What Kind of Cough are You?

Did you know that cough is the most common reason Americans see a doctor, resulting in 28 million visits last year? That is more than two times the amount of visits for the next most common reason Americans went to see their doctor – headache. Cough can be a presenting symptom of very common non-life threatening, though terribly life-disrupting, diseases such as adult onset asthma, seasonal allergies and sinus disease.

Cough can also be a presenting symptom of very common potentially life threatening diseases such as acid reflux disease and esophageal cancer. So where does one start when they have had a chronic cough that has lasted for more than 6 weeks?

Patients with cough are generally recommended to see their primary care physician first when seeking medical attention. This is a good first step because primary care physicians are able to investigate and possibly rule out cough that is caused by problems with the lungs. Once that takes place, the investigation moves to non-lung causes such as nasal, sinus, allergy, throat and stomach causes. Invariably, acid reflux is entertained as a potential source of the cough, and often an antacid treatment is prescribed to a chronic cough patient.

But what does one do if the cough persists despite antacid treatments and knowledge that the problem is not in the lungs?  The answer is the esophagus; the muscular tube that connects the throat to the stomach.  Recent studies have shown that cough and hoarseness are better predictors of esophageal cancer than heartburn or regurgitation. There are 3 ways to look at the esophagus:

1. In the operating room with the patient under general anesthesia, the scope is inserted via the patient’s mouth. This method is not very commonly used.
2. In the endoscopy suite with the patient sedated with intravenous methods. The scope is inserted via the patients mouth. This is the most common method.
3. In the doctor’s office, without sedation, with the patient wide awake. The scope is inserted via the patient’s nose.  By going through the nose one avoids invoking the gag reflex, primarily located in the mouth. This is called TransNasal Esophagosocpy (TNE) and it isn’t utilized in great numbers yet, it is the safest way to examine the esophagus and is therefore rapidly growing in popularity. The idea is that not having to use sedation to examine the esophagus is a much safer way to examine. (Click here to see a TNE featured on The Dr. Oz Show.)