From the Guidelines
A hair in the ear canal near the tympanic membrane can indeed elicit a cough reflex, as evidenced by the Arnold's ear-cough reflex, which is present in approximately 2.3% to 4.2% of people 1. This phenomenon occurs due to the innervation of the ear canal by the auricular branch of the vagus nerve, which also supplies sensory fibers to the throat and lungs. When this nerve is stimulated by a foreign object like a hair touching the ear canal or eardrum, it can activate the same neural pathway that triggers coughing when the respiratory tract is irritated. Some key points to consider:
- The prevalence of Arnold's ear-cough reflex in children with chronic cough is similar to that in healthy children, but it is 11-fold higher in adults with chronic cough compared to healthy adults and adults with respiratory disease without cough 1.
- The reflex can be elicited by mechanical stimulation of the ear canal, such as insertion of a cotton-tip applicator 3 to 5 mm for 2 to 3 seconds 1.
- In patients with chronic cough, it is essential to examine the ears and remove any foreign material or structure, such as a hair resting on the eardrum, as this can be a rare cause of chronic cough 1. To address this issue, the hair should be carefully removed from the ear canal, preferably by a healthcare professional using proper tools like an otoscope and ear curette. It is crucial to avoid attempting to remove the hair with cotton swabs or other objects, as this may push the hair deeper or damage the eardrum. If coughing persists after removal or if removal is difficult, seeking medical attention is recommended.
From the Research
Hair in Ear Canal and Cough Reflex
- A hair in the ear canal near the tympanic membrane can elicit a cough reflex, as demonstrated in several case studies 2, 3.
- The presence of hair in the ear canal can stimulate Arnold's branch of the vagus nerve, leading to the urge-to-cough 2.
- Removal of the hair from the ear canal and external auditory canal can result in significant improvement or complete resolution of cough symptoms 2, 3.
- The condition, known as "Oto-tricho-tussia," can also manifest with symptoms such as tinnitus, chronic pain, and nausea 3.
- Proper ear cleaning habits and examination of the ear canal can help identify and treat this easily treatable cause of chronic cough 2.
Related Symptoms and Treatment
- Hair growth in the tympanic membrane (oto-tricho) can cause symptoms such as tinnitus, chronic pain, cough, and nausea 3, 4.
- Removal of the hair and its follicle can resolve these symptoms and prevent potential complications such as tympanosclerosis, TM micro-perforation, and hearing loss 3, 4.
- Microsuction can be an effective method for removing migrated hair from the ear canal and relieving symptoms 4.