Idiopathology: The Cough That Won't Go Away

I saw my vocal cords yesterday.

They kinda looked like one of those funky-looking sea creatures that is found in the deep, dark abyss of the ocean…where no one ever goes…SO deep that it comes equipped with its own built-in flashlight—except it didn’t need a flashlight, because the flashlight was dangling…from my NOSE. The otolaryngologist (say that 5 times fast, or one time correctly. I will be impressed…) was kind and shot my right nostril with lidocaine before feeding a thin camera with a light attached through said nostril to get a closer look. I actually did quite well, until the camera touched the back of my tongue ever so lightly. I only retched and gagged three times during this five-minute procedure. Yay me.

Now, this is not a procedure that people have done every day. Without going too deep into my respiratory issues, as I am saving those for Respiratory Awareness Month in November, I do have a couple of conditions that led me to the otolaryngologist’s (ENTs) chair. I have suffered from allergy and exercise induced asthma for years, and I was diagnosed with reactive airway disease in March of 2020, both of which cause severe cough that needs to be treated with oral and inhaled steroids. I have a medication system that has worked well in battling my flare ups, but this year, I had an exacerbation that completely punched a hole in my medication regimen and has led me to seek help from other specialists.

I have had a severe cough for over eight weeks, after an asthma exacerbation during outdoor exercise. Not the “ahem, ahem,” throat-clearing kind of cough. It’s the looking-at-her-and-know-she’s-gonna-cough-and-it-still-scares-me kind of cough. It’s the can’t-speak-to-another-human-without-a-cough-drop-in-my-mouth kind of cough. It’s the pulled-a-muscle-in-my-back kind of cough. The O-M-G-does-she-have-COVID cough. It’s a cough-when-I’m-eating-and-CRAP-now-I-aspirated-and-I’m-coughing-MORE kind of cough. There has been no need for me to work out for these last eight weeks. This cough is a full body event. Every time. I bet I cough 100 times a day. And THAT is no exaggeration. No steroid taper, no added inhalers or home nebulizers, and no antibiotics have touched it. I have been through—NO LIE—THIRTEEN bags of Ricola sugar free cough drops (yes, I was counting. And I did not want my teeth rotting out!) Chest CT-negative. Bloodwork for Tuberculosis-negative. I was referred to a pulmonologist (lung doctor) and had pulmonary function tests. My lung capacity was great, but my upper airway showed a possible obstruction. Now we were getting somewhere.

I had a CT of my neck done, and when the results came back negative and showed no obstruction, I all-out ugly cried to my coworkers. You know the feeling—you don’t WISH for a tumor or a collapsing trachea (windpipe), but you really want there to be something that you can FIX. That is what lead me to the guy that shoved the camera up my nose and down my throat. But here is what I learned:

1. Cough drops have a rebound effect. WHO KNEW? I was scolded for consuming so many cough drops. Apparently, as a nurse, I should have known this. This means that if you eat enough of these, eventually, your body develops a dependence upon them, and you will continue to cough without them. I knew this about over the counter nasal spray because I experienced this myself. I used it so much that my nose would remain congested if I DIDN’T use it. I simply had to go congested for a while until my nasal passages regulated on their own. Because of the intensity of my coughing, the ENT doctor didn’t believe this to be the case with me at this time. But I would for sure remember this for next time. I have been introduced to a great herbal supplement called Dr. Schulze’s Throat & Tonsil Spray that is an excellent alternative to cough drops. It is a little intense, and as I playfully refer to it as the devil’s orange juice (hehe), I wouldn’t recommend it for children. It’s a mixture of echinacea, garlic, habanero (YEP!) and peppermint roots, leaves, seeds, and bulbs. It also does contain organic grain alcohol, about as much as in pure vanilla extract. It is in a diffused spray, but I wanted to mention that in case you are opposed to alcohol in any form, even for medicinal purposes.
2. Neurogenic Cough. It’s totally a thing. Because I am not a smoker, I had no infection or virus or cold symptoms at the onset of my asthma exacerbation with no illness since that time, and this has gone on for more than 6 weeks, my condition is now considered “idiopathic”. Yes, it sounds a lot like “idiot”.  Haha. It’s a medical word that basically means “we don’t know what the heck is causing this.” So, what they have to go back to is a hypersensitivity of the nervous system. In fact, that is what neurogenic means—a condition of the nervous system. I learned that coughing is actually a function of the vocal cords, hence my referral to the ENT and the “snaking” of my nasal passage. When you get ready to cough, the vocal cords completely close and allow air to build up behind them. Then they abruptly open and allow the air to quickly expel from the windpipe to either clear foreign objects or to attempt to relieve the tickling or whatever you are feeling that creates that cough sensation.

So, what’s a girl to do? I have been prescribed some additional medications to try to suppress the cough for another week. Next Thursday, I will return to the ENT, and he will perform a nerve block in attempt to eliminate the hypersensitivity of those nerves that are going absolutely haywire, making me cough all over everyone in Maryland. I am SUPER excited about needles in my neck. NOT. But I am having my procedure done at John’s Hopkins Hospital. And my doctor’s name is Dr. Simon Best. What could go wrong?

Eat so many cough drops that you teach your body you can’t stop coughing without them? Real.

Teach your body to cough so much that it won’t stop? Totally real.

As a nurse, I will be the first one to admit that there is SO much I don’t know. But when I do, I want to share it! A couple of takeaways from this—even over the counter meds can cause issues. Cough drops are not candy, and if you are consuming large amounts, there is a problem. Also, I cannot stress the importance of developing a good relationship with your primary care physician. In addition to failed therapies, when I told my PCP how many cough drops I was consuming, that got the ball rolling with pulmonology. He knew me. He already knew my respiratory conditions, and he knew this was different. It took me a while to get into the pulmonologist, but after witnessing my constant, intense coughing, pulmonology got me into a John’s Hopkin’s ENT in FIVE DAYS.  

Don’t be an “idiopathic!” Drop the cough drops. Pick up the phone and call your PCP. I know he/she also wants you to…

Be well!