HomeAnswersOtolaryngology (E.N.T)chronic coughHow to treat chronic cough, blocked ears and popping sound in ears while swallowing?

I have chronic cough, blocked ears and popping sound in ears while swallowing. How to treat it?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At October 24, 2019
Reviewed AtJuly 31, 2023

Patient's Query

Hello doctor,

I am a 66-year-old male with a weight of 198 lbs and a height of 6 feet. For the last four months, I have been continuously facing the following problems, moderate sore throat, feeling like a lump in my deep throat, gastric reflux, poor digestion, a feeling of air blocked in both ears and a popping sound on swallowing. After treatment, these symptoms subside for some time. But now I have deviated septum. Presently I have sticky mucus discharge from the nose in postnasal mode. Sometimes, I also feel stress in the jaws. Due to continuous popping in my ears, mostly my left ear, and a lump feeling in my throat, I am unable to sleep properly. This is having an adverse effect on my health. I have been on medication for almost three months on and off, including Levocetirizine, one tablet twice daily, and Fluticasone spray. I also take Rabeprazole DSR for the reflux issue, steam inhalation, and saline gargles. But symptoms sometimes abate and again come up. I regularly take Bisoprolol, Metformin, and Glimperamide for a few years. Due to soreness in the throat, popping in the ears, and continuous cough, I was unable to sleep. The sticky mucus is viscous and salty in taste and discharges in the throat. RTF test showed partial dysfunction of the left eustachian tube. What could be the likely causes and line of treatment to get rid of this? Could it be due to air pollution or some other allergy source? Due to continuous coughing, my abdominal muscles are painful, and there is a split voice in my throat. It appears like there is an overproduction of mucus all over the respiratory tract. I have started taking the antibiotic Augmentin eight hours once for the last four days, but no relief. This problem is chronic but more intense in the last four months. Presently, it is in the acute stage and not responding to treatment. Please advise.

Hello,

Welcome to icliniq.com.

I understand your concern.

For better clarity, please answer these questions:

Can you take a picture of the back of the throat, showing details of the affected area, and send it to us? Which area do you live in? Do you drive a two-wheeler on polluted roads? Did this worsen during the Diwali season? Do you smoke or drink?

Revert with answers.

Regards.

Patient's Query

Hello doctor,

Thank you. I do not smoke, neither do I drink. I had this chronic problem, but that used to get resolved after some treatment. But this time, the problem has prolonged for the last three to four months despite treatment going on. My current problem is as I mentioned soreness in my deep throat area, pain, burning, and as if something is stuck up. Continuous coughing brings up mucus, excessive formation of the viscous white or light grey mucous, especially in the left side of the nose, and blocked ears popping or clicking on swallowing with a burning sensation in the ear passages. I could not sleep last night due to these problems. The problem is just not responding to treatments, including nasal spray use, Digene tablets, Rabeprazole DSR, Monton-L, steam inhalation, and saline gargles. The intensity keeps changing from time to time. I do have a gastro reflux issue, which too, is chronic. I have started Augmentin 625 mg, three times a day, and today is the fifth day but no improvement yet. I do not drive a two-wheeler and, most of the time, stay indoors. Since the problem is going on for a few months repeatedly, the seasonal effect may not apply. I have taken the best possible picture from close range but without using a spatula. Kindly note I have just completed a three weeks course on Terbinafine 250 mg for skin infection.

Hello,

Welcome to icliniq.com.

I understand your concern.

Your throat is not clear in the picture. (attachment removed to protect patient identity). Nevertheless, with your detailed description, I can make some conclusions, but I need some more details.

1. Did you start the antibiotic on your own, or did some doctor prescribe it?

2. Along with the antibiotic, did you take the Rabeprazole, Domperidone, Montelukast, and Cetirizine tablets as well?

3. Did you take any medicines for lightening and liquidating the mucus?

4. Do you have a fever?

5. Has some doctor done a laryngoscopy on you to rule out any growth or abnormality in the larynx?

6. Is there any wheezing or breathing trouble?

With the preliminary information, I feel it is more of rhinitis with laryngopharyngeal reflux. You need a macrolide antibiotic for five days and a macrolide anti-inflammatory drug for another five weeks. It will take a long time to get rid of the problem. But you need a good lifestyle and dietary advice. You would have to follow the same sincerely to find benefits. Please provide us with all the details sought. Desist from having spicy oily, and masala-rich foods. Tell us about your dietary habits more.

Hope this helps.

Regards.

Patient's Query

Hello doctor,

Thank you. I started Amoxycillin four days ago since things were not improving. I am taking Rabeprazole, and Domperidone DSR, once daily. I am using Fluticasone spray twice a day and Montina-L once daily, along with steam inhalation for liquidating the mucus. I had a fever but only for one day, two days ago. I got a laryngoscopy done just now, and there is no growth, but LPR is positive. I have no breathing trouble. I have two problems, continuous accumulation of mucus in the throat, forcing periodic coughing and spitting, clogged ears, and feeling of dryness or irritation. What is macrolide? My food habits are a simple, pure vegetarian diet and about three cups of tea a day. Such severe symptoms did not occur in the past for so long period, and I am unable to sleep due to irritation in a deep throat and ear canals too, much phlegm generation, and coughing. Congestion is seen more in the left nostril, and the taste is salty with a whitish viscous discharge. I hope you will be able to draw a conclusion and chart the outline of treatment.

Hello,

Welcome to icliniq.com.

I understand your concern.

I would like to say a few things.

