How is the reflex cough test performed in the workup of dysphagia?

Updated: Mar 20, 2020
  • Author: Nam-Jong Paik, MD, PhD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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For the reflex cough test, a 20% solution of L-tartaric acid is dissolved in 2 mL of sterile normal saline. Using a nasal nebulizer, the patient inhales the solution, which stimulates cough receptors in the vestibule of the larynx and initiates the laryngeal cough reflex.

The laryngeal cough reflex protects the laryngeal aditus from significant aspiration and reduces the risk of respiratory complications (eg, pneumonia). An impaired laryngeal cough reflex may permit laryngeal penetration and increase the risk of aspiration pneumonia. An acute cerebrovascular accident often appears to affect the protective cough reflex.

Using a reflex cough test, Addington and colleagues were able to identify which patients with stroke were unlikely to subsequently develop aspiration pneumonia (specificity, 100%). [46]

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