Chronic Cough — When Your Cough Won't Go Away

What is a Chronic Cough?

A cough lasting more than 8 weeks in adults (or more than 4 weeks in children) is considered chronic. It is one of the most common reasons patients eventually arrive at an ENT clinic in Singapore — typically after multiple GP visits, antibiotics, and cough syrups have not worked.

The single most useful insight is that chronic cough is usually not just a lung problem. The cough reflex is triggered from the upper airway in most chronic-cough patients, which is why ENT assessment is essential when chest investigations are normal.

The ENT Causes Your GP May Have Missed

• Post-nasal drip — also called Upper Airway Cough Syndrome. The most common ENT cause of chronic cough.
• Chronic sinusitis — infected mucus dripping down the throat triggers persistent cough
• Allergic rhinitis — allergy-driven post-nasal drip and throat irritation
• Laryngopharyngeal reflux (LPR) — "silent reflux" where stomach acid reaches the throat without classical heartburn
• Laryngeal sensory neuropathy — the cough reflex itself becomes hypersensitive
• Vocal cord dysfunction

Symptoms to Note

• Worse at night or when lying flat (suggests post-nasal drip or reflux)
• Constant throat clearing
• Sensation of mucus stuck at the back of the throat
• Hoarse voice — a strong indicator of reflux
• Triggered by talking, laughing, or cold air
• Productive (with mucus) versus dry
• Associated nasal symptoms — blockage, sneezing, drip

When GP Treatment Isn't Working

Time to see an ENT if:

• Two or more courses of antibiotics and cough syrup have not helped
• Your chest X-ray is normal but the cough persists
• You have nasal symptoms (blockage, drip, sneezing) alongside the cough
• The cough is worse after meals or when lying down
• An inhaler has been prescribed but it is not improving the cough

Diagnosis

• Detailed history — timing, triggers, associated symptoms, medications (ACE inhibitors are a classic missed cause)
• Nasoendoscopy — visualises the post-nasal space, drip, polyps, and sinus drainage
• Laryngoscopy — checks for inflammation of the voice box typical of reflux
• Allergy testing — when an allergic component is suspected
• CT sinuses — when chronic sinusitis is suspected
• Coordination with gastroenterology for objective reflux testing if needed

Treatment Depends on the Cause

Post-Nasal Drip and Sinusitis

• Intranasal corticosteroid spray and saline irrigation
• Antibiotics if there is acute bacterial infection
• Treat the underlying allergic rhinitis
• Functional Endoscopic Sinus Surgery (FESS) for chronic sinusitis with polyps

Laryngopharyngeal Reflux (LPR)

• Proton pump inhibitor medication (omeprazole, esomeprazole)
• No eating 3 hours before bed
• Elevate the head of the bed by 6 inches
• Reduce coffee, alcohol, spicy and fried food
• Treatment course typically 3–6 months for full effect

Allergic Cough

• Antihistamines and intranasal steroids
• Allergen-specific immunotherapy for long-term control
• Allergen avoidance — particularly house dust mite

Why Choose Dr Pang?

• Investigates ALL the common ENT causes — not just the one most patients have already tried
• Nasoendoscopy and laryngoscopy on the first visit — sees what GP examination cannot
• Cross-disciplinary approach with gastroenterology when reflux is the dominant driver
• Treats both adults and children

Frequently Asked Questions