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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Common otolaryngologic symptoms such as coughing and sneezing may not be manifestations of disease of the upper respiratory tract. Two cases are reported in which these symptoms were the first evidence of tic-like disorders. A short discussion of one such disorder, Gilles de la Tourette's syndrome, is presented. The entity of paroxysmal sneezing is also mentioned. It is pointed out that, in the absence of otolaryngologic disease, these disorders may first present to an otolaryngologist for diagnosis.
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PMID:Otolaryngologic presentation of tic-like disorders. 28 86

Examined was material taken from five sheep (ewes) and two weaned lambs having naturally contracted Qu rickettsiosis. Described are the clinical symptoms of the disease and the morphologic changes. The diseased animals showed rise in temperature (39.5--40.5 degrees C), loss of appetite, and depression. Some of the weaned lambs manifested slight cough and digestive troubles. Part of the animals showed nervous symptoms--tic movements of the head and limbs. Morphologically, the liver was edematired, of lower compactness, and the spleen was enlarged, the meninges being hyperemic and peppered with pinpointed hemorrhages. Histologically, a strong diffuse activation and proliferation of the liver capillary endothelium was established along with necrobiosis of the liver epithelial cells and a diffuse leukocyte infiltration. Established was also hyperplasia of the reticular cells and the lymph follicles of the spleen and the bronchial lymph nodes. The epithelial cells of the kidney tubules were involved in vacuolar dystrophy, and in the medular section there were fibroblastic proliferations with hyperemia. Inflammatory changes in the brain were also found.
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PMID:[Histopathology of Q rickettsiosis in sheep]. 60 54

Tourette syndrome (TS) is the most complex tic disorder and presents primarily in the pediatric population between the ages of two and 15. The otolaryngologist may be consulted to see such a patient because of head and neck or facial tics or more often because of phonic or vocal tics such as throat-clearing, sniffing, coughing or abnormal noises. As this disorder has not appeared in the otolaryngologic literature we undertook a retrospective chart review (N = 72) and follow-up questionnaire related to the otolaryngologic aspects of this disorder.
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PMID:Tourette syndrome and otolaryngology. 258 91

Myoclonic jerks involving the proximal limb musculature and tic-like movements (sniffing, coughing, or sighing) were observed in an 11-year-old boy with benign occipital epilepsy treated with carbamazepine (CBZ). The involuntary movements disappeared a few days after withdrawal of CBZ and reappeared with CBZ reintroduction. Plasma CBZ levels were always within the therapeutic range. Polygraphic studies failed to show any electroencephalogram (EEG) changes during myoclonic jerks. Appearance of nonepileptic myoclonus in epileptic children treated with CBZ should be carefully evaluated to prevent worsening of the clinical picture. The coexistence of other involuntary movements (tics) could suggest the correct diagnosis.
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PMID:Carbamazepine-induced nonepileptic myoclonus in a child with benign epilepsy. 365 53

Of 33 patients with psychogenic cough tic, 31 were successfully treated using an unusual reinforced suggestion technique. The cough usually follows an incidental upper respiratory tract infection and persists as a loud paroxysmal barking or honking sound for weeks to months. Paroxysms occur all day but cease with sleep. The diagnosis is often delayed for weeks to months while the patient is exposed to an increasing intensity of diagnostic procedures and therapy. Thirty percent of some 20 patients previously reported in the literature had been hospitalized. The reinforced suggestion technique depends upon the physician's convincing the patient that the persistent cough has weakened the chest muscles, which are now unable to contain the cough, and that a bedsheet tightly wrapped around the chest will provide the necessary support to stop the cough within 24 to 48 hours. The typical patient can produce the cough on command, has an ambivalent response to the prospect of care, is unconcerned about his symptoms, submits willingly to the examination and procedures, and is kept out of school for the duration of the cough. Findings on physical examination are normal except for abnormal gag and corneal reflexes. The gag reflex was depressed in six and absent in 20 of the 31 patients. The corneal reflex was depressed in 16 and absent in 5 of the 31 patients. These abnormal responses help to corroborate the psychogenic etiology. Early recognition of the nonorganic nature of this syndrome will reduce parental anxiety, loss of school time, risk of iatrogenic complications, and unnecessary medical and hospital expense.
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PMID:The cough and the bedsheet. 673 3

Psychogenic cough tic is a troublesome complaint. The cough is a noisy bark or honking, repeated frequently while the child is awake, but absent during sleep. Clinical and laboratory findings are negative, and cough suppressants and other medications are ineffective. The cough usually starts in the winter months and may be preceded by an upper respiratory tract infection. School phobia is frequently a contributory cause, but other psychological problems must also be considered. Treatment is usually by suggestion and identification of the underlying psychological problem. In some cases tranquillizers may be required.
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PMID:'Honking': Psychogenic cough tic in children. 736 Dec 11

