Reflux laryngitis or laryngopharyngeal reflux or extraesophageal GERD, differs from traditional GERD in that it does not manifest as heartburn and tends to occur when the patient is upright as opposed to lying flat. This silent GERD can be present in as many as 80% of patients with chronic cough. The investigations to confirm it are;
1) Ambulatory 24-hour pharyngoesophageal pH monitoring
2) Barium esophagography
4) Upper gastrointestinal endoscopy.
The common causes of chronic cough are postnasal drip (also called upper airway cough syndrome), asthma, and reflux laryngitis / gastroesophageal reflux disease (GERD). These causes are responsible for up to 90 percent of all cases of chronic cough. Less common causes include infections, medications, and chronic lung diseases. Another common cause of chronic cough is nonasthmatic eosinophilic bronchitis. Following causes are usually considered for the chronic cough;
1) Upper airway cough syndrome; they comprise of vasomotor rhinitis; acute nasopharyngitis; and sinusitis. The treatment is by steroid nasal spray or nasal antihistamine. Sinusitis may need antibiotic like trimethoprim-sulfamethoxazole or cefuroxime.
2) Cough variant asthma; this will require bronchodilator medications used in asthma or steroid inhalers. This in your case has been ruled out.
3) Reflux laryngitis and Gastroesophageal reflux disease (GERD); treatment is by avoidance of reflux-inducing foods (fatty foods, chocolate), eating five small meals a day without snacking, avoidance of meals for two to three hours before lying down (except for medications), elevation of the head of the bed and an H2 antagonist or a proton pump inhibitor.
4) Postnasal drip; would need antihistamines and inhaled ipratropium bromide.
5) Non specific cough; Dextromethorphan and/or codeine can be used.
In your case, Upper airway cough syndrome (UACS), previously referred to as postnasal drip syndrome (PNDS) should be ruled out. PNDS refers to the sensation of secretions from the nose or sinuses that drain into the pharynx in addition to nasal discharge and frequent throat clearing. Unfortunately, this is largely based on patients’ subjective symptoms, which frequently do not show any significant physical examination findings. Almost 40% of patients
with PNDS-induced cough are unaware of the presence of postnasal drip or its link to their cough.
Also stop CoQ10, 5-HTP, for a month or more, which rarely may cause cough as a side effect.
Anxiety associated with the history of smoking may augment reflux laryngitis and thus may be a contributory factor.
Please feel free for your follow up questions.
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