CHEST Guidelines-When-Evaluating-Patients-With-Chronic-Cough,-Shoul (1)

When-Evaluating-Patients-With-Chronic-Cough,-Shoul (1)

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The document summarizes a study by Mai et al. that investigated the Arnold Nerve Reflex (ANR) in relation to chronic cough. Richard S. Irwin provides historical context about Philipp Friedrich Arnold, a renowned 19th-century German anatomist who first described what is now known as the Arnold nerve reflex, where stimulation of the auricular branch of the vagus nerve can trigger coughing.<br /><br />The study explored whether a positive ANR could predict the cause, duration, severity, or treatment outcome of chronic coughs, suggesting that a positive ANR indicates vagal hypersensitivity. Despite an observed prevalence of ANR in 25.5% of adults with chronic cough, Mai et al. found the ANR test's clinical usefulness limited as it did not reliably predict any specific diagnostic or treatment outcomes.<br /><br />Irwin argues that while routine ANR testing is not necessary for diagnosing chronic cough, examining the ears should remain a standard part of a physical exam, due to potential external ear conditions (like impacted cerumen) possibly triggering ANR and contributing to chronic cough.<br /><br />The document also notes the broader implications of studying the auricular branch of the vagus nerve as it connects to the brain, hinting at potential therapeutic uses beyond cough, such as in epilepsy, depression, and chronic pain management. This highlights the potential for auricular vagus nerve stimulation as a minimally invasive treatment modality being actively explored in various medical fields.<br /><br />In conclusion, while routine ANR testing for chronic cough may not be recommended, ear examinations remain crucial in clinical assessments. Additionally, ongoing research into vagus nerve stimulation presents promising avenues for treating various conditions.

Keywords

Arnold Nerve Reflex

chronic cough

vagus nerve

auricular branch

vagal hypersensitivity

ear examination

Richard S. Irwin

therapeutic uses

vagus nerve stimulation

medical research