In the first study, we used pulse oximetry to continuously measure SpO2 and pulse rate in inpatients with paroxysmal attacks of acute asthma. Desaturation and increases in pulse rate occurred during coughing, urination, defecation, eating, and sleeping. Desaturation was most severe and frequent when peak expiratory flow was in the red zone. When it was in the yellow zone or blue zone, desaturation was less severe and less frequent. In the second study, outpatients experiencing exacerbations of chronic asthma and inpatients experiencing acute asthmatic attacks inhaled of a beta 2-stimulant via an ultrasonic nebulizer and were monitored with pulse oximetry. In the former, SpO2 either did not change or increased, but in the latter SpO2 decreased markedly when patients were in the red zone. Therefore, when patients inhale a bronchodilator during an acute asthmatic attack they should be carefully monitored with pulse oximetry. In the third study, pulse oximetry was used to measure saturation in outpatients who were suspected of having hyperresponsive airways and had undergone an airway hyperresponsiveness test with an Astograph. Almost all of those who had desaturation of more than 4% from were markedly hyperresponsive. The degree of desaturation and the percent change in respiratory resistance were significantly correlated. In conclusion, pulse oximetry can be useful in the short-term and long-term management of asthma tic patients.
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PMID:[Bronchial asthma and desaturation--assessment by pulse oximetry]. 760 18

The purpose of this study was to investigate the effectiveness of differential reinforcement of the absence of a chronic vocal tic in a 9-year-old male. This procedure was used after problems in the application of a simplified habit reversal procedure were encountered, and when it became evident that a reinforcement procedure was more acceptable to the patient. Once differential reinforcement was implemented, a substantial decrease (to near zero frequency) in coughing and throat clearing resulted. The reduction of coughing and throat clearing was seen within and outside the treatment session. Treatment effects were maintained after fading the reinforcement and throughout posttreatment (50 weeks).
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PMID:Treatment of a vocal tic by differential reinforcement. 764 59

A case of psychogenic cough tic is presented to demonstrate the problems and complications that can arise from misdiagnosis of this dramatic and disabling disorder. It can be confused with TS and may be treated more aggressively than is beneficial. A single case with a recurrent course is described with the hypothesis of a possible autoimmune contribution. The combination of organic precipitants and emotional maintaining factors suggests that psychogenic cough tic is a condition that lies between somatization and transient tic disorder.
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PMID:Psychogenic cough tic: a case report. 933 29

Tourette syndrome is a neurodevelopmental disorder characterized by motor and vocal tics--rapid, repetitive, stereotyped movements or vocalizations. Tourette syndrome typically has a prepubertal onset, and boys are more commonly affected than girls. Symptoms usually begin with transient bouts of simple motor tics. By age 10 years, most children are aware of nearly irresistible somatosensory urges that precede the tics. These urges likely reflect a defect in sensorimotor gating because they intrude into the child's conscious awareness and become a source of distraction and distress. A momentary sense of relief typically follows the completion of a tic. Over the course of hours, tics occur in bouts, with a regular intertic interval. Tics increase during periods of emotional excitement and fatigue. Tics can become "complex" in nature and appear to be purposeful. Tics can be willfully suppressed for brief intervals and can be evoked by the mere mention of them. Tics typically diminish during periods of goal-directed behavior, especially those that involve both heightened attention and fine motor or vocal control, as occur in musical and athletic performances. Over the course of months, tics wax and wane. New tics appear, often in response to new sources of somatosensory irritation, such as the appearance of a persistent vocal tic (a cough) following a cold. Over the course of years, tic severity typically peaks between 8 and 12 years of age. By the end of the second decade of life, many individuals are virtually tic free. Less than 20% of cases continue to experience clinically impairing tics as adults. Tics rarely occur in isolation, and other coexisting conditions--such as behavioral disinhibition, hypersensitivity to a broad range of sensory stimuli, problems with visual motor integration, procedural learning difficulties, attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, depression, anxiety, and emotional instability--are often a greater source of impairment than the tics themselves. Emerging behavioral treatments of Tourette syndrome are based in part on an understanding of the moment-to-moment experience of somatosensory urges and motor response. With identification of specific genes of major effect and advances in our understanding of the neural circuitry of sensorimotor gating, habit formation, and procedural memory--together with insights from postmortem brain studies, in vivo brain imaging, and electrophysiologic recordings--we might be on the threshold of a deeper understanding of the phenomenology and natural history of Tourette syndrome.
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PMID:Tourette syndrome: the self under siege. 1697 Aug 64


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