<p>D has had a cough all summer. She has had a course of prednisone, an inhaler, a Zpack and Singulair. She has a lot of post-nasal drip and I think it might be allergies rather than bronchitis. It is affecting her singing, because she can't take a deep breath without coughing. I want her to see a doctor who knows about singers' health -- I don't think her pediatricians are are the best for this. I've been getting local recommendations, but I'm unsure if it's better to take her to an allergist (under my assumption that it's allergies) or an ENT to cover all bases?</p>
<p>I’d see an allergist. I’ve lived my whole life with post-nasal drip. It ain’t fun :(</p>
<p>Hi Merlehay. I am not a doctor (disclaimer - haha), but have you all considered acid reflux? My daughter went through several doctors and MONTHS of the symptoms you described (even the post-nasal drip, which is weird to me to be associated with reflux, but she had that constant drainage too). She took antibiotics and allergy meds to no avail and a friend told me about silent reflux . . . coughing with no heartburn at all. And I mean terrible coughing, especially when she went to bed. We went to yet another doctor; he said: “Yup, sounds like reflux.” Complicated tests were possible, but he said the best test is to go to the store and buy some OTC meds like Prilosec. We did, and her cough was gone within a couple days. It was a huge relief. We researched and discovered that it’s really common for singers to get reflux . . . if you think about all of the physical aspects of singing, it makes sense. My daughter has done other things since to avoid the reflux, and only takes the meds when necessary. Might be worth a try. :0)</p>
<p>You should probably start with her primary care doctor to get the right referral if you don’t yet know for sure what the issue is. Otherwise you could spend a lot of time going from specialist to specialist.</p>
<p>First: I am not a medical doctor, so keep that in mind when reading the advice below.</p>
<p>I deal with professional singers on a regular basis and what you are describing is normal. Thoughts:</p>
<p>1) Is the cough productive? If not, try a cough suppressant at night, I like Delsym. When a singer has a cough, the tissue surrounding the vocal folds can become hypersensitive and the singer will continue to cough even when there is no need. The Delsym can help take away the edge at night and help get the body over the urge to cough all the time. Sometimes you just have to refuse to cough no matter how much it tickles during the day. Eventually it usually stops as the body realizes there is nothing on the folds.</p>
<p>2) Antibiotics kill good bacteria necessary for digestion and can cause acid reflux where none existed before. So it is possible there is silent reflux.</p>
<p>3) Steroid inhalers can affect the vocal folds. You can get dried out, swollen, and in some cases you can get a yeast infection on the vocal folds, which will affect voice quality.</p>
<p>I would try step 1 first and see if you get results over the weekend. If you do not, I would schedule with an ENT and insist that they do a scope (Rigid or Transnasal). A mirror exam is a cheaper first look. However, I only trust doctors with a lot of experience with singers to use a mirror. You can miss a lot with a mirror only and even the best doctors will tell you they never trust the mirror alone. If there is anything wrong with the folds, the doctor would be able to see. If silent reflux is an issue, he would be able to see that as well. Just make sure you make the issue about her speaking voice and then that it bothers her singing a little too. Insurance companies do not see singing as a vital need and they will usually not pay for singing voice treatment. However, anything that affects the speaking voice is usually covered. So just play the game and make it up. Most docs get it and will code their bills in the proper way so that they get paid.</p>
<p>If you want to share your city, I can tell you if I know any ENTs near by that I would suggest.</p>
<p>VT</p>
<p>Oh dear - I took her to the pediatrician again today out of desperation. He completely dismissed allergies and thought maybe a sinus infection. Gave her an inhaler and Augmentin. Should she not do the inhaler? The side effects to vocal chords doesn’t sound good. She does not cough at night, so he didn’t prescribe a suppressant. He said if she’s not better in a week, she should have a chest xray and/or a CAT scan of her sinuses.
She has a little congestion in the head, but no other symptoms of sickness.
Does reflux cause a wet cough? She does have some digestion issues (delayed gastric emptying among other things) but endoscopies in the past have not shown reflux.
We are in the Chicago area.
This is so frustrating.</p>
<p>Does your family have a history of allergies? I would get that sinus xray. She could have a chronic infection if allergies/sinus infections are a problem. </p>
<p>It’s not a barking cough, is it? Like a seal?</p>
<p>So let me refresh my suggestion: I say get a better primary care doc or impress upon your pediatrician the importance of a good diagnosis and an appropriate specialty referral.</p>
<p>As someone who treats patients with cough, I do not think that starting with a good primary care doctor is the way to go. GP’s are not necessarily able to recognize the source of a cough. I suggest starting with a laryngologist who is very familiar paradoxical vocal fold motion and chronic cough (both vocal-fold related issues that often relate also to upper respiratory infections, etc.) That physician will consider allergies, sinus, reflux, and the possibility that the cough has now become chronic but to vocal fold irritation (for which there is very effective therapeutic treatment that can calm down and then eliminate the cough). He or she will also assess vocal fold tissue health at the same time. I would not recommend trying to self-diagnose via trying to treat different possible causes. It is likely that the cough is by now multifactoral - meaning it may have a few different underlying causes - and a laryngologist is familiar with all of them and can tell you where to focus your treatment - whether the cough is vocal fold triggered or lung triggered. </p>
<p>I am going to post a request in the national voice therapist email listserve for a Chicago-area referral for you and will share the info here!</p>
<p>We dealt with an ENT who specialized in singers. First thing he did was order a “prick test” for allergies. Thick post nasal drip caused chronic cough (esp. at night). Then we scoped the throat at the suggestion of his voice teacher. Had no major allergies, but a thousand minor ones. Allergie shots. Daily reflux meds…ahhh. Also tonsils removed. Ask your primary to recommend an ENT who specializes in voice students.</p>
<p>In my D’s case, the reflux cough was wet and productive a lot of the time.</p>
<p>Finally saw the specialist today. And it wasn’t completely conclusive. Her vocal cords look good, only a tiny bit swollen which he said could be from coughing. From taking her health history (which is pretty involved), the docs decided the most likely cause is reflux (although her throat was only showing mild irritation consistent with reflux). So she has been prescribed Nexium. Also, since she has a lot of post-nasal drip, they prescribed a nasal allergy spray. So hopefully, one or both of these things is the answer.
Really liked the doctor, and will definitely return there if there are future voice issues.</p>