Laryngeal Cryotherapy for Refractory Neurogenic Cough

University of Texas Southwestern Medical Center28 enrolled

Overview

This study aims to evaluate the safety and efficacy of upper aerodigestive tract cryotherapy treatment in patients with refractory neurogenic cough in a prospective pilot study with a validated patient reported outcome measure

This study aims to test a new type of treatment for patients suffering from chronic cough, also known as upper airway cough syndrome. The new treatment involves the use of laryngeal cryotherapy which is the therapeutic freezing of tissue in the throat to numb the overactive sensory nerves in the throat which is believed to reduce cough symptoms. Patients will first undergo a flexible scope of the throat (laryngoscopy) to test for hypersensitive areas in the throat, then undergo the cryotherapy procedure in the office. After that, patients will be followed up in the clinic with the usual standard of care visits and undergo validated cough surveys to track their cough symptoms after the procedure. Possible side effects to this procedure are listed in detail below, and include temporary throat pain and coughing.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Upper-Airway Cough Syndrome

Interventions

Laryngeal cryotherapyPROCEDURE

Laryngeal cryotherapy is the therapeutic freezing of tissue in the throat to numb the overactive sensory nerves in the throat. This technique is believed to reduce cough symptoms in this study.

CryoprobeDEVICE

Cryoprobe is FDA approved for use for the destruction of unwanted tissue along the respiratory tract

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult patients 18 years or older with diagnosis of neurogenic cough * Neurogenic cough is a diagnosis of exclusion applied to persistent cough (8 weeks or longer) * Negative workup for other causes, including sinonasal allergies/chronic sinusitis, cough-variant asthma, and GERD * Patient willing to participate in a clinical trial Exclusion Criteria: * Uncontrolled reflux (scoring on Reflux Symptom index of 13 or higher) * Vocal fold abnormalities or impairment * History of asthma or other underlying lung condition not adequately treated or controlled * Uncontrolled Allergic Rhinitis (Total Nasal Symptom Score \>6, which would indicate moderate disease32) * Reported symptom of postnasal drip * Current smoker * Current neuromodulator medication use * Patient unwilling to participate in clinical trial or sign an informed consent * End stage medical disease with poor life expectancy * Medical instability deemed by the investigators as a contraindication for enrollment * Abnormal Chest X-ray * Abnormal pulmonary function testing (PFTs) * Positive local allergy panel (combined RAST testing)

Locations (1)

UT Southwestern Medical Center

Dallas, Texas, United States

RECRUITING

Outcomes

Primary Outcomes

Improved quality of life of patients suffering from chronic cough

This is a validated patient reported outcome measure for chronic cough. This is a questionnaire of 10 questions about cough symptoms, each question is rated on a scale of 0-4 by the patient. The higher the CSI total score the worsen the cough symptoms are for the patient. The CSI will be compared across 5 time points (Pre-Laryngeal Cryotherapy, 1 week post cryotherapy, 1 month post cryotherapy, 3 months post cryotherapy and 6 months post cryotherapy) using repeated measures one-way ANOVA. Post-hoc pair-wise comparisons with Bonferroni correction will be used, as appropriate.

Time frame: 2 years

Pre and Post-time point differences.

Sample size of 25 was determined based on expectations of a detectable significant within-group using a repeated measures ANOVA across 5 time points (add in the time points) with an alpha level of 0.0125, 85% power, and 1.246 effect size (based on previous work by Simpson et al PMID: 29668037.) needed to observe pre-post time point differences.

Time frame: 2 years

Secondary Outcomes

Pre- and post-treatment measures for the cryotherapy treatment group

This measure is the pre cryotherapy and 1 week post cryotherapy laryngeal aesthesiometer testing. This is a type of validated sensory testing of the larynx performed during an office flexible laryngoscopy where calibrated monofilaments are used to assess how sensitive certain parts of the larynx are. The data collected will be if a specific monofilament (size 6-0, 5-0, and 4-0) can trigger or not trigger a cough reflex when applied to specific subsites of the larynx (aryepiglottic fold, laryngeal aspect of epiglottis, false vocal fold, arytenoid prominence, and lateral and medial piriform sinus

Time frame: 2 years

Central Contacts

Shumon Dhar, MD

CONTACT

214-645-7034 Shumon.Dhar@UTSouthwestern.edu

Paula Arellano-Cruz

CONTACT

214-648-8096 Paula.Arellano-Cruz@UTSouthwestern.edu

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.