Mirtazapine 30 mg as a Potential New Therapy for the Treatment of Laryngeal Sensory Neuropathy
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Khaled Mohamed Abdelzaher1, Marowa Abd El Wahab1, Mostafa Nasr Zayed1
1Department of Otorhinolaryngology, Faculty of Medicine, Minia University, Minia, Egypt . Phoniatric unit,ENT department, Faculty of Medicine, Minia University, Minia, Egypt.
Objective:
Laryngeal sensory neuropathy (LSN) is an irritating laryngeal disorder that may cause intractable cough, globus sensation, and frequent throat clearing. The diagnosis is typically done by exclusion, even if the postulated etiologies are viral, allergic, or idiopathic. The study aims to introduce mirtazapine 30 mg as a potential new therapy.
Study Design:
Pilot study.
Subjects And Methods:
Eighty LSN patients who did not respond to gabapentin and/or amitriptyline were gathered from Minia University Hospital's otorhinolaryngology department and divided into two groups: The Case Group (n = 40) received mirtazapine. In contrast, the Placebo Group (n = 40) administered a placebo capsule once daily for one month. Patients were asked to rank their symptoms on a scale of 0 to 5 in pretreatment and post treatment questionnaires. Voice Handicap Index (VHI) and acoustic analysis were also used as parameters for evaluation. Evidence of treatment intolerance and adverse effects was also documented.
Results:
After 1 month of mirtazapine therapy, the mean post treatment chief complaint severity rating was 1.2, while the mean pretreatment one was 3.9. Treatment significantly improved VHI and acoustic scores (P < 0.001) in the case group and differed significantly from the placebo group. Two patients did not tolerate the medications due to dizziness, and four were missed during follow-up.
Conclusion:
Mirtazapine 30 seems to be a practical therapy choice for LSN. More research is required to compare the results of this treatment protocol with those of other medications used to treat LSN, including systemic drugs or local interventions such as superior laryngeal nerve block injections, to provide additional context and validation for our findings.
Insights
Mirtazapine effectively treats laryngeal sensory neuropathy (LSN) symptoms like cough and throat clearing. This pilot study found mirtazapine significantly improved patient outcomes compared to placebo.
Area of Science:
- Otolaryngology
- Neurology
- Pharmacology
Background:
- Laryngeal sensory neuropathy (LSN) presents with bothersome symptoms including intractable cough, globus sensation, and throat clearing.
- Current LSN diagnosis is often by exclusion, with potential causes including viral, allergic, or idiopathic factors.
- Existing treatments like gabapentin and amitriptyline may not be effective for all LSN patients.
Purpose of the Study:
- To evaluate mirtazapine 30 mg as a novel therapeutic option for patients with laryngeal sensory neuropathy (LSN).
- To assess the efficacy and safety of mirtazapine in LSN patients refractory to conventional treatments.
Main Methods:
- A pilot study involving 80 LSN patients who failed gabapentin and/or amitriptyline treatment.
- Patients were randomized into two groups: 40 received mirtazapine 30 mg daily, and 40 received a placebo for one month.
- Symptom severity, Voice Handicap Index (VHI), and acoustic analysis were used for pre- and post-treatment evaluation.
Main Results:
- Mirtazapine significantly reduced chief complaint severity from a mean of 3.9 to 1.2 post-treatment (P < 0.001).
- Significant improvements were observed in VHI and acoustic analysis scores in the mirtazapine group compared to placebo.
- Two patients experienced dizziness, leading to treatment intolerance; four patients were lost to follow-up.
Conclusions:
- Mirtazapine 30 mg demonstrates potential as a practical therapeutic agent for managing laryngeal sensory neuropathy (LSN).
- Further research is warranted to compare mirtazapine with other LSN treatments, including systemic drugs and local interventions like superior laryngeal nerve blocks.
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