![]() ![]() This can onset even years after beginning such medications. Medication induced cough: ACE inhibitors such as Zestril are well known to cause a foreign body sensation in the throat or a cough.Occasionally PFT’s or a bronchoscopy is indicated. A trial of asthma inhalers may be helpful. A lung exam and chest X-ray can be an important part of evaluation of these patients. Asthma, COPD or other lung conditions can cause coughing directly as “tussive asthma” (seen more commonly in children) or as an indirect result of laryngeal irritation from a pulmonary cough or pulmonary inhalers.Vocal strain can also cause these symptoms. Laryngeal Lesions are not a common cause of these symptoms but certainly can be especially if hoarseness is present or if there is a history of smoking, intubation or anterior neck surgery.These studies should also be considered if the patient’s symptoms persist despite an otherwise negative exam and trial of conservative management or other measures. A history of dysphagia, weight loss or smoking should lead to consideration of an esophogram, dysphagia evaluation or an EGD. Usually there is significant dysphagia associated with these entities. Other esophageal lesions: Although uncommon, other esophageal problems such as a Zenker’s diverticulum, swallowing disorders, or neoplasia can possibly cause these symptoms.Elevating the head of bed by placing a pillow between the box spring or mattress and/or bricks under the headboard posts and avoiding eating within two hours of bedtime are often helpful interventions. In addition to H2 blockers or PPI’s, reflux is treated by avoiding alcohol and tobacco while limiting caffeine to one or two cups per day. Colas usually contain about half the caffeine a serving of coffee does. It usually takes more than two cups of coffee a day to cause reflux symptoms. ![]() Caffeine, alcohol and nicotine all cause lower esophageal sphincter relaxation so a history of significant use of these items should be explored. Gastroesophageal Reflux is commonly associated with the feeling of heartburn or of frank reflux although it often occurs while sleeping so the symptom goes unnoticed.Should sinusitis be present obviously a course of antibiotics perhaps with topical and/or systemic decongestants should be used. Radiology reports rendering an impression of “chronic sinusitis” are often misleading in this regard and unless the report clearly outlines marked abnormalities the X-rays should be reviewed before concluding sinusitis is the cause of the patient’s symptoms. X-rays should be grossly abnormal and not just some “minimal” or “trace” mucoperiosteal thickening. Sometimes sinus X-rays are needed to check for this. ![]()
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