Impact of Tussigenic Stimuli on Perceived Upper Airway Sensation and Motor Cough Response Following Total Laryngectomy
Open Access
- 29 May 2020
- journal article
- research article
- Published by Frontiers Media SA in Frontiers in Physiology
- Vol. 11, 477
- https://doi.org/10.3389/fphys.2020.00477
Abstract
Background: Total laryngectomy (TL) is standard intervention for carcinoma of the head and neck or, in cases of non-functional larynx, as a result of disease or radiation exposure. Laryngeal extirpation serves as a unique human model of both recurrent and superior laryngeal nerve section and offers insight into motor and sensory aspects of cough: both volitional and in response to tussigenic stimuli. While motor changes in cough function are expected among those status post-TL due to postoperative reconstruction of the upper airway, motor cough parameters have not been well described and sensory aspects of cough are unknown in this population, which provides insight into a vagal denervation model in humans. Methods: Data were collected from three groups totaling 80 adults (39 male), including 25 healthy younger adults (HYA), 27 healthy older adults (HOA), and 28 adults post-TL. Cough was elicited both upon command and in response to nebulized capsaicin. Outcome measures included urge to cough and cough airflows. Results: Kruskal–Wallis test showed that two of the three groups differed significantly by urge to cough χ2(2, N = 244) = 8.974, p = 0.011. Post hoc analysis showed that post-TL subjects had reduced perceived urge to cough at all concentrations of capsaicin (p < 0.05). Cough airflows were significantly reduced for post-TL subjects compared to healthy controls in all metrics except post-peak phase integral (PPPI) for which HOA and TLs were comparable under both volitional and capsaicin-induced conditions. Conclusions: These findings support the hypothesis that both cough airflow and sensations are significantly reduced in post-TL subjects when compared with HOA. Interestingly, HOA and post-TL subjects have comparably reduced UTC and cough airflows when compared to HYA. The only metric of cough airflow for which these groups differ is the PPPI, which may be a compensatory adaptation for reduced cough airflows and/or sensation.Keywords
This publication has 22 references indexed in Scilit:
- Changes in Chemosensitivity and Mechanosensitivity in Aging and Parkinson’s DiseaseDysphagia, 2011
- Appropriate depth of placement of oral endotracheal tube and its possible determinants in Indian adult patientsIndian Journal of Anaesthesia, 2011
- Perception of urge-to-cough and dyspnea in healthy smokers with decreased cough reflex sensitivityCough, 2010
- Laryngeal somatosensory deficits in Parkinson’s disease: implications for speech respiratory and phonatory controlExperimental Brain Research, 2009
- The urge-to-cough and cough motor response modulation by the central effects of nicotinePulmonary Pharmacology & Therapeutics, 2009
- Impaired urge-to-cough in elderly patients with aspiration pneumoniaCough, 2008
- Water Aerosols and CoughPulmonary Pharmacology & Therapeutics, 2002
- The science of nebulised drug deliveryThorax, 1997
- The nasopharyngeal airwayAnaesthesia, 1993
- Sensation of Thirst in Normal and Laryngectomized ManPerceptual and Motor Skills, 1987