ABSTRACT

Background: Chronic cough is the most common symptom for which a patient seeks medical attention; however, many patients with chronic cough fail to obtain an accurate diagnosis and effective treatment. Chronic cough patients are especially enigmatic for the otolaryngologist.

Materials and Methods: Retrospective review of 50 consecutive chronic cough patients. None of the subjects had primary pulmonary disease; although 54% (26/50) had been previously diagnosed with asthma. All subjects underwent laryngeal examination, 92% had reflux testing, 72% had esophagoscopy, and 60% had laryngeal electromyography.

Results: The clinical diagnosis for chronic cough was reflux alone in 40% (20/50), neurogenic (cough) alone in 14% (7/50), and both (reflux-related and neurogenic cough) in 46% (23/50). Eighty-six percent (43/50) had pH-documented reflux; 56% had neuropathic findings on laryngeal EMG; and 46% met criteria for both reflux and vocal fold paresis. The mean number of pH-documented pharyngeal reflux events pH <5 was 146. Of the 43 abnormal pH studies, 93% (43/46) had pharyngeal reflux, but only 37% (16/43) had abnormal esophageal pH data (pH <4). Thus, had those subjects undergone traditional esophageal or impedance reflux testing, 63% (27/43) would have been falsely considered negative. In addition, 36 subjects underwent esophagoscopy and 64% (23/36) had significant pathology. Eighty-eight percent (44/50) responded favorably to treatment.

Conclusions: Although other causes must be excluded, chronic cough in otolaryngologic practice is usually related to airway reflux and/or a neurogenic cause. Airway reflux testing for chronic cough requires specific pharyngeal pH-monitoring technology that is not yet widely available; however, accurate diagnosis is essential to provide effective, patient-specific treatment. In addition, the alarmingly high rate of esophageal pathology in this series of chronic cough patients underscores the need for esophageal screening in patients with airway reflux.