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Hi, My Wife Has A Persistent Cough And Throat Inflammation

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Posted on Sun, 19 Feb 2023
Question: Hi,

My wife has a persistent cough and throat inflammation.

The history is as follows:

- around the 7th of January, she was infected with COVID. Symptoms were slight fever, pain in limbs and dry cough. She recovered from COVID around the 15th of January with cough as the only remaining symptom resolving.

- around the 19th of January, she developed coughing again which was more severe and this time seemed to develop phlegm. She saw a doctor on the 20th of January who diagnosed a bacterial throat infection. She was prescribed 625mg Amoxycillin/clavulanate (Curam) to be taken twice day for five days. She was also given Cophadyl-e syrup, Fedac tablets and Trotipont XXXXXXX lozenges.

Her coughing still persisted and was particularly serious at night and she saw a doctor again on the 23rd of January. The doctor said the signs of bacterial infection were not really there anymore and treated the nasal drip and inflammation with chlorpheniramine tablets to be taken at night for 5 nights, dextromethorphan syrup 10ml 3 times daily, fexofenadine tablets (180mg) to be taken in the morning for 5 days, serratiopeptidase 10mg tablets to be taken 3 times daily for 5 days and Trotipont Echinacea lozenges.

Her cough still continued to be quite severe at night and in the morning so she saw an ENT specialist who reviewed with a nasal endoscope and saw quite enlarged turbinates and also an inflamed throat (some pictures from the scope are attached). She was prescribed Nazolin 0.05% spray to be used twice daily with two sprays per nostril for alternate weeks, Avazmys spray to be used twice daily with two sprays per nostril and to be continued even when the Nazolin was stopped for one week after the first week, Rupatadine to be used twice daily and prednisolone 5mg (4 tablets each time twice daily) for 5 days.

Her cough is still persisting and likely mainly caused by nasal drip. Should she continue with the current medications prescribed by the ENT? Would saline sprays or steam be of assistance?

Will there be any issue with suddenly stopping the prednisolone after 5 days or should she taper off the medication? Could the prednisolone cause any issues as she also has slightly elevated blood pressure? Can she continue to take Ramipril tablets in the meantime? Generally for how long can Prednisolone be taken at current doses (40mg per day)?

Also is it ok to take antacids such as Gaviscon or will it interact with the antihistamine sprays and tablets?

Is the use of a steroid nasal inhaler such as Symbicort potentially helpful.



Thank you.
doctor
Answered by Dr. Naveen Kumar Nanjasetty (20 hours later)
Brief Answer:
Cough could be due to Laryngopharyngeal reflux

Detailed Answer:
Hi

Thanks for posting the query and a detailed history

After going through the history and images, I am of the opinion that your wife is having a cough secondary to Laryngopharyngeal reflux. This is a condition wherein the acid from the stomach regurgitates into the throat, causing irritation and inducing cough. Images posted show the features of Laryngopharyngeal reflux.

Her cough is persisting and likely mainly caused by nasal drip. Should she continue with the current medications prescribed by the ENT?
Avamys can be continued. The other medicines can be stopped.

Would saline sprays or steam be of assistance?
Saline spray can be continued as it helps in reducing the irritation of the throat. Steam may not be beneficial.

Will there be any issue with suddenly stopping the prednisolone after 5 days or should she taper off the medication?
No. Tapering of the medication is not required.

Could the prednisolone cause any issues as she also has slightly elevated blood pressure?
Yes, it can be safely taken

Can she continue to take Ramipril tablets in the meantime?
Ramipril can induce the cough. Discuss with your doctor about this.

Generally for how long can Predni, howe taken at current doses (40mg per day)?
It can be safely taken up to ten days.

Also is it ok to take antacids such as Gaviscon or will it interact with the antihistamine sprays and tablets?
Antacids or Proton pump inhibitors such as Pantoprazole can help reduce the cough. That's the medicine of choice at present.

