Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Michael Z. Lerner

Abstract

Purpose: Superior laryngeal nerve (SLN) block utilizing triamcinolone (TA) or methylprednisolone acetate (MP) has been described as an efficacious treatment for refractory cough (RC). Particulate corticosteroid injection in the neck carries a risk of large-particle embolization and devastating neurologic sequela in the event of inadvertent intravascular injection. Herein, we compare the efficacy of a soluble steroid (dexamethasone, SS) with particulate steroids (PS) in reducing cough severity in RC-patients.Materials and Methods: Patient charts for those receiving SLN blocks by fellowship-trained laryngologists for the sole indication of RC were reviewed. Drug/dose, timing/laterality, and adjuvant treatments were compared using chi-squared test. A paired t-test was used to assess post-treatment improvement and a non-inferiority test was performed to compare improvement between two groups. Results: Of 40 patients included, 27 (67.5%) received SS. Patient and treatment characteristics did not significantly differ between the two cohorts. Significant improvement in cough suppression index (CSI) post-treatment was found in both groups (PS, p=0.024; SS, p<0.001); improvement in the SS group was statistically non-inferior (p=0.003) to that in the PS group. Conclusions: Our pilot study is the first to compare steroids in the field of Otolaryngology, specifically as a component of SLN blocks for refractory cough. Herein, we illustrate that dexamethasone may be a safe alternative to weaker particulate steroids while non-inferior as a treatment for RC. Generalizability is limited by our study’s retrospective study design and small sample size limiting our ability to conduct multivariate analysis and adjust for follow-up time.

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This is an Open Access Thesis.

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