Sensory neuropathic cough (SNC), or neurogenic cough, is a chronic cough that is usually dry. People may also experience ticking, burning, or painful sensations in the throat. It occurs when the nerves in the throat and larynx become overly sensitive, resulting in excessive coughing.
In the United States, neuropathic coughing may affect around 11% of people. The condition is more common in females and older adults.
Doctors may rule out other possible causes of cough before diagnosing SNC.
This article looks at the symptoms, causes, treatment, and outlook of SNC.
Symptoms of SNC may include:
- a persistent dry cough lasting for at least 8 weeks in adults or 4 weeks in children
- sudden sensory sensations, such as a tickling throat or dry patches, just before a coughing episode starts
- pain, burning, or tingling sensations in the throat
- excessive throat clearing
- a feeling of something being caught in the throat
People may experience hundreds of coughing episodes daily. Severe coughing episodes may cause other symptoms, such as:
- stress incontinence
- laryngospasm — a short spasm of the vocal cords, making it difficult to speak or breathe temporarily
- sleep disturbance
- reduced quality of life, if coughing affects everyday activities, work, or relationships
Certain triggers may cause coughing episodes, such as:
- inhaling cold air
- strong smells
In many cases, there is no clear cause of SNC. However, the condition may occur due to:
- Upper respiratory infection: A cold or upper respiratory infection may affect the nerves that control throat sensations. The nerves may become overly sensitive to breathing, swallowing, or other typical sensory stimuli and create an atypical response, such as coughing. This may also happen by itself, without a known cause.
- Neuralgia: This refers to pain from nerve irritation or damage that can occur from a virus or medical procedure, such as surgery.
- Hypersensitivity of the larynx: The larynx plays an important role in the cough reflex, which includes multiple muscles in the chest and airways responding to stimuli to produce a cough. Hypersensitivity of the larynx may result in excessive coughing.
- Nerve hypersensitivity: People with SNC can have hypersensitivity of sensory receptors on the larynx. Sensory receptors respond to stimulation, and hypersensitivity means they have an exaggerated response to typical stimuli. Hypersensitivity of the superior laryngeal nerve, which supplies the larynx, may cause SNC.
Doctors may diagnose people with SNC after ruling out other possible causes or if individuals have not responded to standard cough treatments.
Doctors may carry out tests to check for other conditions that can cause chronic cough, such as:
- postnasal drip
- chronic bronchitis
- gastroesophageal reflux disease
- side effects of medication, such as angiotensin converting enzyme inhibitors for treating high blood pressure
- lung cancer
If tests for other conditions produce negative results and standard cough treatments are not effective, a doctor may diagnose SNC.
According to the American Academy of Otolaryngology–Head and Neck Surgery, treatment for SNC may include cough retraining therapy, medications, or medical procedures.
Initial treatments for SNC may involve working with a speech-language specialist to teach people how to control and suppress coughing. Retraining may include:
- when feeling the urge to cough, swallowing instead of coughing
- sipping water
- staying properly hydrated
- avoiding smoking, caffeine, and alcohol
- breathing through the nose rather than the mouth
- avoiding straining when speaking
Certain medications may also help treat SNC. These may include:
- gabapentin (Neurontin)
- pregabalin (Lyrica)
- amitriptyline (Elavil), which is a tricyclic antidepressant
Gabapentin and pregabalin are common treatment options for SNC, but they may cause side effects, such as:
They can also cause a person to experience withdrawal symptoms after they stop the medication.
People can speak with a doctor if they have any concerns about medication side effects. They can also consult a healthcare professional if they have concerns about these drugs interacting with any existing medications or health issues.
Medical procedures, which a doctor may carry out in-office, may also help treat SNC. A doctor may use nerve blocks, where they inject certain medications or substances into a person’s throat or vocal cords to lessen coughing. This may include:
- numbing agents
- botulinum (Botox)
According to a 2021 study, topical capsaicin may be a potential treatment for SNC. Out of 201 participants with SNC, topical capsaicin provided some symptom relief in 63.7% of people and resulted in 75% or more cough reduction in 30.8% of individuals.
Topical capsaicin may be easy for people to use and has minimal side effects, with no known interactions with medications.
Treatments may help ease symptoms or resolve SNC. Medications, such as amitriptyline, may be effective in reducing cough and related symptoms, while topical capsaicin may help in cough reduction.
SNC is a chronic cough that is due to an issue with the nerves in the throat and upper respiratory system. Irritation or damage to nerve endings may cause SNC.
SNC causes a persistent cough for more than 8 weeks in adults and 4 weeks in children. It may cause ticking, burning, or dry sensations in the throat.
Treatments may include cough retraining therapy, medications, and nerve blocks. Treatments may help reduce symptoms, improve quality of life, and could resolve the condition.