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

Peter Vytautas Dicpinigaitis, Ahmad Kantar, Oladunni Enilari, Francesco Paravati

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)675-679
Number of pages5
Issue number3
StatePublished - Mar 1 2018


  • airway hyperresponsiveness
  • cough
  • sex

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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