Reflex vs. volitional cough differences amongst head and neck cancer survivors characterized by time since treatment and aspiration status☆
Section snippets
Purpose
Disordered cough, or dystussia, is commonly associated with disordered swallowing, or dysphagia (Pitts et al., 2012), which is a leading cause of toxicity and mortality among Head and Neck cancer (HNC) survivors following treatment completion (Langerman et al., 2007). Over half of these survivor’s experience dysphagia following multimodal therapy (Langendijk et al., 2009) a third of which is characterized as silent, or ingestion of material below the glottis without cough (Langerman et al., 2007
Methods
This cross-sectional convenience sample included 33 HNC survivors (Fig. 1) aged 43–80 years old (average 64 years) all of whom received doses of at least 45 Gray (Gy) to head and neck cancer subsites (Table 1). This demarcation was chosen based on existing literature positing that doses of 45 Gy or more to structures involved in swallow results in degradation of this function (Eisbruch et al., 2004). Bilateral mobility of the true vocal folds was verified through endoscopic observation and
Procedures
Cough airflow metrics were obtained using established methods (Hegland et al., 2016) wherein participants were outfitted with a facemask covering the nose and mouth and coupled to a pneumotachograph (MLT 1000, ADInstruments Inc; Colorado Springs, CO) and differential pressure transducer. Airflow measures were recorded after volume calibration with 3-liter Vitalograph syringe (McKesson; Cork, Ireland). Airflow signals were recorded to LabChart7 (ADInstruments) with proprietary software for
Statistical analysis
Descriptive statistics were used to summarize group data; including mean, median, range and standard deviations. Homogeneity within each group was determined with one-way analysis of variance and none of the dependent variables (sex, age, diagnose site, tumor/nodal stage, pack-per-year smoking history or total dose to site) violated Levene’s statistic. To determine differences in the primary outcome of cough airflow (peak expiratory flow rate: PEFR, peak expiratory flow rise time: PEFRT, and
Results
Participants were three months to six years status post treatment completion, 12 of whom were within the subacute phase of treatment completion (average five months) and 21 of whom were in the chronic phase (12 or more months, average 30 months or 2.5 years). The most common site was oral cavity 39 % (n = 13) and pharynx (n = 7) followed by larynx (n = 5), salivary (n = 4) and other head and neck (n = 4); most laryngeal/hypopharyngeal primaries did not meet inclusionary criteria. Eight of those
Discussion
Reflexive cough is a cough in response to tussigenic stimulation of peripheral sensory receptors. Sensory receptors in the laryngeal epithelium are comprised of nociceptive afferents (Yamamoto and Sakada, 1986) responsible for sensing pain and temperature. These include free nerve endings which are comprised of both Aδ and C-fibers (Schulze et al., 1993). Aδ-fibers detect pressure, cold temperature and reliably produce a cough in response to either mechano- or chemostimulation, both of which
Authors’ contributions
AF and KH formulated methods, AF and YM carried out experimental protocol, AF prepared manuscript with edits from NS, NC and KH.
Consent to participate
All participants provided verbal and written informed consent.
Ethical approval
The protocol received ethical approval in accordance with the Declaration of Helsinki from the University of Florida Institutional Review Board.
Declaration of Competing Interest
The authors report no declarations of interest.
Acknowledgements
Funding provided by NIH common fund SPARC #OT2OD023854 and Neal Pitts Foundation.
References (37)
- et al.
Epidemiology and demographics of the head and neck Cancer population
Oral Maxillofac. Surg. Clin. North Am.
(2018) - et al.
Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT?
Int. J. Radiat. Oncol. Biol. Phys.
(2004) - et al.
Cough motor mechanics
Respir. Physiol. Neurobiol.
(2006) - et al.
Examination of swallowing maneuver training and transfer of practiced behaviors to laryngeal vestibule kinematics in functional swallowing of healthy adults
Physiol. Behav.
(2017) - et al.
A predictive model for swallowing dysfunction after curative radiotherapy in head and neck cancer
Radiother. Oncol.
(2009) - et al.
Voluntary control of cough
Pulm. Pharmacol. Ther.
(2002) - et al.
Voluntary and reflex cough: similarities and differences
Pulm. Pharmacol. Ther.
(2011) - et al.
Oropharyngeal and laryngeal sensory innervation in the pathophysiology of swallowing disorders and sensory stimulation treatments
Ann. N. Y. Acad. Sci.
(2016) - et al.
Radiation-induced neuropathies in head and neck cancer: prevention and treatment modalities
Cancer Med. Sci.
(2020) - et al.
Respiratory Kinematic and airflow differences between reflex and voluntary cough in healthy young adults
Front. Physiol.
(2015)
Clinical cough I: the urge-to-cough: a respiratory sensation
Unilateral superior laryngeal nerve lesion in an animal model of dysphagia and its effect on sucking and swallowing
Dysphagia
Localization of transient receptor potential vanilloid (TRPV) in the human larynx
Acta Otolaryngol.
Sequential voluntary cough and aspiration risk in Parkinson’s disease
Lung
Comparison of two methods for inducing reflex cough in patients with Parkinson’s disease, with and without dysphagia
Dysphagia
Adaptation of swallowing hyo-laryngeal kinematics is distinct in oral vs. pharyngeal sensory processing
J. Appl. Physiol.
Aspiration pneumonia after chemo-intensity-modulated radiation therapy of oropharyngeal carcinoma and its clinical and dysphagia-related predictors
Head Neck
Late dysphagia after radiotherapy-based treatment of head and neck cancer
Cancer
Cited by (2)
Characterization of Ethyl Butyrate–Induced Cough Before and After Breath Control Techniques in Healthy Adults
2023, American Journal of Speech-Language Pathology
- ☆
This work is an elaboration of a poster presentation given November, 2019 at the Annual meeting of the American Speech and Hearing Association and virtual podium presentation given March, 2020 at the annual meeting of the Dysphagia Research Society.