Chronic Cough-the Whole Ball of Wax

When you are not certain about theorigin of a patient's chronic cough,check the ears for cerumen impaction.Although postnasal drip,asthma, and gastroesophageal refluxdisease are more common causes,cerumen impaction can activate thecough reflex through stimulation ofArnold's nerve. Removal of impactedwax may resolve the cough and eliminatethe need for radiographs orblood work.
-- Ali Ahmadizadeh, MD
   Hoboken, NJ