Let me introduce you to Mr. Cough, who I must admit in many ways is not the “typical patient” I see coming into the office for a consultation. Yet, his story serves as a lesson to all of us: beware of the “unlikely” situation. Mr. Cough’s story has a happy ending unlike that of the recent tragic story of Natasha Richardson; yet, they have one thing in common: the “unlikely” situation.
When I first saw Mr. Cough he told me he had been coughing for the previous eleven months. He had seen a couple of very excellent chest medicine specialist and had the complete workup for his chest; yet, no abnormality had been found. He had been treated with multiple antibiotics and inhalers yet the cough was keeping him up at night. He also had a mild post nasal drip (drainage from his nose going into the back of his throat), mild congestion of his nose and occasional headaches. The reality is that his nasal drip and nasal congestion symptoms were very mild and really never bothered him.
The biggest problem for Mr. Cough was that he could not sleep at night. He would get up during the night coughing and this prevented him from getting a good night’s rest. Yet, after eleven months of doing everything every doctor told him without improvement of his symptoms, he finally obtained a CT scan of his sinuses. The scan showed him to have extensive sinus infection with blockage of all his sinuses.
To make a long story very short, Mr. Cough had sinus surgery and his sinuses were a mess, to put it bluntly in layman’s language. His sinus infection had progressed to such a severe point that even though he improved markedly after his surgery, the infection was so bad that he healed with scar tissue formation which required a second sinus surgery a few months later.
As I mentioned in the beginning of the article, the ending is good. After the second surgery Mr. Cough’s sinus and chest symptoms improved markedly. However, due to the prolonged nature of his problem, Mr. Cough had developed asthma symptoms which I am again happy to say have been able to be controlled easily with medicine now that his sinus infection is completed resolved.
Here is the caveat: there are three main reasons people get cough symptoms beyond the typical cold and they are: asthma, acid reflux and sinus infections. Obviously in Mr. Cough’s situation the sinus infection was the main reason for his cough. However, since Mr. Cough had very minor complaints relating to his nose and sinuses, this cause was overlooked until months and months later.
The next time you get a cough that lingers for a while think about Mr. Cough’s.