ALA044 - A Systematic Review and Meta-Analysis of Neuromodulators to Treat Chronic Laryngeal Hypersensitivity
Friday, April 29, 2022
11:14 AM – 11:20 AM CT
Location: Landmark D
Rafael E. Amador-González, MD; Neel K. Bhatt, MD; Seth M. Cohen, MD, MPH; Russel Goebel, MD; Jacob P. Noordzij, MD; Lauren Tracey, MD; Masanao Yajima, PhD; Gintas P. Krisciunas, MPH, MA
Introduction: Chronic laryngitis can present with numerous symptoms, including chronic cough. Patients who do not respond to traditional treatments are sometimes diagnosed as having chronic laryngeal hypersensitivity (CLH). In some centers, neuromodulators are prescribed off-label despite limited evidence of efficacy. A previous meta-analysis that included 3 clinical trials suggested neuromodulator therapy improved cough-related quality-of-life. This current meta-analysis examined whether neuromodulating agents can reduce cough frequency among patients with CLH.
Methods: PRISMA guidelines were followed. Online databases PubMed, Embase, Medline, Cochrane Review, and publication bibliographies were searched from 01/01/2000-07/31/2021 using MESH terms. 999 abstracts were identified/screened, 28 studies were fully reviewed, 3 met all inclusion criteria. Only randomized controlled trials (RCT) investigating CLH patients with comparable cough frequency outcomes were included. Potentially eligible papers were reviewed by 3 authors. The meta-analysis used an inverse variance method, restricted maximum-likelihood estimator for tau^2, Q-profile for CI of tau^2 and tau, and Hedges’g.
Results: Fixed-effects point estimates for the difference between the change in log coughs per hour (from baseline to intervention end) comparing treatment to control were -0.215, 95%CI[-0.5107, 0.0825].
Conclusions: This study suggests that neuromodulators may reduce cough frequency. However, high-quality evidence is lacking. This could be due to limited treatment effect or due to limitations in the design and analysis of existing clinical trials. Well-designed RCTs are needed to authoritatively test the efficacy of neuromodulating agents for the treatment of CLH.