Chronic cough — ENT causes and treatment
Chronic cough is one that lasts more than 8 weeks and is not harmless — it often has a hidden cause that requires ENT or gastroenterology workup. Many patients with chronic cough go from doctor to doctor without a clear diagnosis. The key is a systematic workup that rules out all common causes.
What is chronic cough
By definition, chronic cough lasts more than 8 weeks in adults (4 weeks in children). It differs from:
- Acute cough — less than 3 weeks, most often cold or acute infection
- Subacute — 3–8 weeks, often post-infectious
- Chronic — more than 8 weeks, requires systematic workup
Most common ENT causes of chronic cough
Upper airway cough syndrome (postnasal drip)
The most common ENT cause. Mucus from the nose and sinuses drains down the back of the throat and irritates it, triggering the cough reflex. Patients often also feel “constant throat clearing” and a need to “clear the throat”. Causes include allergic rhinitis, chronic sinusitis.
Reflux disease (GERD and LPR)
Stomach contents return to the esophagus and can reach the larynx. Laryngopharyngeal reflux (LPR) is particularly important because it doesn’t necessarily cause heartburn — the patient may have only cough, hoarseness, lump-in-throat sensation, throat clearing. Treatment is PPIs (proton pump inhibitors) + lifestyle changes.
Chronic laryngitis
Inflammation of the larynx and vocal cords. Often associated with reflux, smoking, or professional voice overuse.
Asthma
In some patients, asthma manifests only as cough (without typical wheezing). Should be ruled out with spirometry.
ACE inhibitors (blood pressure medications)
A dry, irritating cough in 10–20% of patients on ACE inhibitors (enalapril, ramipril). Resolves by switching to another medication.
⚠️ When chronic cough is alarming
Don’t wait — a thorough workup with a pulmonologist is essential if your chronic cough includes:
- Hemoptysis (coughing up blood)
- Unexplained weight loss
- Hoarseness lasting more than 3 weeks (may indicate laryngeal tumor)
- Difficulty swallowing
- Chest pain
- Smoking 20+ years + chronic cough
- Night sweats, high fever
Diagnostics
Chronic cough requires systematic workup, not just “a cough remedy”. Our approach:
- Detailed history — when the cough occurs, whether there is secretion, dry or productive, what medications are taken
- Endoscopic exam of the nose, throat, and larynx — directly shows whether there is postnasal drip, reflux changes on the vocal cords, polyps
- MLS (microlaryngoscopy) — detailed magnified exam of the vocal cords
- Collaboration with a pulmonologist (spirometry) and gastroenterologist (24h pH monitoring) when indicated
Treatment
Depending on the cause:
- UACS — topical nasal corticosteroids, rinses, antihistamines for allergy, treatment of sinusitis
- LPR/GERD — PPIs for 8–12 weeks, avoiding late meals, elevating the head of the bed, weight reduction
- Asthma — bronchodilators, inhaled corticosteroids (via pulmonologist)
- ACE inhibitor cough — medication switch in agreement with the cardiologist
💡 What you can do
- Keep a diary: when you cough, what you eat, what the weather is
- Stop smoking — the biggest aggravating factor for almost every cause
- Avoid late meals, coffee, alcohol, chocolate, tomatoes (reflux triggers)
- Elevate the head of your bed 10–15 cm (4–6 in)
- Drink enough fluids — a dry throat worsens cough
Related topics
🗣️ Voice & larynx (hub)
👃 Nose & sinuses
🔍 All symptoms
Been coughing for months?
A systematic workup for chronic cough in one clinic — endoscopic exam, MLS, coordination with pulmonologist and gastroenterologist when needed.