Neuropathy as Alternative Cause of Chronic Cough - Neurontin Treatment
Hi LPR Team,
I just got back from a visit with Dr Anthony Jahn, a well-known Dr in NYC who deals with a lot of LPR, especially in the singing community. I really hate changing doctors so frequently, but I've moved a lot and it seems that all the best tri-state LPR docs refuse to take my insurance, United Healthcare - otherwise I'd still be going to Sataloff and Lyons in Philly. Dr. Jahn was very nice, and proposed an alternate theory to LPR - he suggested that it was possible I had vagal neuropathy - which is basically a hypersensitive larynx. Though I am strongly inclined to disagree with him about neuropathy as a stand-alone theory (I have too many classic LPR symptoms that don't fit in with neuropathy), I am more open to the possibility that I have a hypersensitive larynx either as a result of the reflux or a hypersensitive larynx that makes the reflux experinece even worse. (Hypersensitive larynx does not explain the burning sensation in my nasal passages whenever I begin coughing/refluxing and the subsequent stuffed up sinusitis-like symptoms. Nor does hypersensitive larynx explain why I feel great when laying in bed, and only reflux during upright positions).
Anyway, there's a point to this. It seems that vagal neuropathy is treatable with neurontin to some degree. Yes, neurontin is a rather strong drug with many undesriable side effects, but for those of you who fail to respond to PPIs, this is just another angle to try.
I just googled Neurontin and LPR and discovered that Dr. Peak Woo, another well-known New York City ENT who specializes in laryngeal disorders, had done a study in 2003/2004 that he presented, along with Dr. Bryant Lee in 2004 at the 2004 American Laryngolgy Association Convention. He claims that 17 of the 23 subjects responded positively to neurontin treatment.
Here's the summary (I don't have the article in full):
Chronic Cough as a Sign of Vagal
Neuropathy: Diagnosis, Work Up and
Bryant Lee, MD*
Peak Woo, MD
New York, NY
Chronic cough is often attributed to reflux, post nasal drip or
asthma. We present 23 patients with chronic cough as a manifes-
tation of sensory neuropathy involving the superior or recurrent
Twenty-three patients have been identified with sudden onset
of cough with laryngospasm after viral illness or surgery. Cough
and laryngospasm were the most common complaints. Fifty-two
percent (12/23) had concomitant unilateral superior laryngeal
nerve (SLN) or recurrent laryngeal nerve (RLN) motor neuropa-
thy documented by EMG. After a negative workup or treatment
for reflux, asthma or post-nasal drip, these patients were treated
with Gabapentin (Neurontin) at 300 – 90 mg per day.
Symptomatic relief was achieved in 17 patients.
Sensory neuropathy of the RLN or SLN should be considered
in the work up and management of patients with cough and
In addition, Dr. Jahn also gave me the tname of a Canadian doctor who is doing research into using neurontin as a treatment for this condition - his name is Murray Morrison and he is a doctor at Vancouver General Hospital, Willow Pavillion, in Vancouver, British Columbia.
Nonetheless, I found it interesting that Dr. John would propose this alternative hypothesis, yet he suggested that I take the following steps before I experiment with Neurontin -
1. Have a 24 hour monitoring done to evaluate reflux breakthrough while on PPIs.
2. If breakthrough exists, strongly consider the Nissen Fundoplication (I asked him about the Stretta procedure but he wasn't familiar with it)
3. If my breakthrough symptoms do not go away and I choose not to do the Nissen, then consider Neurontin.
4. If I choose to do the Nissen and the symptoms still don't go away, consider trying Neurontin.
I also asked him about his experience with other LPR patients. He told me he's had about 100 or so LPR patients, and only 1 or 2 of them chose to ultimately do the Nissen, but it helped that individual (s).