For years I've had a persistent cough and a need to clear my throat. Sometimes I gets bad enough that it makes me gag and go into severe coughing "attacks" where I can't stop coughing for about a minute, sometimes resulting in vomiting. It gets a lot worse when I exert myself physically or when I eat (especially sugary food). Some days are better than others, but I can't think of a day where I haven't had this problem. It can be extremely draining and embarrassing.
I've been to doctors over the years and it came down to post nasal drip. I've had several blood tests and x-rays and there's nothing seriously wrong. A few years ago, my sinuses were pretty much permanently shut and surgery was performed to remove tissue and a cyst, which restored my ability to breathe through my nose, but the cough and throat clearing persists to this day. Pseudoephedrine seem to help, maybe a little, but I'm not sure. Also, I have a cleft uvula, but I don't know if this is relevant and my previous doctor never said anything about it besides noticing it.
I have had a few occurrences (very rare) where bits of food got into my sinuses.
I haven't been to a doctor in a few years since I no longer have health insurance.
I don't really know what to do about this, I wish it would go away, but nothing seems to help.
What you describe in nice detail suggests several possibilities. First, that your cough may be caused by one of the three most common causes: the post-nasal drip you mentioned, Gastroesophageal reflux disease (GERD) or Asthma. Second, is related to your mention of “a few occurrences where bits of food get into your sinuses”. This suggests that you may have what is called a “swallowing disorder.” This could result in regurgitation from the esophagus or the pharynx (the back of your throat, seen when a doctor looks in your mouth.)
My advice is two-fold. First that you meet with your doctor to inquire about two things: 1) could your cough be secondary to one of the “most common causes” listed above. That your cough worsens is consistent with exercise induced asthma and, 2 if any of the following information on a divided epiglottis ( the anatomic structure that prevents food, liquid or mucous from passing into your lungs), taken from a text book of Ear Nose & Throat disease might apply to you, especially since a cleft uvula is not infrequently associated with a cleft epiglottis
A bifid epiglottis is a rare anomaly defined as a cleft of the epiglottis encompassing at least two thirds of its length. The infants typically present with stridor or aspiration, although they also can be asymptomatic. The diagnosis is made on laryngoscopy, and if the epiglottis is lax, prolapsing into the laryngeal inlet, supraglottoplasty can be performed.
Associated congenital anomalies are common and tend to be midline. In the head and neck these anomalies include cleft palate, cleft uvula, micrognathia, and microglossia (see Table 202-1). Polydactyly has been reported in approximately 75% of patients with a bifid epiglottis. The hypothalamic-pituitary axis is often disrupted in children with a bifid epiglottis. Congenital hamartomas or the absence of the pituitary gland can lead to growth hormone insufficiency with resultant growth retardation, secondary hypothyroidism with resultant cretinism, or secondary hypoadrenalism resulting in salt wasting and hypoglycemia.
Pallister-Hall syndrome (PHS), or congenital hypothalamic hamartoblastoma syndrome, is commonly associated with a bifid epiglottis. Laryngoscopic examination of 26 subjects with PHS showed that 15 had a bifid or cleft epiglottis (58%). Other associated features of the syndrome include polydactyly, pituitary dysfunction, imperforate anus, and laryngotracheal cleft. It has an autosomal dominant inheritance pattern, with variable expressivity and is caused by a mutation in the GLI3 gene. Because of the high incidence of hypothalamic-pituitary problems, all infants with a congenitally bifid epiglottis should undergo an MRI of the brain, an endocrine evaluation, and a genetics consultation.
I am sorry that you no longer have health insurance but yours is a serious problem that pretty much demands medical attention. If you can only afford to meet with one doctor, my choice would be that it be an ENT specialist and that you share this response with him/her.
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