{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T04:20:47Z","timestamp":1782447647979,"version":"3.54.5"},"reference-count":34,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:00:00Z","timestamp":1742515200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Assess practice trends among laryngologists within the United States surrounding neuromodulator use for chronic cough treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Anonymous 29\u2010item survey comprised of a mixture of multiple choice, Likert scale, and free\u2010text answers was electronically distributed to practicing laryngologists in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty\u2010five laryngologists from 26 states responded. The majority (96.5%) prescribe neuromodulators for chronic cough and are the preferred first\u2010line treatment for refractory explained chronic cough (37.8%) and unexplained chronic cough (50.6%). Gabapentin (97.6%), amitriptyline (91.5%), and tramadol (73.2%) are the most used. The preferred first\u2010line drugs were also gabapentin (45.1%), amitriptyline (39.0%), and tramadol (11.0%). Most wait 3\u20136\u2009months before making changes when a neuromodulator is successful, then wean to the lowest possible cough\u2010controlling dose (68.3%) or taper off completely (24.4%). When a neuromodulator fails: 43.9% wean and try another neuromodulator; others shift to a superior laryngeal nerve (SLN) block (24.4%). When cough recurs almost immediately after weaning an effective neuromodulator, most will re\u2010initiate it again (97.6% likely or highly likely). If the cough recurs in the future, typical practice includes reinitiating the same prior effective neuromodulator at its previously tolerated effective dose (40.5%) or re\u2010titrating to the new effective dose needed (51.9%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Laryngologists routinely prescribe neuromodulators for unexplained and refractory chronic cough. Gabapentin and amitriptyline are the preferred first\u2010line agents, generally titrated to maximal effect, balancing against side effects. A low threshold to reinitiate previously effective neuromodulators exists when cough recurs. If an initial neuromodulator is unsuccessful, either a different neuromodulator or a SLN block is considered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>5<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.32109","type":"journal-article","created":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T08:44:23Z","timestamp":1742719463000},"page":"2454-2462","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Practice Trends in Laryngology: Neuromodulators for Treatment of Chronic Cough"],"prefix":"10.1002","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4417-7700","authenticated-orcid":false,"given":"Christopher D.","family":"Dwyer","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\u2014Head and Neck Surgery, Harvard Medical School Brigham &amp; Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael M.","family":"Johns","sequence":"additional","affiliation":[{"name":"USC Voice Center, Caruso Department of Otolaryngology\u2014Head and Neck Surgery Keck School of Medicine  California Los Angeles USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer J.","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\u2014Head and Neck Surgery, Harvard Medical School Brigham &amp; Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5666-2482","authenticated-orcid":false,"given":"Thomas L.","family":"Carroll","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\u2014Head and Neck Surgery, Harvard Medical School Brigham &amp; Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,21]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-7125(16)34331-0"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.129.1.1"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60596-6"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.15-1496"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25186"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940511400401"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2006.02.003"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2010.07.009"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60776-4"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000244377.60334.e3"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.15-1271"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599812471817"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26393"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2023.103815"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2024.0898"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26160"},{"issue":"3","key":"e_1_2_7_18_1","first-page":"S1","article-title":"The Utility and Feasibility of Extending Beyond Traditional Patient Descriptions in Daily Practice","volume":"130","author":"Shin J. 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