the vagus nerve supplying the ear may also elicit a cough. This ear-cough reflex is also known as Arnold's reflex. Weakness of the respiratory muscles, tracheostomy, or vocal cord pathology (including paralysis or anesthesia) may prevent effective clearing of the airways. Dysfunction The reflex is impaired in the person whose abdominals and respiratory muscles are weak. This problem can be caused by disease conditions that lead to muscle weakness or paralysis, by prolonged inactivity, or as outcome of surgery involving these muscles. Bed rest interferes with the expansion of the chest and limits the amount of air that can be taken into the lungs in preparation for coughing, making the cough weak and ineffective. This reflex may also be impaired by damage to the internal branch of the superior laryngeal nerve which relays the afferent branch of the reflex arc. This nerve is most commonly damaged by swallowing a foreign object, such as a chicken bone, resulting in it being lodged in the piriform recess (in the laryngopharynx) or by surgical removal of said object. Testing The cough reflex can be tested by inhaling air with nebulized 200 μmol/L capsaicin. See also Cough References Further reading Cough Reflex: http://www.healthhype.com/cough-reflex-physiology-process-ear-cough-reflexes.html Ganong WF, "Chapter 36. Regulation of Respiration" (Chapter). Ganong WF: Review of Medical Physiology, 22nd Edition: https://web.archive.org/web/20071221162754/http://www.accessmedicine.com/content.aspx?aID=706628 Reflexes