Israel Medical Association Journal

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.

Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. It is assumed that sleep is involved in the pathogenesis of BPPV, and that habitual head-lying side during sleep correlates with the affected side in the posterior semicircular canal BPPV.

Objectives: To investigate the relationship between the preferred sleeping position and the affected semicircular canal in patients with BPPV.

Methods: We performed a retrospective data review of patients seeking help for vertigo/dizziness who had undergone clinical evaluation including a Dix–Hallpike test. Patients diagnosed with posterior canal BPPV (p-BPPV) were asked to define their preferred lying side (right, left, supine, or variable) during the night sleep. Affected semicircular canal (right posterior or left posterior) was registered along with demographic data.

Results: In all, 237 patients were diagnosed with p-BPPV. Patients with horizontal semicircular canal BPPV (n=11) were excluded. Patient mean age was 57 years (range 14–87). There were 150 patients with right p-BPPV and 87 patients with left p-BPPV. Among the patients, 122 (52%) habitually slept on the right side. Of those, 102 (84%) were diagnosed with right p-BPPV (P = 0.0006), while 82 patients (34%) habitually slept on the left side. Fifty-three (65%) were diagnosed with left p-BPPV (P < 0.0001). There were no differences in right vs. left p-BPPV in the 33 patients (14%) who expressed no preference concerning their sleeping positions.

Conclusions: Our study highlights the etiology of BPPV and showed that changing sleep position habits might be helpful in preventing recurrent BPPV.

Objectives: To examine prospectively the feasibility of vessel sealing in tracheostomy.

Methods: A vessel-sealing device was used in 24 consecutive patients undergoing tracheostomy. There were no exclusion criteria for enrolling the patients. No other hemostatic technique was used for dividing the isthmus.

Results: There were no bleeding events throughout the postoperative period. The operating time savingwas 5–10 minutes.

Conclusions: Use of the vessel sealer was found to be straightforward, efficacious, rapid and safe.