Reflux laryngitis or laryngopharyngeal reflux or extraesophageal GERD is a silent GERD that can be present in as many as 80% of patients with chronic cough. The investigations to confirm it are;
1) Ambulatory 24-hour pharyngoesophageal pH monitoring
2) Barium esophagography
4) Upper gastrointestinal endoscopy.
You may also get a chest x-ray and spirometry for the complete evaluation of the chronic cough.
The common causes of chronic cough are postnasal drip (also called upper airway cough syndrome), asthma, and reflux laryngitis / gastroesophageal reflux disease (GERD). These causes are responsible for up to 90 percent of all cases of chronic cough. Less common causes include infections, medications, and chronic lung diseases. Another common cause of chronic cough is nonasthmatic eosinophilic bronchitis. Following causes are usually considered for the chronic cough;
1) Upper airway cough syndrome; they comprise of vasomotor rhinitis; acute nasopharyngitis; and sinusitis. The treatment is by steroid nasal spray or nasal antihistamine. Sinusitis may need antibiotics like trimethoprim-sulfamethoxazole or cefuroxime.
2) Cough variant asthma; this will require bronchodilator medications used in asthma or steroid inhalers.
3) Reflux laryngitis and Gastroesophageal reflux disease (GERD); treatment is by avoidance of reflux-inducing foods (fatty foods, chocolate), eating five small meals a day without snacking, avoidance of meals for two to three hours before lying down (except for medications), the elevation of the head of the bed and an H2 antagonist or a proton pump inhibitor.
4) Postnasal drip; would need antihistamines and inhaled ipratropium bromide.
5) Non-specific cough; Dextromethorphan and/or codeine can be used.
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