June 18, 2009
Ask the experts
COUGHING TILL I VOMIT
Q: I am a non-smoker but I have had a persistent cough since last year. I cough quite badly, especially at night when I go to bed.
My throat feels so itchy I feel like I am choking. I cough till tears run from my eyes or till I vomit.
Sometimes, I also cough during the day. I have seen three GPs and was referred early this year to an ear, nose and throat (ENT) specialist who said my cough is due to gastric reflux. I was given omeprazole to treat the reflux. However, I do not feel any improvement. Is it safe to take omeprazole for a long period of time? I was asked to take one pill twice a day.
Should I see a gastroenterologist too?
A: Chronic cough is usually due to sinusitis, allergic conditions, hypersensitivity of the airways following an infection or gastric acid reflux or stomach acid reflux.
It is always necessary to check the nose and throat and this is best done with the use of an endoscope which is inserted via the nose to the throat area to view the lower throat and voice box areas. Typically, one can detect sinusitis with this method.
In your case, it appears that sinusitis was excluded. Hence the remaining possibilities would be allergic reactions possibly to food, or just hyper-reactivity of the airways following an infection.
The hyper-reactivity may go on for several weeks or even several months. During this time, it should be treated symptomatically. This means that medicine is given to reduce the cough itself. It is much like when you have a headache and painkillers are given to reduce the pain. At the same time, reflux medication such as omeprazole is advised for use up to eight weeks.
If the cough persists, then it would be fair to test for food allergies.
Dr Stephen Lee is a specialist in ear, nose and throat surgery at Raffles Hospital.
A: There are three main causes of chronic cough: Lung problem, ENT diseases and the less well recognised and under diagnosed Gastroesophageal Reflux Disease (Gerd), that is, reflux of acid from the stomach back to the oesophagus.
Acid causes either direct irritation of the airways or spasm of the airways from nerve reflex leading to coughs that typically worsen at night while one is sleeping.
Acid blocker is commonly prescribed to reduce acid reflux, thus reducing the cough. However, generic omeprazole is usually not strong enough to suppress acid effectively especially in Gerd.
If symptoms persist despite completing a three- to four-week course of omeprazole, a stronger and more effective acid blocker will be needed.
Further evaluation by a gastroenterologist is recommended, as endoscopy or acidity tests should be done to assess the extent of Gerd. Moderate to severe acid damage to the oesophagus may need a stronger and longer duration of acid suppression especially in patients with chronic cough.
Dr Law Ngai Moh is a specialist in gastroenterology at Raffles Hospital.
PRESSURE ON THE FACE
Q: I am 18 years old. For the past two years, I have been experiencing great pressure on my face, especially around the sinuses.
It starts from the bridge of my nose and slowly spreads to the cheeks, eyebrows and sides of my temples. It gets worse when I bend down. A CT scan found my sinuses to be only a little congested.
Recently, my ears feel hot and turn red frequently. Could there possibly be something wrong with my blood vessels?
A: Your symptoms are common and are often due to obstruction of the sinuses. There are many sinuses in the nose/facial areas. The sinuses are normally air filled but they have very small openings. These openings enter the nose passage. When the openings are blocked by swelling of the lining (due perhaps to allergic reaction, inflammation, infection or, rarely, tumours), the symptoms of blockage occur. I do not think blood vessels are the cause.
It is good to have your sinuses checked and perhaps allergy-tested by an ENT surgeon.
Dr Luke Tan is a ear, nose and throat consultant, head and neck surgeon at Gleneagles Hospital