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עמוד בית
Wed, 30.07.25

CASE COMMUNICATIONS

IMAJ | volume 27

Journal 7, July 2025
pages: 454-455

Chronic Cough Caused by Arnold’s Nerve Ear-Cough Reflex

1 Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel 2 Department of Otorhinolaryngology–Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel 3 Reichman University, Herzliya, Israel 4 Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel

Summary

Chronic cough is a common clinical symptom with a broad differential diagnosis, including respiratory, gastrointestinal, and neurological causes. A rare yet important cause is Arnold’s nerve reflex (ear-cough reflex) and triggered by stimulation of the auricular branch of the vagus nerve. We present the case of a 77-year-old man with a persistent dry cough and no significant medical history other than mild hypertension. The patient reported paresthesia in his left ear and noted that his cough was often triggered by touching the ear. A comprehensive physical and neurological examination, including otoscopy, was performed. Examination revealed cerumen impaction covering the posterior wall of the left external ear canal. Removal of the cerumen immediately triggered a cough but resulted in complete resolution of symptoms within one day. This case emphasizes the importance of considering Arnold’s nerve reflex as an underlying cause of chronic cough. A thorough physical examination, particularly otoscopy, is essential for accurate diagnosis. Understanding the neuropathic basis of the ear-cough reflex provides insights into targeted management including neuromodulator therapy.

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