Chronic intractable cough and silent sinusitis: role of functional endoscopic sinus surgery

Abstract

Intractable chronic cough is common and challenging, but treatable. This paper presents a prospective study of adult patients who were referred for ENT diagnosis and management of chronic cough. In 61 patients a nasal cause was responsible for the cough. All patients were evaluated clinically, had nasal endoscopy, allergy skin tests, postnasal discharge culture and sensitivity and CT Scans. In 43 patients the cough was attributed to silent sinusitis (diagnosed on CT findings with minimal symptoms). The spectrum and frequency of causes found; postviral (20%), infective rhino sinusitis (18%), allergic rhino sinusitis (15%), nonallergic rhino sinusitis (9%), nasal polyps (8%) and more than one nasal diagnosis (30%).All patients received medical treatment initially; of these 12 patients with medically recalcitrant chronic sinusitis had functional endoscopic sinus surgery (FESS).The cough was attributed to postnasal drip and/or irritation of cough receptors in the sinuses. CT sinuses were crucial in diagnosis.Treatment outcome was obtained 3–6 months later; subjective outcome in patients undergoing FESS was better as compared to nonsurgical group.