Ann Clin Otolaryngol | Volume 2, Issue 3 | Research Article | Open Access
Minyoung Jang1, Samuel J. Rubin1, Daniel J. Stein1,2 and Jacob Pieter Noordzij1*
1Department of Otolaryngology, Boston University, Boston, USA
2Department of Internal Medicine, University of Virginia, Charlottesville, USA
*Correspondance to: J. Pieter Noordzij
Fulltext PDFObjective: A neuropathic etiology has been suggested for patients with chronic laryngopharyngitis symptoms without visible structural pathology. Prior studies have shown that treatment with neuro-modulating medications is beneficial, but it is unknown if this was due to placebo effect. Our objective was to compare the efficacy of amitriptyline versus placebo in treating chronic laryngopharyngeal neuropathy. Study
Design: Prospective, randomized placebo-controlled trial.
Methods: Patients were randomized to receive placebo or amitriptyline for 8 weeks. Primary outcome was change in modified Reflux Symptom Index (mRSI) score. Secondary outcomes were change in Voice Handicap Index-10 (VHI) scores, rates of adverse effects, and overall symptom severity.
Results: Eighteen patients completed the study. The average difference in mRSI and VHI scores after treatment were not significantly different between study arms. However, more subjects taking amitriptyline felt their symptoms had subjectively improved (6 out of 9, 67%), while the remainder noted no change. In the placebo group, only 4 out of 9 subjects (44%) felt their symptoms were better and 2 felt worse. Subjects took an average of 25 mg of amitriptyline or placebo daily by the end of the 8 week treatment period. No serious adverse effects were noted.
Conclusion: Although there was a trend toward greater subjective improvement in overall symptoms with amitriptyline, interpretation is limited due to the small sample size. Larger randomized controlled trials to determine the efficacy of neuro-modulating agents in the treatment of chronic laryngopharyngeal neuropathy, as well as better metrics to characterize this disorder are warranted.
Cough; Laryngitis; Chronic laryngopharyngeal neuropathy; Amitriptyline
Jang M, Rubin SJ, Stein DJ, Noordzij JP. Randomized Double Blind Trial of Amitriptyline versus Placebo in Treatment of Chronic Laryngopharyngeal Neuropathy-Preliminary Results. Ann Clin Otolaryngol. 2017; 2(3): 1016.