Laryngeal Botox injection in recalcitrant cases of chronic cough

Background: Chronic cough is a common and often diagnostically challenging symptom seen by clinicians across multiple specialties. We aimed to assess the effect of laryngeal botulinum toxin A (Botox) injection for cases of neurogenic cough. Methods: Patients were recruited through a specialist laryngology clinic in Adelaide, Australia. Cases of recalcitrant chronic cough were identified using our Adelaide Protocol and treatment with laryngeal Botox injection was offered to these patients. Validated questionnaires assessing cough severity and quality of life were recorded before and 6 weeks after treatment, which consisted of electromyography (EMG) guided injection of 1.0–2.0 units of Botox bilaterally to the thyroarytenoid muscles. Results: Of 268 patients referred to our chronic cough clinic, 22 were offered laryngeal Botox injection, with 20 proceeding to treatment. 17 were female, with an age median of 62.5 and average symptom duration of 2 years. After treatment with Botox, Cough Severity Scale improved from an average of 7.1 to 2.5, Leicester Cough Questionnaire (LCQ) improved from 10.8 to 14.9 and Newcastle Laryngeal Hypersensitivity Questionnaire (NLHQ) improved from 9.1 to 14.4. Symptoms resolved after the Botox wore off for 14 of the 20 patients. Complications included minor dysphonia and dysphagia. Conclusions: Our study shows that laryngeal Botox injection is a successful option in the treatment of recalcitrant chronic cough.