Abstract
The most common diagnoses in patients with a chronic cough and a normal chest radiograph include asthma, chronic rhinitis, sinusitis, gastro-esophageal reflux disease, or a combination of these. Failure to respond to appropriate treatment should cause the treating physician to consider alternative diagnoses. We report the case of a 16-year-old girl with chronic cough who failed to improve despite a prolonged course of oral prednisone, inhaled corticosteroids, short- and long-acting beta agonists, and theophylline used for suspected cough variant asthma. She was also treated empirically for sinusitis and gastroesophageal reflux disease without improvement. Further history revealed symptoms of episodic aphonia, early satiety, substernal discomfort, and the sensation of mucus lodging in the throat after eating. A diagnosis of dysphagia was entertained and referral was made for evaluation by a speech pathologist. A video fluoroscopic swallowing function study was obtained. She had a moderate stage 1 and stage 3 dysfunction. Following outpatient dysphagia therapy, her coughing and choking resolved. Esophageal dysphagia needs to be considered in patients with chronic cough who fail to respond to treatment for more common causes.
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