Chronic Cough, Reflux, Postnasal Drip Syndrome, and the Otolaryngologist

Successful Behavioral Therapy includes elevating the head off the bed, which can be helpful in patients with GERD (GastroEsophageal Reflux Disease) and sometimes in patients with LPR (LaryngoPharyngeal Reflux), depending on the patient’s symptoms. Esophageal function in the GERD patient generally demonstrates esophageal dysmotility with significantly prolonged esophageal acid clearance times and Lower Esophageal Sphincter dysfunction. In contrast, the LPR patient has good esophageal function with near normal esophageal acid clearance. Generally, LPR patients have Upper Esophageal Sphincter dysfunction (5, 6). In addition, the larynx is far more susceptible to acid injury than esophagus because in the larynx there are no acid clearing mechanisms (peristalsis; salivary bicarbonate) and the laryngeal tissues are thin, fragile and poorly adapted to protect against reflux.

Design. Literature review. Results.

When the refluxed stomach acid comes into contact with the lining of the esophagus, it causes a burning sensation in the chest or in the throat that we call acid or heartburn indigestion. When stomach contents irritate the voice box and back of the throat/nose, symptoms are less often heartburn, and more often consist of post nasal drip, throat clearing, cough, and lump in the throat.

In either method, the goal is to interfere with the allergic response to specific allergens to which the patient is sensitive. These drugs — for example, prednisone, methylprednisolone (Medrol), and hydrocortisone (Hydrocortone, Cortef) — are highly effective in allergic patients. They are best used for short-term management of allergic problems, and a health care professional must monitor their use, as there are potential serious side effects when using these medications for extended periods. These are reserved only for very severe cases that do not respond to the usual treatment with nasal steroids and antihistamines.

Silent reflux is a condition in which stomach acid causes throat discomfort, behind the breastbone in the middle of the trunk especially. 33. Kaufman JA, Houghland JE, Quiroga E, Cahill M, Pellegrini CA, Oelschlager BK. Long-term outcomes of laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD)-related airway disorder.

These findings can be induced by other conditions, such as postnasal drip, allergies, asthma, voice abuse, and even by repetitive behaviors such as throat clearing. The classic symptom of GERD is heartburn. Many people have LPR without any associated heartburn and they experience chest pain instead, hoarseness, difficulty swallowing, excessive mucous, throat clearing, a sensation of a lump in the throat, sore throat, choking spells, wheezing, post-nasal drip, dry cough, or bad breath. A gastroenterologist may decide to order some additional tests to evaluate your GERD.

Chronic cough can be associated with many diseases that overlap more than one medical specialty often. A detailed assessment of the patient with chronic cough relies on a multidisciplinary approach and close cooperation between pulmonary medicine, gastroenterology, and otolaryngology. Gastrooesophageal reflux and postnasal drip syndrome account for a significant number of cases of chronic nonproductive cough seen in otolaryngology practice.

Medications should be discussed with your physician. Pregnancy will markedly increase symptoms of heartburn and sometimes throat symptoms as well. This is partly due to the space taken up by the growing infant. One should avoid clothing that fits across the midsection of the body tightly. It is helpful to practice diaphragmatic or abdominal breathing.

Non-allergic rhinitis with nasal eosinophilia syndrome (NARES) is characterized by a clear nasal discharge. The nasal discharge is found to have eosinophils (allergic cell type), although the patient may not have any other evidence of allergy by skin history or testing or symptoms. Discover what foods are causing your acid reflux.A proven association between certain acid and foods reflux is the key to discovering what causes GORD. show that in patients with nasal obstruction, LPR might have a causative role and that in these patients, comorbid LPR should be investigated for and treated with a PPI as a component of management for nasal obstruction.

Post-nasal drip

Pepsin in the esophagus can cause damage if the pH is less than 4, explaining why we prescribe anti-GERD agents to raise the pH to 4 or higher. In the larynx, damage can occur at an even higher pH. Pepsin in the area of the larynx is active at a pH of 6 still. 5 and does not become inactive until the pH is 8 approximately. Any pepsin lingering in the larynx can be reactivated within 24 hours if the pH changes. Pepsin in the wrong place for any period of time can become reactivated should the pH drop to less than 8, which occurs in everybody given a 24-hour time window almost.

Another issue when attempting to diagnose PNDS-induced cough is that GERD is often associated with a high prevalence of upper respiratory symptoms and therefore can either coexist or mimic PNDS [35]. The introduction of the-more widely accepted in Americas-term of “Upper Airway Cough Syndrome” (UACS) was made based on the need to answer the question whether “the conditions listed above actually produce cough through a final common pathway of PND or whether, in fact, in some circumstances they cause irritation or inflammation of upper airway structures that directly stimulate cough receptors and produce cough independently of or in addition to any associated PND” [35]. I’m Dr. David Johnson.

For adults with silent reflux, some lifestyle changes can keep the throat from becoming irritated and dry. Adults have a cold or the flu before they develop LPR often.

Irwin RS, Zawacki JK, Curley FJ, French CL, Hoffman PJ. Chronic cough as the sole presenting manifestation of gastroesophageal reflux. 2. Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults.

. Every day Glands in the nose and throat normally produce 1-2 quarts of mucus. This mucus moistens the lining of the nose and sinuses, humidifies the fresh air, traps inhaled particles, and helps to fight infections. . Throughout the day Normally this mucus is swallowed unconsciously many times. When the mucus becomes thick or excessive in volume, it can cause the sensation of post-nasal drip. Post-nasal drainage can lead to cough, sore throat, frequent throat clearing, and the feeling of a lump in the throat.

It is important to understand that Silent Reflux is caused by a combination of acid and the stomach enzyme pepsin. This is why it is unlikely that blocking the acid is going to help you alone. Every reflux shoots up your esophagus and into your throat then. So it is no wonder that a lot of patients have issues there.

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