for Neurogenic Cough: Safety, Feasibility, and Prospective Outcomes.

Abstract

Despite the prevalence of neurogenic chronic cough (NCC), treatment options remain limited. This study investigates selective laryngeal cryotherapy (SLC) as a potential sensory neurolytic therapy. The primary objective was to explore the feasibility and safety of SLC, while the secondary objectives assessed efficacy in the reduction of laryngeal hypersensation and cough symptoms. Patients with refractory NCC were prospectively recruited. Patients underwent laryngeal laser sensory testing (LST), immediately followed by awake SLC treatment. Cough measures including the cough severity index (CSI) and urge to cough visual analog scale (UTC-VAS) were collected at baseline and regular intervals. At 1-month postprocedure, additional LST was performed. Safety, tolerability, and adverse events were recorded. Thirty patients with NCC were enrolled. All patients successfully completed awake SLC. There were no serious adverse events or unanticipated adverse device effects. 21% of patients experienced at least one treatment-emergent adverse event, all of which self-resolved within 2 days. Post-SLC patients had a higher mean laser power threshold, 7.5 W (SD 2.42) to trigger a cough response compared to their baseline threshold of 2.8 W (SD 2.76) (p < 0.001). By 6 months, patients demonstrated sustained improvement compared to their baseline, with a reduction in CSI of -8.25 (95% CI 11.60, -4.91) (p < 0.001) and UTC-VAS -18.07 (95% CI -29.71, -6.43) (p = 0.003). The data suggest that awake laryngeal cryotherapy is feasible, tolerable, and safe. SLC reduced laryngeal hypersensitivity, and while it is a promising treatment option for neurogenic cough, further research is required to confirm its long-term effectiveness.