Advice Guide, Primary Care, CPD, Clinical, Continuous Professional Development
This month we have a guest post by Miss Romana Kuchai, Consultant ENT Surgeon at Bupa Cromwell Hospital. Miss Kuchai presented at our recent ENT CPD event held at the Royal Institution of Great Britain. Her talk covered key issues pertaining to role of the larynx in cough and how to avoid common misdiagnoses in primary care. The key take-aways for GPs have been summarised by Miss Romana in brief below:
Cough is a common symptom that affects 40% of the population at some time in their life. Multiple aetiologies are associated with cough resulting in much hypothesising as to the exact causes. More recently the concept of cough hypersensitivity syndrome has arisen and this goes some way to explain cough that seemingly has no ‘organic cause’.
The most common causes of cough remain:
-Post nasal drip
-GERD
-Asthma
Yet a small number of these patients actually suffer with cough. It is however imperative that assessment of swallow is undertaken if at all in question and with an aging population, presbyphagia should be kept in mind as 2% will develop it. Laryngeal causes in particular such as laryngospasm and laryngotracheal stenosis may present as more unusual causes of cough and diagnosis firmly lies with an ENT Specialist. The future of the management of cough lies in multi-disciplinary Cough Clinics that involve Respiratory Physician and ENT Specialist. A simple examination with a flexible nasolaryngopharyngoscopy forms a key part of the assessment. Gastroenterologists and Speech Therapy may form part of the extended MDT Clinic. This provides a comprehensive assessment of the causes of cough which is the basis of its long term treatment. General additional advice for the patient includes drinking plenty of water, avoiding regular clearing of the throat and frequent steam inhalation.
If initial basic treatment options are unsuccessful referral to a Respiratory or ENT Specialist is important to further investigate all other possible causes.
Presented by Miss Romana Kuchai MD FRCS ORL-HNS
Consultant ENT Surgeon
