Chronic cough and the larynx

Abstract

As a cause of chronic cough, gastroesophageal reflux (GER) and laryngeal allergy have received attention recently. It is now obvious that GER definitely affects some laryngeal diseases, such as nonproductive and irritable cough, hoarseness, laryngospasm, and so on. In some patients with impaired esophageal motility, the acid may reflux into the airways, thereby inducing chronic cough. In other patients, cough may result from a vagally mediated reflex triggered by the presence of acid in the midesophagus or distal esophagus. The use of 24-hour esophageal pH monitoring has been accepted as the most sensitive method of diagnosing GER. The treatments for GER include change in posture, weight, and diet, pharmacologic, and surgical. Antireflux surgery is indicated when conservative treatments fail. Two clinical types of laryngeal allergy exist: chronic and acute. The chronic type causes chronic cough and abnormal sensation of the throat, whereas the acute type is prone to cause more severe symptoms, such as dyspnea, in addition to cough and hoarseness. Because diagnostic criteria have not been established, further investigation is anticipated.