Throat & Voice

Chronic or prolonged cough – What you need to know

February 3, 2020
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Frustrated with the constant hacking and throat irritation that wouldn’t go away for months? You are likely not alone. Chronic or prolonged cough is an annoying symptom that can have a significant impact on the quality of life of the sufferer. This is one of the most common symptom seen by Dr Gan, an ENT Specialist in Singapore with a subspecialty training in nose & sinuses.



What is cough?



Coughing Clipart



Cough is a protective reflex that results in expulsion of air from your lung to clear the upper airway of foreign bodies, mucous and irritants. When cough is persistent, it is often a symptom of an underlying condition. The most common way to classify cough is based on its duration as follows:


Acute – Less than 3 weeks duration
Subacute – 3-8 weeks duration
Chronic- More than 8 weeks duration



What is the cause of my persistent cough?


Acute cough (< 3 weeks duration) is most commonly due to a viral upper respiratory tract infection (e.g. common cold). It often resolves on its own without the need for medications or a visit to the doctor.


Subacute and chronic cough or often called “prolonged cough” as the approach to these two groups of cough are similar. The table below is a list of potential causes of chronic cough (not meant to be exhaustive):



Nasal and Sinusitus Stages



A study in a restructured hospital in Singapore has shown that the most common cause of cough in the local context are postnasal drip, acid reflux from the stomach, and Asthma. This is in line with international studies that have shown that more than 90% of chronic cough are due to these 3 conditions.



What is Postnasal Drip?



Post Natal Drip



Postnasal drip refers to the feeling of mucous stuck at the back of your nose and throat. The cause is often due to over production of mucous (e.g. in Rhinitis (“sensitive nose”)) or thick mucous from Sinusitis (infection of the sinuses). Mucous from these nasal conditions can irritate and cause swelling of the voice box (medically known as laryngitis). The voice box can also be swollen because of acid irritation from the stomach (medically known as laryngopharngeal reflux aka LPR). A swollen voice box can cause symptoms like throat itchiness, frequent throat clearing, hoarse voice, sore throat, feeling of something stuck and a cough.



What do I expect when I see an ENT Specialist for chronic cough?


Your ENT Specialist will likely take thorough medical history and perform a complete ear, nose and throat examination. It is also important to inform your doctor of your regular medications as some medications can cause cough. For a complete assessment of your cough, your ENT Specialist will likely recommend a nasoendoscopy (nose scope done in the clinic under local anaesthesia). A nasoendoscopy allows the assessment of the nasal cavity, outflow tract of the sinuses as well as the throat and voice box. It is a relatively painless procedure that takes only a few minutes to perform and can often be tolerated in children as young as four years old. If you have symptoms suggestive of a lung condition (e.g shortness of breath, wheezing etc), a chest X-ray may be ordered. Your ENT Specialist may also refer you to a Lung Specialist to have a lung function test done if he/she suspects that you may have Asthma or a lung condition.



How is chronic cough treated?


This depends on the underlying cause.: Common treatments include:

  •  Nasal steroid sprays and antihistamines for Rhinitis
  •  Oral antibiotics, nasal steroid sprays and a nasal douche (“salt wash of the nose/sinuses”) for Sinusitis
  •  Acid suppressant medications and lifestyle modifications for patients with Laryngopharngeal Reflux
  •  Inhaled asthma drugs for Asthma
  •  Stop smoking for smoker’s cough
  •  Stop certain medications (e.g. ACE inhibitors for high blood pressure, NSAIDs etc ) for drug-induced cough



What are the warning signs of a cough?


You should visit your doctor if you have:


  • Cough lasting longer than 2-3 weeks that is not related to any recent cold/chest infections
  • Thick or coloured phlegm
  • Extreme tiredness
  • Shortness of breath
  • Blood in your phlegm
  • High fever
  • Loss of weight and appetite



When should I take cough suppressants?



Pure Honey



Sometimes the cause of the cough may not be found (e.g. Idiopathic cough or “cough hypersensitivity syndrome”), your doctor may give you a course of cough suppressants to keep you comfortable. Having said that, there is no evidence that cough suppressants are effective and may have potential side effects if taken long term. Studies have shown that 2 teaspoons of honey a day (taken at bedtime) is as effective as dextromethorphan, one of the most commonly used cough suppressant. Honey may reduce night time coughing and improve sleep in children. However, due to a rare but potentially serious risk of bacterial infection (called botulism), honey should never be given to a child younger than 1 year old.


For common questions on cough and cold, do check out my Q&A sessions on DxD



Best wishes,


Dr Gan Eng Cern
ENT Specialist Singapore

    When Should You See an ENT Specialist in Singapore?

    • Any ear, nose or throat symptoms that you are troubled with or concerned about
    • Persistent blocked nose with mouth breathing or snoring

    Dr Gan Eng Cern

    Dr Gan Eng Cern is a distinguished ENT doctor with fellowship training. In addition to his clinical practice as an ear, nose and throat specialist in Singapore, Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.


    • 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
    • 2016 – Best Educator Award (Eastern Health Alliance)
    • 2016 – “Wow” Award (Patient Compliment)
    • 2014 – Eastern Health Alliance Caring Award – Silver
    • 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
    • 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
    • 2007 – Singhealth Best Doctor Award


    • MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
    • MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
    • MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
    • FAMS – Fellow of the Academy of Medicine Singapore

    Why Choose Dr Gan Eng Cern


    Reliable & Reputable ENT Expert

    Experienced and patient ENT Specialist who has your best interests at heart. We aim to provide you with accessible and specialized care for any ENT condition in a comfortable setting.


    Friendly & Helpful Clinic Staff

    Our friendly staff will assist you to the best of our ability and we are happy to accept most insurance providers and assist with E-filing with relevant insurance providers or Medisave.


    Advanced ENT Equipment & Fully Equipped Facility

    Our ENT Specialist, Dr Gan Eng Cern, will be able to diagnose and offer personalised treatments for your specific ENT condition. You can expect a high level of ENT care in a spacious setting with in-house minor surgical, endoscopy, allergy testing and microscopy services.


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    There are various financial options available for you to ensure that you are able to receive the most optimal treatment and care. Our ENT clinic staff will be able to assist you with your medical insurance claims and work with your chosen healthcare organization to minimize the hassle and paperwork required. In some cases, you may be able to utilise the funds in your Medisave account to defray part of the costs of your treatment. As our clinic is accredited by the Medisave board, we are able to process your claims from your Medisave for certain clinic procedures.

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