Chronic cough in infants and children

Area of Science:

• Otolaryngology
• Pediatric Pulmonology
• Allergy and Immunology

Background:

• Chronic cough is a common and challenging issue in pediatric patients.
• Identifying the underlying cause is crucial for effective management.
• Normal chest roentgenograms can complicate diagnosis in children.

Purpose of the Study:

• To evaluate the diagnostic yield of various investigations for chronic cough in children.
• To determine the efficacy of specific therapy for chronic cough in pediatric patients.
• To highlight the role of otolaryngology evaluation in complex cases.

Main Methods:

• Retrospective evaluation of 38 infants and children (<16 years) with chronic cough (>4 weeks) and normal chest X-rays.
• Diagnostic workup included history, physical exam, chest roentgenogram, endoscopy, paranasal sinus roentgenograms, and pulmonary function tests with methacholine challenge.
• Therapeutic interventions were based on specific diagnoses.

Main Results:

• Specific therapy led to resolution or control of chronic cough in 33 (87%) of patients.
• Cough-variant asthma was the most common diagnosis (45%), followed by sinusitis (16%), aberrant innominate artery (13%), psychogenic cough (8%), and subglottic stenosis (8%).
• Endoscopy, paranasal sinus roentgenograms, and methacholine challenge testing were effective diagnostic tools.

Conclusions:

• Accurate diagnosis through comprehensive evaluation is essential for managing chronic cough in children.
• Specific treatment targeting the underlying cause is highly effective.
• Otolaryngology referral and endoscopic evaluation are vital, especially in young children and when initial treatments fail.