The self-prescription of antibiotics was unnecessary. You have again chosen the wrong medicine yourself. Complete the full course and stop it. Macrolides are a particular class of antibiotics that have some action against microfilms. I would suggest you take a twice-daily dosage of 500 mg of Clarithromycin for one week, followed by once daily of 250 mg of Clarithromycin for the next five weeks. Take Esomeprazole 40 mg with Domperidone 10 mg in the morning on an empty stomach and take plain Pantoprazole 40 mg on an empty stomach in the night for a month. Continue Montek LC (Montelukast sodium and Levocetirizine) in the evening for a month. Start on Allegra 120 (Fexofenadine) tablet once daily in the morning for seven days. Take Mucinac (Acetylcysteine) 600 mg dispersible tablet twice daily, mixed in a glass of water. Stop gargles and steam. Avoid exposure to sun, dust, smoke, and pollution. Get an air purifier at home. Stay away from pollen. Take a regular diet. Do not fast. Do not drink a lot of water immediately after food. Do not lie down for two hours after any meal. Do not drink late in the evening. Drink adequate water but not immediately before or after meals. Check these. Do some regular exercises like brisk walking, etc., indoors.

I hope this helps.

Kind regards.

Patient's Query

Hello doctor,

Thanks for the reply. Last time, I consulted you in this thread, and you gave me treatment. I followed the same. There was some improvement. But for the last two months again, I have been having problems. No treatment is working, which are as follows:

Fluticasone sprays twice a day. Now I have stopped. I took Levocetirizine with Montelukast for almost a month. Earlier I took Omeprazole-D. Now I am taking Rabeprazole with Itopride one in the morning empty stomach. But I feel Itopride should be taken more. When should it be taken after or before meals, but it is a combined drug? I had got my throat checked fully. There was no growth requiring investigation, but chronic LPR is confirmed. I also got an endoscopy done. A mild hernia at the esophagus was detected. These could be caused by continuous irritation by acid. It seems to be more of LPR and reflux than GERD. I managed to reduce weight from 202 to 189 lbs by fasting, diet reduction, Pranayama, and walking 1000 steps more, which I cannot do presently. I have started taking short walks since long walks I cannot do due to mid-thoracic pain in my back when walking. I also do Pranayama like Kapalbhati 100 times, Alom vilom 120 times, and Bhastrika 45 to 50 times. But my belly refuses to go inside, and my stomach feels full and hard. The doctors did not find anything wrong. Stage 2 liver fattening was detected though. I do not drink. Neither I smoke, nor do I take spicy and fatty foods? This coupled with my stress, little hernia, indigestion, and tummy could be the cause of reflux causing repeated coughing out and trying to cough up a small amount of viscous phlegm. I also feel phlegm run down my nose in post-nasal flow. My pulse oximeter readings show 97 % and PI 1.8 % to 5.6 %, varying at different times. I was prescribed an asthma inhaler by the chest department twice a day. But despite all this, there is no relief as of date. I feel throat roughness and dryness of mouth and burning on tongue sensation many times. Other regular medicines are Metformin, Glimepiride, and Losartan in the evening and Bisoprolol and folic acid in the morning. I feel slight irritation in my throat all the time, but the main thing is feeling as if something is sticking or lump, and I have to cough up to clear mucus. I cannot sleep at night unless I take Clonazepam 5 mg tablet chewable, which was prescribed to me for leg burning sensation due to cervical and L4-L5 compression. I also noticed that after consuming food, I suddenly have a lot of mucus formation, which appears coming from the left nostril cavity and throat for a few minutes, then subsides, and I have to draw mucus from the left nostril inside, frequently. I have to clear my throat. But the mucus will not go away. Sometimes it may be a symptom of relaxation. The rest are mentioned already in the early correspondence of this thread. I am fed up and now planning to stop every medicine. Stress too, is a cause I know but am unable to handle it. I am now 68 years old and just do not like hardened tummy bulge, which I never had. Only since a year. Can Pregabalin tablets 2 in night I take could cause this tummy and weight gain? I can afford to stop as my spine leg burning is under control at the moment. Kindly go through all these slowly as it appears as a compounded and messed up report, along with earlier reports and symptoms I sent. I am not doing gargles and steam as was advised by you earlier. Should I start or not? Just take a fresh view and clear up the mess. Too many things and too many medicines. Even as a patient, I am not happy. But this throat irritation and sticking in the throat is taking a toll.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Regardless of the pandemic, patients have started flocking to hospitals once again. In your case, you have to check three things, diet, stress, and sugar. If all three are under control, then medicines do not have much role. When the above three are not under control, you will need medicines for the throat. As we have addressed before, the sensation of a lump in the throat or the so-called globus feeling is due to acidity. We call it laryngopharyngeal reflux. Now certain factors can aggravate the reflux and worsen it. These are allergies, spicy diet, dust, pollution, stress, and erratic food habits. I am not happy with the irregular scheme of treatment that you have followed. You did not review back with me after the prescribed course of medicines. Nor have you taken medicines as prescribed by me. The medicines were to be followed, and you were supposed to review back with me if you had not found improvement. On the contrary, you have followed up after 11 months. You leave us with no option but to reassess everything. I request you to upload the latest reports of your blood sugar values, complete hemogram, laryngoscopy, and any other relevant investigations done in the last 30 days. If you do not have fresh investigations, I suggest you get those done. Ideally, I would prefer a physical consultation for a patient like you who has been suffering for a long time. Let me know if you would be open for a consultation at my clinic.

Do revert back, and we shall help you.

Regards.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Shyam Kalyan. N
Dr. Shyam Kalyan. N

Otolaryngology (E.N.T)

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