Evidence map›Paper›PMID 41176556›Full record

Observational studyEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026

The auricular cough reflex: lateralization, prevalence, procedural determinants, and the role of examiner handedness.

Julia van de Loo, Marcel Mayer, Kariem Sharaf, Hans Eckel, Louis Jansen, Jens Peter Klussmann, Jan Christoffer Luers

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Julia van de LooMedical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50924, Cologne, Germany. Julia.van-de-loo@uk-koeln.de.ORCID http://orcid.org/0009-0002-3556-3738
Marcel MayerMedical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50924, Cologne, Germany.
Kariem SharafMedical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50924, Cologne, Germany.
Hans EckelMedical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50924, Cologne, Germany.
Louis JansenMedical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50924, Cologne, Germany.
Jens Peter KlussmannMedical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50924, Cologne, Germany.
Jan Christoffer LuersMedical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50924, Cologne, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe auricular cough reflex (Arnold's reflex) is a vagally mediated somato-visceral response triggered by stimulation of the external auditory canal (EAC). While classically considered rare, its clinical relevance in otologic procedures remains underexplored.

objectiveThis study aimed to evaluate the prevalence, lateralization, and potential risk factors of the Arnold reflex during routine otologic examinations, with particular attention to examiner handedness, hearing aid use, and EAC inflammation.

methodsIn this prospective observational study, 404 consecutive patients undergoing bilateral ear wax removal in a university otology clinic were assessed for reflex-induced coughing. Reflex occurrence, laterality, instrument type, hearing aid use, signs of local infection, age, and sex were documented. Statistical analyses included chi-square tests, logistic regression, and McNemar's test.

resultsA cough reflex was elicited in 52 patients (12.9%), predominantly right-sided (73.1%, p < 0.001). The reflex was most frequently triggered by curettes (84.6%). No significant association was found between reflex presence and hearing aid use, local infection, age, or sex. The strong right-ear predominance, observed exclusively with a right-handed examiner, suggests that handedness and canal wall anatomy may influence reflex induction.

conclusionThe Arnold cough reflex occurs more commonly than historically reported, with a notable right-sided predominance potentially linked to examiner handedness and procedural factors. Routine otologic variables such as age, sex, hearing aid use, and local inflammation had no measurable effect. These findings underscore the importance of examiner awareness and gentle technique in the EAC. Future studies should explore anatomical mapping, neurophysiological mechanisms, and the potential role of habituation in chronic ear stimulation.

Indexed as

CoughEar CanalFunctional LateralityReflexAdolescentAdultAgedAged, 80 and overFemaleHumansMaleMiddle AgedPrevalenceProspective StudiesRisk FactorsYoung AdultArnold`s reflexAuricular cough reflexExternal auditory canal (EAC)Hearing aidOtologic examinationOtologyOtoscopy

Identifiers

PMID41176556

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.