A reader asks: I am 52-years old. I have been suffering from a cough for the last 8 months. It all started as a common cold. Since then I have been to an ENT specialist and Pulmonologist. Blood tests, chest and sinus X-ray, CT scan, allergy test, nasal endoscopy were done.
Different medicines were tried, including steroid, but resulted in only a temporary relief. I am really concerned as to what causes the cough. The cough is really bad, at work it disturbs other people. My sleep is interrupted with the cough and I feel tired during the day. I really don’t know what to do next. Please advise.
I have been suffering from Sinus for the past 10 to 15 years.
Dr Nikita Malhotra (Specialist ENT Surgeon in Dubai) replies: I completely understand that a persistent cough can be quite annoying to the body and ears, for both ourselves as well as those around us. However, as you have realized the seriousness of your problem, half the battle has already been won. Coughing is a natural process, which we undergo when we experience uneasiness in our throats. Excessive coughing is a tedious process to cure, but it must be cured at the earliest.
The following could be the differential diagnosis for excessive coughing:
Laryngopharyngeal Reflux (LPR): It is similar to another condition, gastro esophageal reflux disease, GERD that results from the contents of the stomach backing up (reflux). But the symptoms of LPR are often different than those that are typical of GERD. Stomach acid backs up into the back of your throat (pharynx) or voice box (larynx), or even into the back of your nasal airway due to laxity of the sphincter between the esophagus and stomach. It can cause inflammation in areas that are not protected against gastric acid exposure. This could lead to a "Barking" or chronic cough. Diagnosis is made by an endoscopic exam, an ENT office procedure that involves viewing the throat and vocal cords with a flexible viewing instrument.
Mycoplasma Infection: Caused by a bacterium called Mycoplasma Pneumoniae, this could be another cause of a chronic lingering cough. Most mycoplasma infections cause mild to moderate clinical symptoms such as chills, cough (usually dry and not bloody), fever, headache and sore throat. This infection cannot be diagnosed based on symptoms alone; laboratory testing is essential for detecting IgM antibodies. Antibiotics of the macrolide and quinolone families work well in eradicating the infection.
Allergic Cough: Persistent or improperly treated allergic inflammation of the nose (Allergic Rhinitis) could lead to a persistent postnasal drip irritating the throat, thereby producing a chronic irritating dry cough. An ENT consult with a prescription involving long term antihistamines supported by intranasal steroid sprays could help in relieving the symptoms.
To conclude, a visit to an ENT Specialist would be advisable to conduct tests and a detailed examination to rule out the above mentioned conditions.
