M., a 10-year-old boy, was brought to the office by his mother upon referral from his ENT for a continuous cough problem that had been present for more than a month.
Before coming to the office his mother had also taken him to an allergist.
The cough had started just over a month before my consultation, with the onset of a flu virus that had lasted about two weeks.
M.'s medical history reported previous allergies and asthma for which M. is under constant monitoring and drug therapy. M. was also positive for laryngopharyngeal reflux, and M. was also under pharmacological therapy for this disorder. For his cough, however, he had been prescribed syrups. None of the therapies were able to significantly reduce the onset of cough.
I asked the mother if she was willing to have M. examined again by an ENT, and I had indicated to her the name of a professional with whom I work because we often work in collaboration and therefore I believed that this possibility would be beneficial to the child.
The new ENT evaluation highlighted edema and erythema of the vocal cords without formations or lesions. The posterior glottis showed erythema, indicative of reflux. During vocal production there was a normal behavior of the vocal cords. The request for a deep inhalation triggered the cough.
M. reported that he was really bothered by this cough which made him exhausted and gave him, in the strongest bouts, headaches. M. reported feeling a continuous itch in his throat which led him to cough. The doctor did not attribute the cough to any psychogenic cause. The only time the cough was absent was at night. There was no evidence of neurological problems, and no family history of Tourette's syndrome.
The vocal evaluation showed moderate hoarseness, probably attributable to the excessive coughing fits. The other perceptual parameters were normal. Breathing was intermittent, with irregular inspiration in an attempt to sedate and avoid coughing fits. During speaking, breathing was more regular and rhythmic.
Cough: two types of cough were present during the ENT visit, the first was a loud cough with an attack approximately every 16-18 seconds; the second sounded more like a whistle with a lower frequency. Throat clearing appeared intermittently.
Immediately after the ENT I carried out the osteopathic evaluation in which it emerged: bilateral occiput consular compression, with left temporalis in RI; right zygomatic and maxillary in RE; hyoid and larynx in superoposteriority and right rotation; right clavicle in antero-superiority; upper ribs in inspiration and upper dorsal in multisegmental dysfunction. Limitation of diaphragmatic excursion with diaphragm in exhalation; right sacrum twist; right leg and foot in D. The evaluation was difficult due to the constant coughing fits.
The speech therapist who collaborates in the office with the ENT was then asked to teach M. solutions to reduce his cough.
The therapy therefore consisted of exercises with the speech therapist which included: swallowing liquids or saliva decisively or more slowly in response to the sudden desire to cough; blow through pursed lips or take a sigh before coughing when you feel the urge or to break the sequence of coughing; perform gentle and slow abdominal breathing followed by a long exhalation with swallowing or sighing during periods of coughing; take a deep breath; raise your voice or sing or speak louder to engage the vocal cords more.
After 5 lessons of about 10 minutes each, M. was able to control his coughing fits.
We then continued with osteopathic sessions (3) for general rebalancing of the dysfunctions found and everything was followed by a new ENT evaluation.
In total the therapies lasted 2 weeks.
At the second evaluation, both the edema and the erythema were significantly reduced. Today M. had a new check-up 2 months after the last visit and reported that he no longer had a cough or wheezing and that he had suspended the pharmacological therapies that he had been using for some time.