Impact of Tussigenic Stimuli on Perceived Upper Airway Sensation and Motor Cough Response Following Total Laryngectomy

Amy Fullerton; Yuhan Mou; Natalie Silver; Neil Chheda; Donald C Bolser; Karen Wheeler-Hegland

doi:10.3389/fphys.2020.00477

Impact of Tussigenic Stimuli on Perceived Upper Airway Sensation and Motor Cough Response Following Total Laryngectomy

Front Physiol. 2020 May 29:11:477. doi: 10.3389/fphys.2020.00477. eCollection 2020.

Authors

Amy Fullerton¹, Yuhan Mou², Natalie Silver³, Neil Chheda³, Donald C Bolser⁴, Karen Wheeler-Hegland²

Affiliations

¹ Department of Communication Sciences and Disorders, Brooks Rehabilitation College of Healthcare Science, Jacksonville University, Jacksonville, FL, United States.
² Laboratory of Upper Airway Dysfunction, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, United States.
³ Division of Head and Neck Surgery, Laboratory of Head and Neck Cancer Translational Science, Department of Otolaryngology, University of Florida, Gainesville, FL, United States.
⁴ Laboratory of Physiology and Pharmacology of Cough and Airway Protection, Department of Physiological Sciences, University of Florida, Gainesville, FL, United States.

Abstract

Background: Total laryngectomy (TL) is standard intervention for carcinoma of the head and neck or, in cases of non-functional larynx, as a result of disease or radiation exposure. Laryngeal extirpation serves as a unique human model of both recurrent and superior laryngeal nerve section and offers insight into motor and sensory aspects of cough: both volitional and in response to tussigenic stimuli. While motor changes in cough function are expected among those status post-TL due to postoperative reconstruction of the upper airway, motor cough parameters have not been well described and sensory aspects of cough are unknown in this population, which provides insight into a vagal denervation model in humans.

Methods: Data were collected from three groups totaling 80 adults (39 male), including 25 healthy younger adults (HYA), 27 healthy older adults (HOA), and 28 adults post-TL. Cough was elicited both upon command and in response to nebulized capsaicin. Outcome measures included urge to cough and cough airflows.

Results: Kruskal-Wallis test showed that two of the three groups differed significantly by urge to cough χ²(2, N = 244) = 8.974, p = 0.011. Post hoc analysis showed that post-TL subjects had reduced perceived urge to cough at all concentrations of capsaicin (p < 0.05). Cough airflows were significantly reduced for post-TL subjects compared to healthy controls in all metrics except post-peak phase integral (PPPI) for which HOA and TLs were comparable under both volitional and capsaicin-induced conditions.

Conclusions: These findings support the hypothesis that both cough airflow and sensations are significantly reduced in post-TL subjects when compared with HOA. Interestingly, HOA and post-TL subjects have comparably reduced UTC and cough airflows when compared to HYA. The only metric of cough airflow for which these groups differ is the PPPI, which may be a compensatory adaptation for reduced cough airflows and/or sensation.

Keywords: airway protection; capsaicin; laryngectomy; respiratory defensive reflex; urge to cough.

Grants and funding

OT2 OD023854/OD/NIH HHS/United States