Which Medical Specialty Should I See for Severe Cough and Nasal Issues?

Which specialty should I see? (Due to severe coughing along with nasal congestion and runny nose issues.)

Dr.
Hong: Hello! I started experiencing coughing symptoms on the fourth day of the Lunar New Year this year (to clarify: I actually had severe sneezing on February 9th, and I visited a primary care clinic that day and began medication treatment.
However, the next day I developed nasal congestion and even yellow nasal discharge, but I had not yet started coughing during that period).
I have been coughing so severely that I have vomited food from my stomach and the medications I took (the coughing is very intense).
So far, I have visited an otolaryngology clinic three times (due to persistent nasal congestion and runny nose), but despite continuous medication treatment, I still experience pain and itching in my chest area (it feels like there are internal wounds that are both painful and itchy), which leads to severe coughing.
Given that I still have nasal congestion, a runny nose, and even some headaches, which department should I see if I need to go to a large hospital? (Note: I have been coughing since the fourth day of the Lunar New Year! I mainly cannot expel anything! I constantly feel salty mucus being coughed up! My chest area feels very uncomfortable and I have become sensitive to dust; even being in a dusty environment or riding a motorcycle outside triggers severe coughing that leads to nausea and vomiting).
I kindly request your response, thank you! I apologize for any inconvenience this may cause you!

Niming, 30~39 year old female. Ask Date: 2021/02/22

Dr. Hong Yuanbin reply Internal Medicine

Based on your description, it seems you may have an acute respiratory infection combined with bronchitis, exacerbated by recent severe air pollution, which is causing your persistent cough.
If you have already seen an otolaryngologist, I recommend visiting a pulmonology clinic to check for any lung issues.
Thank you for your inquiry.

Reply Date: 2021/02/22

More Info

Based on your detailed description of symptoms, it appears that you are experiencing a complex interplay of respiratory issues that may involve both upper and lower respiratory tracts. Given the chronic nature of your cough, nasal congestion, and the discomfort you are feeling in your chest, it is essential to approach this situation with a comprehensive understanding of the potential underlying causes and the appropriate medical specialties to consult.

Recommended Medical Specialties
1. Pulmonology (Chest Medicine): Given your persistent cough, especially one that has led to vomiting and discomfort in the chest area, a pulmonologist would be an appropriate specialist to consult. They focus on diseases of the lungs and respiratory system, and they can conduct further evaluations such as pulmonary function tests, imaging studies (like a chest X-ray or CT scan), and possibly bronchoscopy if necessary. This will help determine if there are any underlying conditions such as bronchitis, asthma, or even more serious issues like bronchiectasis or interstitial lung disease.

2. Otolaryngology (ENT): Since you have ongoing nasal symptoms, including nasal congestion and yellow nasal discharge, an ENT specialist can also provide valuable insights. They can evaluate for conditions such as chronic sinusitis, nasal polyps, or other anatomical issues that might be contributing to your symptoms. They may perform a nasal endoscopy to visualize the nasal passages and sinuses directly.

3. Allergy and Immunology: If your symptoms are exacerbated by environmental factors (like dust), it might be beneficial to see an allergist. They can conduct tests to determine if you have allergies that could be contributing to your respiratory symptoms. Allergies can lead to chronic rhinitis, which can cause nasal congestion and post-nasal drip, leading to coughing.

Additional Considerations
- Chronic Cough: A cough lasting more than eight weeks is considered chronic and can be caused by various factors, including post-nasal drip, asthma, gastroesophageal reflux disease (GERD), or chronic bronchitis. Given your symptoms, it would be prudent to evaluate these possibilities.

- Post-Nasal Drip: This condition occurs when excess mucus accumulates in the back of the throat, often leading to coughing, especially at night or when lying down. It can be caused by allergies, sinus infections, or other irritants.

- Asthma: Your description of cough that worsens in dusty environments and the sensation of chest tightness could indicate asthma. A pulmonologist can perform tests to assess your lung function and determine if asthma is a contributing factor.

- Gastroesophageal Reflux Disease (GERD): Sometimes, acid reflux can cause chronic cough, especially if you experience symptoms like heartburn or regurgitation. Discussing this with your healthcare provider may lead to further evaluation.

Next Steps
1. Schedule Appointments: Consider making appointments with both a pulmonologist and an ENT specialist. They can work collaboratively to address your symptoms from different angles.

2. Document Symptoms: Keep a detailed record of your symptoms, including when they occur, their severity, and any potential triggers. This information will be invaluable during your consultations.

3. Lifestyle Modifications: In the meantime, consider lifestyle changes that may alleviate your symptoms. This includes avoiding known allergens, using a humidifier to keep airways moist, and staying hydrated.

4. Follow-Up: If your symptoms persist or worsen, do not hesitate to seek immediate medical attention. Persistent cough and respiratory discomfort warrant thorough investigation to rule out serious conditions.

In summary, your situation requires a multi-faceted approach involving both pulmonology and ENT specialties. By addressing both the upper and lower respiratory issues, you can work towards finding a resolution to your chronic cough and nasal problems.

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