COUGHING
In my specialty of Ear, Nose and Throat I am frequently asked to evaluate a patient with a cough. While everyone from time to time has minor coughing associated with a cold or other respiratory infection I wanted to discuss the more persistent or chronic variety and make suggestions on treatment.
Commonly, we think of a cough as a process to rid the throat and lungs of mucus, phlegm or other secretions. And that is the most frequent reason that people cough. The airway around the voice box is very sensitive to any fluid that may enter the area and our body has a reflex to get rid of it to clear the airway. All of us are familiar with that form of coughing. As I said it is usually associated with an upper respiratory infection and lasts 2-3 weeks at the most that her body is able to heal.
I wish to discuss coughs that last much longer than that, sometimes months or even years. These are the type of patients that are referred to me for evaluation to look for the source.
A cough that is wet or productive and lasts for over a month without other symptoms may be due to a silent persistent sinus infection. While sinus infections usually cause facial pain and pressure, occasionally there are no such symptoms. The infection will drain to the back of the nose associated and it is inhaled towards the lungs where the natural reflexes takeover, resulting in a cough. I have personally seen many patients in my practice with a persistent wet productive cough that had normal chest x-ray findings but only after high resolution CT scanning of the sinuses was the source discovered and treated appropriately.
Another type of cough is throat clearing. All of us are familiar with someone who has to clear their throat frequently during speaking or doing normal activities. It may be associated with a lump in the throat sensation or hoarseness. Those patients require thorough examination of the vocal cords to rule out vocal cord polyps or nodules. Often the source of throat clearing behavior is undiagnosed acid reflux coming from the esophagus and irritating the voice box. Treatment of underlying reflux often solves the problem Proper treatment of this condition also often involves making the patient aware of the throat clearing behavior so he or she will make a conscious effort to stop the act. Persistent clearing of the throat actually continues to irritate the vocal cords and may prolong the symptoms. Finally, I wish to talk about a dry persistent cough which may be nothing more than a tickle in the throat or be associated with some shortness of breath. This may be a condition referred to as cough variant asthma. Most of us think of asthma as a condition that affects the lungs and leads to wheezing. In some individuals the allergic inflammation that makes up asthma only affects the area of the airway just below the vocal cords. This may present as a cough that wakes people up at night or is just this dry irritative tickle that will not go away. Usually this condition is easy to diagnose once examination has been completed. In most people it would respond to medications such as inhalers or other prescriptions that are effective for the treatment of asthma.
Because of my background in both ear, nose and throat as well as a fellowship in allergy I am comfortable in diagnosing and treating many types of cough.
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