Laryngeal Sensitivity In Patients With Cough Hypersensitivity Syndrome

Objective:Chronic cough is the most common clinical symptom,and cough reflex hypersensitivity may be an important factor in chronic cough.To investigate whether there is a hypersensitive state in the larynx of patients with cough hypersensitivity syndrome and its relationship with cough hypersensitivity syndrome.To provide basis for clinical diagnosis and follow-up research on cough hypersensitivity syndrome.Methods: From September 2018 to December 2019,we collected materials of patients with Cough hypersensitivity syndrome who were visit in ORL-HNS of Yijishan Hospital of Wannan Medical College,the control group was volunteers without cough symptoms,the case was selected in accordance with 《Guidelines for the diagnosis and treatment of cough(2015)》.To Select patients with chronic cough who sow a doctor for the first time.After admission,the patients with cough caused by nose,pharynx,lung and allergic diseases,reflux pharyngitis and gastroesophageal reflux were excluded,and the patients with unexplained cough were selected,at the same time,the age,sex,cough time and concomitant symptoms were recorded.After screening patients with unexplained cough,a certain amount of capsaicin aerosol particles were sprayed into the subjects’ throat by atomization to induce cough,The cough sensitivity was expressed by the lowest challenge concentration(C5)of cough ≥ 5 times after inhalation.At first,atomized saline was sprayed as the basic control.Then the lowest concentration(1.95 umo L/L)of human atomized capsaicin solution was inhaled,and the number of coughing within 30 s was recorded,the test was terminated when the C5 standard was reached,and the concentration was the threshold value for coughing.If the C5 standard can not be reached,the next concentration of suction will be carried out,and the concentration will be increased by 1times each time.If the concentration reaches 1000 umol/L,the test should be terminated when the subject does not have C5,the threshold concentration was recorded as greater than 1000umol/L.If the patient has obvious discomfort(such as severe retrosternal burning sensation,shortness of breath,dyspnea,etc.),the test should also be terminated immediately.The capsaicin sensitivity threshold of five coughs was recorded for each patient.The C5,sex and age of the control group without cough were recorded by the same method at the same time,the statistical results are calculated by spss19.0 software.,the age statistics of the experimental group and the control group were analyzed by T test,gender by chi-square test and the difference of C5 logarithmic Log(C5)data of cough 5 times between the experimental group and the control group was compared by Kruskal-Wallis test.Results:In this study,a total of 48 patients with cough hypersensitivity syndrome(experimental group)were collected,including 25 females(52.08%)and 23 males(47.92%).In the experimental group,the oldest age was 76 years old,the youngest age was 30 years old,the average age was 49.10 ±11.56 years old,the longest cough time was 240 months,and the shortest cough time was 3 months.There were 26 females and 22 males in the control group,the maximum age was 70 years old,the minimum age was 21 years old,the average age was 44.81±2.075 years old..In the experimental group,the concentration threshold of cough for 5 times was 31.2umol/L in 9 cases,accounting for 18.75%;the threshold was 62.50umol/L in 11 cases,accounting for 22.92%;the threshold was 125umol/L in 13 cases,accounting for 27.08%;the threshold was 250umol/L in 6 cases,accounting for 12.50%;and the threshold was 500umol/L in9 cases,accounting for 18.75%.In the control group,the concentration threshold of cough for 5times was 62.5umol/L in 6 cases,accounting for 12.50%;the concentration threshold was125umol/L in 12 cases,accounting for 25.00%;the concentration threshold was 250umol/L in 23 cases,accounting for 47.91%;and the concentration threshold was 500mol/L in 7 cases,accounting for 14.59%.Among the concomitant symptoms of cough patients,there were dryness in pharynx and throat in 40 cases(83.33%),itching in pharynx or throat in 36 cases(75.0%),foreign body sensation in pharynx or throat in 32 cases(66.67%),cough after meal in 10 cases(20.83%),frequent throat clearing in 6 cases(12.5%),and simple cough in 2 cases without concomitant symptoms(4.2%).During the experiment,mild nausea and discomfort was found in6 cases and nausea and discomfort in 2 cases.The concentration of capsaicin C5 logarithmic Log(C5)P in the experimental group and the control group was 0.005,less than 0.01,,and there was significant difference between the two groups.Conclusion:There are peripheral pathway changes in cough reflex arc in cough hypersensitivity syndrome.Laryngeal sensitivity in patients with cough hypersensitivity syndrome is higher than that in normal subjects,and laryngeal hypersensitivity is related to cough hypersensitivity syndrome.Laryngeal hypersensitivity plays a certain role in the pathogenesis of cough hypersensitivity syndrome and is related to abnormal laryngeal sensation.