Chronic Throat Cough: Causes, Symptoms, and Treatment Options

Chronic cough in the throat?

Hello Doctor: I have been experiencing a persistent cough for several years.
I didn't pay much attention to it before, but it seems to have worsened significantly over the past year, causing considerable disruption to my daily life.
Recently, the coughing has intensified, particularly at the junction of my throat and nasal passages.
I suspect it may be related to post-nasal drip, as I have been feeling particularly swollen in that area with a sensation of heat in my throat, accompanied by some pain.
Occasionally, my left ear also experiences sharp pain, and the lower part of my throat, near the collarbone, feels very itchy, which leads to continuous coughing.
Over the past few days, I've also felt some pain in my throat and chest.
I visited a local clinic where the doctor performed a nasal endoscopy (I'm not sure of the exact term, but it involved a soft tube inserted through my nostril).
He mentioned that there were no significant issues and suggested that I might have an allergic predisposition and throat inflammation.
However, after taking medication for two weeks, my condition hasn't improved much.
I would like to ask if I need to undergo a laryngoscopy or any other tests.
Additionally, do general clinics typically have laryngoscopes, and what is the procedure and duration of the examination? I'm unsure if the nasal endoscopy I had previously examined my throat as well, or if a laryngoscopy is the same as a nasopharyngoscopy.
Currently, my symptoms include throat pain, itching, redness, swelling, and ear pain, but there are no neck lumps.
The post-nasal drip and phlegm are clear and white, and I don't experience any significant discomfort while swallowing.
My voice is occasionally a bit muffled but not hoarse.
I hope you can clarify these questions for me.
I apologize for the lengthy message, and thank you very much.

Mr. Chen, 20~29 year old female. Ask Date: 2017/06/10

Dr. Li Jiaxuan reply Otolaryngology

A flexible laryngoscope can also be inserted through the nasal cavity, but it is unclear whether your initial examination only reached the nasal area or included the larynx.
It is recommended to consider medication treatment, and if the condition persists, it is advisable to follow up with an otolaryngologist at the hospital for further evaluation and examination.
Wishing you good health.

Reply Date: 2017/06/10

More Info

Chronic throat cough can be a frustrating and debilitating condition, especially when it persists for years and begins to interfere with daily life. Based on your description, it sounds like you are experiencing a combination of symptoms that may be attributed to several underlying causes, including allergies, post-nasal drip, and possibly chronic laryngitis or pharyngitis.

Causes of Chronic Throat Cough
1. Allergies: Allergic rhinitis can lead to post-nasal drip, where mucus from the nasal passages drips down the back of the throat, causing irritation and a persistent cough. Common allergens include pollen, dust mites, pet dander, and mold.

2. Post-Nasal Drip: This is often a result of allergies or sinus infections. The excess mucus can irritate the throat, leading to a chronic cough. Symptoms may include a sensation of mucus dripping down the throat, throat clearing, and a cough that worsens at night.

3. Chronic Laryngitis: Inflammation of the larynx can cause a chronic cough, hoarseness, and throat discomfort. This condition can be exacerbated by irritants such as smoke, pollution, or excessive voice use.

4. Gastroesophageal Reflux Disease (GERD): Acid reflux can irritate the throat and lead to a chronic cough. Symptoms may include a burning sensation in the throat, sour taste in the mouth, and cough that worsens after eating or when lying down.

5. Infections: Chronic infections, such as those caused by bacteria or viruses, can lead to ongoing throat irritation and coughing. While your previous nasal endoscopy showed no significant issues, it is still possible to have a lingering infection that requires further investigation.

Symptoms to Monitor
- Throat Pain and Swelling: The sensation of swelling and pain in the throat, along with ear pain, may indicate inflammation or infection.

- Cough Characteristics: Note whether your cough is dry or productive (producing mucus), as this can help differentiate between causes.

- Duration and Timing: Chronic cough is typically defined as lasting more than eight weeks. If your symptoms have been persistent, it may warrant further investigation.

- Associated Symptoms: Keep track of any additional symptoms such as fever, weight loss, or changes in voice, which could indicate a more serious condition.

Diagnostic Options
Given your symptoms and the lack of improvement with initial treatment, it may be beneficial to pursue further diagnostic testing:
1. Laryngoscopy: This procedure allows a doctor to examine the larynx (voice box) and surrounding areas more closely. It can help identify any abnormalities or inflammation that may not have been visible during the nasal endoscopy.

2. Allergy Testing: If allergies are suspected, skin or blood tests can help identify specific allergens that may be contributing to your symptoms.

3. Imaging Studies: In some cases, imaging studies such as a CT scan of the sinuses may be recommended to evaluate for chronic sinusitis or other structural issues.

4. Trial of Medications: If allergies are suspected, a trial of antihistamines or nasal corticosteroids may be beneficial. If GERD is a concern, a trial of proton pump inhibitors may help determine if acid reflux is contributing to your symptoms.

Treatment Options
- Allergy Management: If allergies are confirmed, avoiding triggers and using antihistamines or nasal corticosteroids can help reduce symptoms.

- Hydration and Humidification: Staying well-hydrated and using a humidifier can help soothe throat irritation.

- Voice Rest: If laryngitis is suspected, resting your voice can help reduce inflammation.

- Reflux Management: If GERD is a concern, lifestyle modifications such as avoiding trigger foods, eating smaller meals, and elevating the head during sleep can be beneficial.

Conclusion
Chronic throat cough can stem from various causes, and it is essential to identify the underlying issue to determine the most effective treatment. Given your ongoing symptoms and lack of improvement, I recommend consulting with an ENT specialist for further evaluation, including a laryngoscopy, to gain a clearer understanding of your condition. Additionally, discussing your symptoms and treatment options with your healthcare provider can help tailor a management plan that addresses your specific needs.

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