Diabolical Coughing— Prima Facie Protocols for Diagnosis and Treatment of Medically Jaded Patients

The use of botulinum toxin injection as a new treatment for chronic (neurogenic) cough is new and novel. In an article by Sasieta and colleagues in this issue of JAMA Otolaryngology—Head & Neck Surgery, 22 patients whose chronic coughing had been repeatedly evaluated and treated for many years without benefit received 31 distinct injections of very large doses of botulinum toxin type A (BtxA) into each thyroarytenoid muscle. In this retrospective study, response to treatment was assessed via telephone follow-up using patient self-reporting of percent improvement of cough at 1 and 2 months. The primary outcome of treatment success was defined as a 50% or greater reduction in the patient's subjective perception or assessment of their cough severity.

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