Sensory Neuropathic Cough (SNC)
When coughing doesn’t stop.
Sensory Neuropathic Cough (SNC) is a chronic cough disorder that is thought to have a neurogenic cause.
Sensory neuropathic cough (SNC) 1 is also sometimes referred to as a cough caused by “laryngeal sensory neuropathy,” or is sometimes grouped within the more general category of “refractory chronic cough.”
Symptoms of Sensory Neuropathic Cough
A person with SNC may cough dozens to hundreds of times per day, often also waking up at night to cough. A few of these daily coughing attacks may become violent and last 30 seconds to several minutes. The person’s eyes may tear up and the nose may run; the person may gag or throw up; the person may leak urine, or worse; a few of our patients have even broken one or more ribs during a violent coughing attack. A key characteristic of SNC is that a coughing attack is typically, though not always, preceded by an abrupt sensation in the throat; this sensation may be described as a “tickle,” a “sudden dry patch,” “like inhaling a powdered doughnut,” “dripping mucus,” or something else.
Possible Explanation for SNC
SNC is thought to be a relative to neuralgia, like post-herpetic neuralgia (persistent pain long after an outbreak of shingles has resolved), or even diabetic neuropathy (“I feel bees stinging my feet”), except that the sensations felt by SNC patients are not painful. With SNC, it may be that the nerve endings in a person’s throat have become damaged, so that they “misfire” and cause this cough-provoking tickling or similar sensations.
Treatment for SNC
Many individuals with SNC have found relief through use of a neuralgia medication, such as amitriptyline 2, desipramine 3, gabapentin 4, pregabalin, oxcarbazepine, and others. These kinds of medications may help to reduce or abolish a person’s coughing by diminishing the nerve-ending “misfires” caused by SNC. In our experience, patients sometimes need to work through more than one of these neuralgia medication options, at varying dosage levels, before they arrive at a satisfactory degree of relief. Another treatment option that can be tried is capsaicin. For more about treatment, see our second video (SNC: Medications) below.
Audio Examples of SNC
Note: Some aspects of these patients’ experiences are atypical; not all patients have the same experience with SNC.
Photos of SNC
A collection of photo essays demonstrating SNC in various patients.
Bruising from Sensory Neuropathic Cough
Videos about SNC
SNC, Part I: Coughing That Won’t Go AwaySensory neuropathic cough is a chronic cough condition that does not respond to the usual treatments. Many individuals who have been coughing for years find relief from treatment with “neuralgia” medications.
SNC Part II: MedicationsDr. Bastian continues from SNC, Part I and introduces potential medications to treat sensory neuropathic cough.
Still Coughing After COVID?In this video, Dr. Robert W. Bastian explains three explanations for coughing in the context of Covid-19 infection, with emphasis on the potential for sensory neuropathic cough (Phase 3).
Phantom Phlegm!!Patients with Sensory Neuropathic Cough (SNC) comment on feeling mucus drip down their throats, but often…it isn’t there!
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Bastian RW, Vaidya AM, Delsupehe KG. Sensory neuropathic cough: a common and treatable cause of chronic cough. Otolaryngol Head and Neck Surg. 2006; 135(1): 17-21. 
Jeyakumar A, Brickman TM, Haben M. Effectiveness of amitriptyline versus cough suppressants in the treatment of chronic cough resulting from postviral vagal neuropathy. Laryngoscope. 2006; 116: 2108-2112. 
Bastian ZJ, Bastian RW. The use of neuralgia medications to treat sensory neuropathic cough: our experience in a retrospective cohort of thirty-two patients. PeerJ. 2015; 3:e816. 
Ryan NM, Birring SS, Gibson PG. Gabapentin for refractory chronic cough: a randomized, double-blind, placebo-controlled trial. Lancet. 2012; 380(9853): 1583-9.