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ENT Partners of Texas Blog

ENT Partners of Texas Blog

Feel Like Coughing When You Touch Your Ear Canal

Have you ever noticed that when you touch the entrance to one of your ear canals in just the right spot that it makes you want to cough? If so, you are one of the 2 – 16 % of people who have an active oto-respiratory reflex (O-RR) (also known as the  oto-pulmonary reflex). The (O-RR) consists of the cough reflex produced by direct mechanical stimulation of the deep portion of the posterior wall of the external auditory meatus ( Latin – a passage; in this case, the entrance to the ear canal). The sensation in this portion of the ear canal is carried by the auricular (pertaining to the external ear – the auricle) branch of the vagus (Latin – wandering) nerve. The vagus nerve, also known as the 10th cranial nerve, is the most important nerve that carries information from our thoracic (heart and lungs) and abdominal (stomach, intestines, etc) organs to our brain. The auricular branch of this nerve is also called Arnold’s nerve (Friedrich Arnold <8 January 1803 – 5 July 1890> was professor emeritus of anatomy and physiology at Heidelberg.).

An otolaryngologist will occasionally think of Friedrich and his nerve  as he tries to clean wax out of an ear in a patient who is unable to stay still due to coughing every time his posterior ear canal is touched. One may also see this occasionally in patient with hearing aid molds that stimulate the nerve and cause a tickle or an outright cough. I always check patients with a chronic cough to make certain that they do not have wax or a hair that may be stimulating the area.

In the cases in which the hearing aid may be triggering the cough or tickle, one may inject the canal with a local anesthetic to see if that controls the problem. If the injection works temporarily, a permanent success may be achieved by a small procedure in the operating room, elevating the skin of the canal and drilling the bone along the course of the nerve to disrupt its transmission.

I wonder what the teleological reason for the existence of this oto-respiratory reflex is? Why would we be programmed to cough when our external ear canal is stimulated?

I can think of two possible reasons:

  1. If, while we slept, a small creature (think cockroach here) started to explore that dark crevice known as our ear canal, perhaps the cough would awaken us and give us the opportunity to try to intervene.
  2. Perhaps it is God’s way of trying to get us to put that Q-tip down so that we don’t jam all of our wax deep into the canal, compelling our local ENT to go spelunking  to clean it out
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