TY - JOUR T1 - Incidence of Arnold's nerve reflex in patients with chronic cough JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2016.PA3545 VL - 48 IS - suppl 60 SP - PA3545 AU - Peter Dicpinigaitis Y1 - 2016/09/01 UR - http://erj.ersjournals.com/content/48/suppl_60/PA3545.abstract N2 - Background: In animals and man, cough can only be induced by stimulation of a structure innervated by the vagus nerve or one of its branches. The auricular branch of the vagus nerve (Arnold's nerve) supplies the external acoustic meatus. Induction of cough by manipulation of the ear is known as Arnold's nerve reflex or ear-cough reflex. Three previous studies evaluating a total of 1702 outpatients presenting to an otorhinolaryngologist revealed an incidence of Arnold's cough reflex of 2.64%. To our knowledge, the incidence of the ear-cough reflex in patients with chronic cough has not been previously studied.Methods: Patients presenting to a specialty cough center (Montefiore Cough Center, New York, USA) for evaluation of chronic cough (>8 weeks duration) underwent physical examination that included the insertion of a cotton-tipped swab (bud) into the external acoustic meatus of each ear and mechanical stimulation of its circumference. Cough occurring within 10 seconds of stimulation was considered induced by the intervention.Results: To date, 33 (24 female, 9 male) of a planned 100 consecutive subjects have been evaluated. Overall incidence of Arnold's nerve reflex was 11/33 (33 %), with a significant gender difference: 42 % (10/24) in women; 11 % (1/9) in men.Conclusion: The incidence of Arnold's nerve reflex is much higher in patients with chronic cough than in other populations previously studied. Such hypersensitivity of a branch of the vagus nerve is consistent with the recently-proposed concept of the Cough Hypersensitivity Syndrome, in which sensory hypersensitivity is the presumed mechanism by which chronic refractory cough arises and persists in a population of predisposed individuals. ER -