Management of Vocal Cord Damage After Chronic Coughing
Understanding the Mechanism of Vocal Cord Damage
- Violent coughing generates intrathoracic pressures up to 300 mm Hg, propelling air past the vocal cords at velocities approaching 500 miles per hour during the expiratory phase, causing vocal cord edema from trauma to the laryngeal structures during their violent undulations, resulting in reversible, extrathoracic, variable upper airway obstruction visible on flow-volume loops 1, 2
Primary Treatment Approach: Address the Underlying Cough
- The American Thoracic Society recommends systematically evaluating for upper airway cough syndrome, asthma, gastroesophageal reflux disease, and ACE inhibitor use as these are the most common causes of chronic cough 3
- Discontinuing ACE inhibitors if present can lead to resolution of cough within 3-7 days after withdrawal, as recommended by the American College of Chest Physicians 4, 3
Symptomatic Management During Treatment
- The American College of Chest Physicians suggests using dextromethorphan (60 mg for maximum effect) for cough suppression with fewer side effects than codeine 7
- Menthol lozenges or vapor can offer short-term relief through cold and menthol-sensitive receptors, as recommended by the American Thoracic Society 7
- Adequate hydration and simple honey-lemon mixtures can provide symptomatic relief, according to the American College of Chest Physicians 7
- Smoking cessation is mandatory as smoking worsens both cough and laryngeal symptoms, as stated by the European Respiratory Society 8, 7