Chronic Cough: Allergies and Treatment Options - Otolaryngology

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Chronic cough can be a frustrating and persistent issue, especially when it has been ongoing for over a year. Based on your description, it seems that your cough is likely related to a combination of factors, including nasal allergies, post-nasal drip, and possibly gastroesophageal reflux disease (GERD). Let's break down the potential causes and treatment options.


Understanding Chronic Cough
1. Nasal Allergies: Allergies can lead to inflammation in the nasal passages, causing symptoms such as nasal congestion, post-nasal drip, and a chronic cough. Post-nasal drip occurs when mucus accumulates in the back of the throat, leading to irritation and coughing. Your history of nasal polyps and a deviated septum can exacerbate these symptoms, as they can obstruct airflow and promote mucus buildup.

2. Post-Nasal Drip: This is a common cause of chronic cough. When mucus drips down the back of the throat, it can trigger a cough reflex. This is often worse in the morning due to overnight mucus accumulation.

3. Gastroesophageal Reflux Disease (GERD): Although you mentioned that you do not cough at night, GERD can still contribute to chronic cough. Acid reflux can irritate the throat and lead to coughing, especially after meals or when lying down.

4. Other Factors: Environmental irritants, such as smoke, pollution, or strong odors, can also contribute to chronic cough. Additionally, if you have a history of respiratory infections, they can leave the airways sensitive and reactive.


Treatment Options
1. Allergy Management: Since nasal allergies are a significant factor, consider the following:
- Antihistamines: You mentioned using antihistamines, which can help reduce nasal symptoms. However, some individuals may require a combination of medications for better control.

- Nasal Corticosteroids: These can significantly reduce inflammation in the nasal passages and help with post-nasal drip. They are often more effective than antihistamines alone for nasal allergy symptoms.

- Saline Nasal Irrigation: Using a saline rinse can help clear mucus and allergens from the nasal passages, providing relief from congestion and post-nasal drip.

2. GERD Management: If GERD is suspected, consider:
- Dietary Changes: Avoiding trigger foods (spicy, fatty, or acidic foods) can help reduce reflux symptoms.

- Proton Pump Inhibitors (PPIs): Medications like omeprazole can reduce stomach acid production and help manage reflux symptoms.

3. Lifestyle Modifications:
- Avoid Irritants: Stay away from smoke, strong perfumes, and other irritants that can exacerbate your cough.

- Stay Hydrated: Drinking plenty of fluids can help thin mucus and reduce throat irritation.

4. Follow-Up with Specialists: Since you have already seen multiple specialists, it may be beneficial to follow up with an allergist or an ear, nose, and throat (ENT) specialist for further evaluation. They can perform specific allergy tests and assess whether additional treatments, such as immunotherapy (allergy shots), might be appropriate.

5. Consideration of Other Conditions: If your cough persists despite treatment, it may be worth investigating other potential causes, such as asthma or chronic bronchitis. A thorough evaluation, including pulmonary function tests, may be necessary.


Conclusion
While it may not be possible to "cure" nasal allergies entirely, effective management can significantly reduce your symptoms and improve your quality of life. It is essential to work closely with your healthcare providers to develop a comprehensive treatment plan tailored to your specific needs. Regular follow-ups and adjustments to your treatment regimen may be necessary to achieve optimal control of your chronic cough.