Many cases of earwax impaction (or foreign body presence) and the relationship to chronic cough may go unrecognized. The routine incorporation of examination of the external auditory canal in patients with chronic cough may reveal a number of patients with impacted earwax.1 The literature suggests that 2% to 6% of the general population have impacted earwax.1 Patients over 65 years of age have much higher prevalence of impacted earwax. Removal of impacted earwax in patients with chronic cough may resolve the symptoms, as demonstrated in the following case:
A 63-year-old white man, an avid beach enthusiast, with a history of hyperlipidemia, history of smoking, and with conductive hearing loss of the right ear, presented with a chronic dry cough of 6 months duration. Coughing episodes were often precipitated by eating. Coughing spells often lasted several hours. The cough was refractory to treatment for postnasal drip, cough-variant asthma, and gastroesophageal reflux disease. A chest x-ray study was negative for pathology. In preparation for an audiogram for a hearing aid device, a circumferential foreign body was noted deep and medially in the left external auditory canal abutting the tympanic membrane, and was subsequently removed. The foreign body consisted of a concretion of sand with earwax. Unexpectedly, the chronic cough resolved over several days.
The persistent mechanical stimulation of the vagal nerve may be the mechanism associated with a chronic cough through the somatic sensory branch of the vagal nerve, known as Arnold’s nerve.2 Arnold’s nerve innervates the posterior and inferior meatal skin. Fifteen cases have been reported in the literature.2, 3 The majority of cases were associated with earwax or a foreign body.
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-Kellyanne Rose Gold, JD, Jacob L. Wester, MD, Robert Gold, MD
This article originally appeared in the April 2017 issue of The American Journal of Medicine.
