CHEST Guidelines-When-Evaluating-Patients-With-Chronic-Cough,-Shoul

When-Evaluating-Patients-With-Chronic-Cough,-Shoul

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The article by Richard S. Irwin explores whether clinicians should routinely test for the Arnold nerve reflex (ANR) or examine ears when dealing with patients who have chronic cough. The ANR, first described by Philipp Friedrich Arnold, involves stimulation of the auricular branch of the vagus nerve, which can induce coughing. The paper reviews a study by Mai et al., which suggests that a positive ANR may indicate vagal hypersensitivity, although it does not reliably predict the cause, duration, or treatment outcome of a cough. Thus, routine ANR testing is not deemed essential.<br /><br />However, examining the ears during a physical check-up is recommended. External ear conditions such as impacted cerumen, foreign bodies, or dislodged pressure tubes could trigger the ANR and contribute to chronic cough. Addressing these conditions can improve symptoms. Irwin notes the ear's connection to other reflexes, suggesting examinations could benefit patients with related issues such as gagging or syncope.<br /><br />The piece also touches upon the potential of auricular vagus nerve stimulation as a nonpharmacologic treatment for various conditions like epilepsy, depression, and chronic pain, thanks to its modulatory influence on the CNS. Although currently not effective for treating coughs specifically, the research in this area continues to grow.<br /><br />In conclusion, while ANR testing isn't critical for diagnosing chronic cough, ear examinations remain valuable. The auricular branch of the vagus nerve offers insight into broader neural mechanisms, reflecting Arnold’s lasting impact on medical science.

Keywords

Arnold nerve reflex

chronic cough

vagus nerve

ear examination

vagal hypersensitivity

auricular vagus nerve stimulation

nonpharmacologic treatment

Philipp Friedrich Arnold

external ear conditions

neural mechanisms