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Proc R Soc Med. 1922; 15(Otol Sect): 15–18.
PMCID: PMC2101062
PMID: 19982448

The Course and Relations of Arnold’s Nerve (Auricular Branch of the Vagus) in the Temporal Bone

Albert A. Gray
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    Elsevier

    Chest

    Volume 153, Issue 3 , March 2018 , Pages 675-679
    Chest

    Original Research: Signs and Symptoms of Chest Disease

    Prevalence of Arnold Nerve Reflex in Adults and Children With Chronic Cough

    Author links open overlay panel Peter V.DicpinigaitisMD, FCCPa AhmadKantarMD, PhDb OladunniEnilariMDa FrancescoParavatiMDc

    https://doi.org/10.1016/j.chest.2017.11.019 Get rights and content

    Background

    Cough originates from stimulation of structures innervated by the vagus nerve, including the airways and distal esophagus. Arnold nerve reflex describes the induction of cough by stimulation of the external auditory canal, which is innervated by the auricular branch of the vagus. Historically, the prevalence of this reflex has been reported in the range of 2% to 3% on the basis of studies of outpatients in otolaryngology practices, but has not been investigated in healthy volunteers or in patients with chronic cough.

    Methods

    Two hundred adults and 100 children with chronic cough, as well as 100 adult and 100 pediatric volunteers, underwent evaluation consisting of stimulation of the external auditory canal of each ear with a cotton-tipped applicator. Cough occurring within 10 seconds of stimulation was considered induced by the intervention.

    Results

    Arnold nerve reflex was present in 25.5% of adults and 3% of children with chronic cough. The prevalence of the reflex was 2% among healthy adults and children. In adults with chronic cough, Arnold nerve reflex was observed more commonly in women (31.6%) than men (12.5%) and was unilateral in the majority of patients (90.2%).

    Conclusions

    The greater than 12 fold prevalence of Arnold nerve reflex in adults with chronic cough compared with healthy volunteers supports the concept of cough hypersensitivity syndrome (CHS), in which vagal hypersensitivity is proposed to underlie chronic refractory cough. The absence of increased prevalence among children with chronic cough suggests that cough hypersensitivity syndrome is an acquired condition, perhaps triggered by viral respiratory infection or other environmental factor.

    Key Words

    airway hyperresponsiveness
    cough
    sex

    Abbreviations

    CHS

    cough hypersensitivity syndrome
    UTC

    urge-to-cough

    FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

    © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
    No articles found.

    Citing articles

    View article metrics

    About ScienceDirect Remote access Shopping cart Contact and support Terms and conditions Privacy policy

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    Copyright © 2018 Elsevier B.V. or its licensors or contributors. ScienceDirect ® is a registered trademark of Elsevier B.V.

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      Elsevier

      Chest

      Volume 153, Issue 3 , March 2018 , Pages 675-679
      Chest

      Original Research: Signs and Symptoms of Chest Disease

      Prevalence of Arnold Nerve Reflex in Adults and Children With Chronic Cough

      Author links open overlay panel Peter V.DicpinigaitisMD, FCCPa AhmadKantarMD, PhDb OladunniEnilariMDa FrancescoParavatiMDc

      https://doi.org/10.1016/j.chest.2017.11.019 Get rights and content

      Background

      Cough originates from stimulation of structures innervated by the vagus nerve, including the airways and distal esophagus. Arnold nerve reflex describes the induction of cough by stimulation of the external auditory canal, which is innervated by the auricular branch of the vagus. Historically, the prevalence of this reflex has been reported in the range of 2% to 3% on the basis of studies of outpatients in otolaryngology practices, but has not been investigated in healthy volunteers or in patients with chronic cough.

      Methods

      Two hundred adults and 100 children with chronic cough, as well as 100 adult and 100 pediatric volunteers, underwent evaluation consisting of stimulation of the external auditory canal of each ear with a cotton-tipped applicator. Cough occurring within 10 seconds of stimulation was considered induced by the intervention.

      Results

      Arnold nerve reflex was present in 25.5% of adults and 3% of children with chronic cough. The prevalence of the reflex was 2% among healthy adults and children. In adults with chronic cough, Arnold nerve reflex was observed more commonly in women (31.6%) than men (12.5%) and was unilateral in the majority of patients (90.2%).

      Conclusions

      The greater than 12 fold prevalence of Arnold nerve reflex in adults with chronic cough compared with healthy volunteers supports the concept of cough hypersensitivity syndrome (CHS), in which vagal hypersensitivity is proposed to underlie chronic refractory cough. The absence of increased prevalence among children with chronic cough suggests that cough hypersensitivity syndrome is an acquired condition, perhaps triggered by viral respiratory infection or other environmental factor.

      Key Words

      airway hyperresponsiveness
      cough
      sex

      Abbreviations

      CHS

      cough hypersensitivity syndrome
      UTC

      urge-to-cough

      FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

      © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
      No articles found.

      Citing articles

      View article metrics

      About ScienceDirect Remote access Shopping cart Contact and support Terms and conditions Privacy policy

      We use cookies to help provide and enhance our service and tailor content and ads. By continuing you agree to the use of cookies .

      Copyright © 2018 Elsevier B.V. or its licensors or contributors. ScienceDirect ® is a registered trademark of Elsevier B.V.