Prolonged cough

Are you troubled with recurrent involuntary throat clearing, irritation and cough? If so, I can help

There may be numerous causes; thankfully most are benign.

However, it is important to exclude worrying conditions like cancer of the voice box or lungs, paralysis of the vocal cords or fixed narrowing of the windpipe. 

What causes chronic cough?

Most of the time there isn’t a single cause. Certain lifestyle choices may also worsen the cough and throat irritation. Here are 10 common benign causes or contributors:

  1. Prolonged infections: viral, bacterial or fungal 
  2. Tobacco smoking
  3. Gastroesophageal reflux (in this case technically called laryngopharyngeal reflux)
  4. Nasal inflammation, sinusitis and post nasal inflammatory drip
  5. Asthma and/ or its medication
  6. Allergy
  7. Other lung problems such as bronchitis or emphysema
  8. Certain medications for example some older generation blood pressure pills
  9. Dehydration
  10. Voice overuse (vocal abuse)


I would like to see you urgently when you have worrying additional symptoms. Here are 8 that are concerning:

  1. Noisy breathing at rest or with exercise 
  2. Coughing up blood  
  3. A continuous hoarse voice lasting for more than two weeks
  4. Pain in the voice box or neck.
  5. Swallowing difficulty and/ or painful swallow
  6. Choking on food and fluid 
  7. Regurgitation of undigested food
  8. Recent unexplained weight loss

How will I obtain a diagnosis?

The most important part of my clinical examination is to obtain a really good view of your voice box and the upper part of your windpipe. I will use a high-definition camera that will gently be passed through your nose. This is connected to a large TV screen to give me and you an amplified view of your voice-box and its surrounding anatomy.

I will assess the mobility of the vocal cords and attempt a look at the part of the voice-box underneath the cords (called the sub-glottis) and the upper windpipe (trachea).

Some lesions in the vocal cords may not be immediately apparent and only show up with a special variation of this examination called a video-stroboscopy. This visually slows down the surface vibrations of the vocal cords and will enable me to diagnose subtle underlying vocal cord lesions.

I may arrange some blood tests and a chest X ray. I may also recommend a high-definition CT scan of the voice box, windpipe, chest, and/ or sinuses. 

If food or fluid appears to be going down the wrong way when you swallow, a useful investigation is a video-swallow X-ray study. This is useful in demonstrating aspiration and inhalation of food and fluid.  

If the problem is still not clear, I may recommend an examination of the voice box and windpipe under general anaesthetic: a procedure called a microlaryngoscopy and tracheo-bronchoscopy. 

If I feel you may have a primary lung or gastroenterology problem, I will refer you to my very experienced and highly skilled respiratory and gastroenterology colleagues. 

My aim is to provide a comprehensive diagnostic package to get to the bottom of your problem.  

My approach to treating prolonged benign causes of cough?

Most benign causes of cough usually respond to voice hygiene measures designed to be kind to your voice box, in addition to medicinal treatment for any underlying or aggravating medical conditions.

Some conditions such as vocal cord paralysis or lumps on the cords will benefit from surgery. 

Here are some practical tips for all cough and voice problems. Drink plenty of water, stop smoking and avoid gastric reflux causing food or fluids such as fizzy drinks, caffeine and fatty foods. Brushing your teeth at night and antiseptic gargles are also beneficial. Humidification can reduce irritation from a dry throat. If you are prone to allergy then an air purifier with a HEPA filter is useful.

Many of my patients find speech therapy extremely helpful; this is a form of physiotherapy to help you take control of your irritable voice box and reduce the tension in the muscles surrounding it. There is evidence that certain medications that reduce the sensitivity of the voice box, when used in conjunction with speech therapy, can help to cure long term cough.   

I work with some of the most experienced and highly regarded speech therapists in London.

Please do get in touch if you have an irritating prolonged cough