What Causes Chronic Cough Despite Having Normal Chest X-ray And CT Scan?

Posted on Sat, 13 Jun 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sat, 13 Jun 2015 Answered on

Fri, 3 Jul 2015 Last reviewed on

Question : I've had a chronic cough for 16 months now, bronchoscopy, CT scans of sinuses and chest are normal, barium swallow was normal. I'm getting to the point that I'm coughing till I'm gagging, it hurts to swallow (chest/esophageal area, not throat) and I now have to eat soft, non-spicy foods (spicy foods cause an intense burning sensation in my mouth, not esophagus). Additionally, I've been running a low grade fever the entire time (99.6 - 100.6 when my normal is 97.3). The cough (I assume) has also killed my voice. I've seen and ENT, allergist and pulmonologist and they can find no root cause. I'm beyond frustrated as it's sapped the life and energy out of me.

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
You are mostly having bronchitis.

Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
By your history and description, in my opinion, you are mostly having bronchitis.
So better to get done PFT (Pulmonary Function Test). It is needed for the diagnosis of bronchitis. It will also tell you about severity of the disease and treatment of bronchitis is based on severity only.
You may need inhaled bronchodilators and inhaled corticosteroid. Oral bronchodilators and mucolytic drugs are also useful.
So please let me know
1. Are you smoker?
2. Have you ever undergone PFT?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (4 hours later)

The pulmonologist says my lungs are clear. Bronchitis is what started this mess in Feb 2014. I quit smoking in 1988. I've been on Dulera and ProAir for the last 6 months and that hasn't made a dent in it. Now it fEels like,when I swallow, either whatever "goes down the wrong pipe" or my esophagus spasms, causing radiating pain for a few seconds.

Answered by Dr. Drkaushal85 (38 minutes later)

Brief Answer:
You might be having GERD (gastroesophageal reflux disease).

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
You might be having GERD (gastroesophageal reflux disease). It is laxity of gastroesophageal sphincter.
Because of this the acid of the stomach tends to come up in the esophagus and cause the symptoms of Central burning chest pain, burping etc.
This reflux can also cause micro aspiration in the lungs.
And these micro aspiration can cause coughing, more at the time of eating and drinking.
Please let me know, have you ever undergone upper GI scopy?
I will be happy to help you further.
Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (2 hours later)

I have done the barium swallow to rule out GERD and the results indicated that I do not have GERD. According to the broncosopy, my epiglotis is highly inflamed but otherwise everything is normal/inconclusive. Drinking water actually helps mitigate the session of hot lye being poured down my throat (that's how bad my throat feels) and the colder the water the better.

Other physical issues have developed during this timeframe which I assume are unrelated to whatever is going on but include the low grade fever I mentioned earlier, patches of darkened thick skin on my arms and legs, contact dermatitis from antibiotic bandaids and a complete blowout of my lower GI due to the antibiotics. I'm on my second month of OTC probiotics and am finally starting to get some relief on the last.

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
You might be having psychological cough.

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
Since your extensive investigations like CT thorax, PNS, barium swallow, bronchoscopy etc are normal, no need to worry for any major Pulmonary or Upper airway pathology for your cough.
Psychological cough can be the reason in the absence of obvious organic cause.
And this coughing can cause inflammation of epiglottis due to friction.
So please let me know
1. Have you ever consulted psychiatrist?
2. Are you having stressful life?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar