Turn your head and cough

This is the hospital. I was working the day shift out of fluoroscopy division. My leaden apron and thyroid shield were threatening to shine in the dark, after all the barium compound I had been slinging about lately. On that certain day - a toddler with recent episode of vomiting, then an older man a few days post an initial stroke, and after that - a guy who had complained of a frequent 'tickle' in his throat, sometimes happening with mealtimes, and sometimes not.

Just the facts, please, Sir. The man answered by saying that he needed to cough throughout the day. "It wasn't the kind of cough that made it hard to breathe, but it nagged me and it just won't go away. Warm drinks, cough drops, and then I still feel that I can't cough out what's in there!" The job entrusted to the radiologist and to me included: describe the pharyngeal swallow function, and see how all parts of the sequence were coordinated.

What did the modified barium swallow results tell us? There was no more than trace penetration of swallowed food or liquid into the larynx. Coughs happened, but they were out of sync with the sequence of swallowing. OUT OF SYNC! The radiologist and I agreed: it's not a swallowing problem but a cough problem. As I drilled down into this patient's history, more and more became clear - this was a chronic cough.

Smokers often have a chronic cough. So do many persons with chronic respiratory diseases, and those who have suffered environmental insults to their cardiopulmonary systems. Gastrointestinal insults as well. Persons such as the patient described above may have seen this doctor and that; family medicine, GI medicine, ENT medicine, pulmonology, internal medicine, infectious disease, allergy, etc., etc., before they learn that they have chronic cough. I told him he most likely had chronic cough. Just the facts, sir. What to do about this chronic cough? Speech - language pathologists have answers. This case continues.