RT Journal Article
SR Electronic
T1 Chronic tonsillar enlargement and cough: preliminary evidence of a novel and treatable cause of chronic cough
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 199
OP 201
DO 10.1183/09031936.03.00066403
VO 23
IS 2
A1 S.S. Birring
A1 C. Passant
A1 R.B. Patel
A1 B. Prudon
A1 G.E. Murty
A1 I.D. Pavord
YR 2004
UL http://erj.ersjournals.com/content/23/2/199.abstract
AB Tonsillar enlargement is sometimes seen in patients with otherwise unexplained chronic cough although its significance is unclear. In this study, the authors set out to test the hypothesis that cough symptoms and cough reflex sensitivity will improve after tonsillectomy in patients with otherwise unexplained chronic cough and enlarged tonsils. Eight consecutive patients with unexplained chronic cough and enlarged tonsils were recruited from 236 patients seen in a cough clinic between 2000 and 2001. Six patients with enlarged tonsils and no cough who were undergoing tonsillectomy for other reasons were recruited as a control group. All patients rated cough severity on a cough visual analogue score (0–100 mm) and had capsaicin cough reflex sensitivity measurement twice before and again 3 months after tonsillectomy. Patients with a chronic cough had heightened cough reflex sensitivity compared with the control group at baseline. There was a significant improvement in mean cough visual analogue score 3 months after tonsillectomy in patients with chronic cough (mean difference 30 mm; 95% confidence interval of difference 8–51 mm). The geometric mean concentration of capsaicin required to cause five coughs increased from 4 to 207 µmol·L−1 after tonsillectomy in patients with chronic cough (mean difference from baseline 5.6 doubling concentrations; 95% confidence interval of difference 3.1–8.2). There was no change in cough reflex sensitivity in control patients after tonsillectomy. These preliminary findings suggest for the first time a possible role for tonsillectomy in patients with enlarged tonsils in whom other causes of cough have been ruled out. S.S. Birring is a British Lung Foundation clinical research fellow. This study was funded by the British Lung Foundation and University Hospitals of Leicester NHS Trust.