Is the use of a steroid nasal inhaler such as Symbicort potentially helpful.
It can be taken if there is Asthma or breathing difficulty.

Apart from the above:
1. She should drink frequent sips of lukewarm water
2. Avoid coffee, chilled food, and beverages

I hope this answers your query. Revert to me if you have any further queries.

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon


Above answer was peer-reviewed by : Dr. Saisudha Kotla
doctor
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Follow up: Dr. Naveen Kumar Nanjasetty (11 hours later)
Dear Dr. XXXXXXX

Thank you for the information and opinion.

I will certainly look at gastric reflux as one of the main likely causes of my wife's throat inflammation.

Are there any distinguishing features of the images to differentiate the condition from nasal drip combined with post bacterial infection and heightened immune response especially after COVID infection? I noted that there were certain nodes or protruding nodules in the images.

After taking PPIs and antacids, the cough previously had been reduced but I did not see it as the main cause given that the nose was stuffy and appeared blocked to an extent. I will concentrate more on reflux as being a likely cause of the inflamed throat.

Thanks for the information on the current medications prescribed with conditions for their safe usage.



Thank you,
Regards.
doctor
Answered by Dr. Naveen Kumar Nanjasetty (11 hours later)
Brief Answer:
The posterior pharyngeal wall appears granular; congestion near voice box

Detailed Answer:
Hi

Thanks for writing back

Are there any distinguishing features of the images to differentiate the condition from nasal drip combined with post-bacterial infection and heightened immune response, especially after COVID infection?
The features suggesting Laryngopharyngeal reflux are:
a. The posterior pharyngeal wall is granular
b. There is congestion around the voice box area which may be secondary to the acid spilling over

The post-nasal drip, or the sense of mucus tracking down the throat, is one of the significant features of Laryngopharyngeal reflux. With proton pump inhibitors, she would get better. Also, encourage her to drink frequent sips of lukewarm water and avoid coffee.

I hope this clarifies your doubts. I wish ma'am good health.

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. LAKSHMI
doctor
Answered by
Dr.
Dr. Naveen Kumar Nanjasetty

Otolaryngologist / ENT Specialist

Practicing since :2001

Answered : 2540 Questions

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Hi, My Wife Has A Persistent Cough And Throat Inflammation

Brief Answer: Cough could be due to Laryngopharyngeal reflux Detailed Answer: Hi Thanks for posting the query and a detailed history After going through the history and images, I am of the opinion that your wife is having a cough secondary to Laryngopharyngeal reflux. This is a condition wherein the acid from the stomach regurgitates into the throat, causing irritation and inducing cough. Images posted show the features of Laryngopharyngeal reflux. Her cough is persisting and likely mainly caused by nasal drip. Should she continue with the current medications prescribed by the ENT? Avamys can be continued. The other medicines can be stopped. Would saline sprays or steam be of assistance? Saline spray can be continued as it helps in reducing the irritation of the throat. Steam may not be beneficial. Will there be any issue with suddenly stopping the prednisolone after 5 days or should she taper off the medication? No. Tapering of the medication is not required. Could the prednisolone cause any issues as she also has slightly elevated blood pressure? Yes, it can be safely taken Can she continue to take Ramipril tablets in the meantime? Ramipril can induce the cough. Discuss with your doctor about this. Generally for how long can Predni, howe taken at current doses (40mg per day)? It can be safely taken up to ten days. Also is it ok to take antacids such as Gaviscon or will it interact with the antihistamine sprays and tablets? Antacids or Proton pump inhibitors such as Pantoprazole can help reduce the cough. That's the medicine of choice at present. Is the use of a steroid nasal inhaler such as Symbicort potentially helpful. It can be taken if there is Asthma or breathing difficulty. Apart from the above: 1. She should drink frequent sips of lukewarm water 2. Avoid coffee, chilled food, and beverages I hope this answers your query. Revert to me if you have any further queries. Regards Dr. Naveen Kumar N ENT and Head & Neck Surgeon