What kind of doctor should I see?
January 15, 2010 4:28 PM   Subscribe

I have a persistent cough and WAY too many respiratory infections. What kind of doctor should I see? YANAD/YANMD, etc.

Over the past two years, I've had in the range of 8-12 upper respiratory infections per year. They generally clear up with antibiotics, only to come back within a month or two. When it's not infected, I have considerable post-nasal drip that inevitably turns into another bout of sinusitis or bronchitis. I am well-known as the person who is sick all the time.

I had a fairly persistent cough while growing up and typically got 1-2 URIs per year through high school and college (Seattle and Indiana). Then I moved to AZ, was great for about six months, then this started. I sometimes drive back to Seattle or Indiana and have noticed that about when I cross Oklahoma, I start feeling a lot better - the drip dries up and I feel great until I return to AZ. My thought is that it's something due to the dry, dusty air.

I've seen an allergist and had a skin test done for environmental factors but didn't react to anything (even mold and cats). He eventually diagnosed me with non-allergic rhinitis (and possibly a touch of asthma). Inhalers tend to help; I've used Nasonex and while it keeps me from being stuffed up, it doesn't particularly help. He put me on prednisone for about a week and it helped some. He comments that my nasal passages appear dry, red, and inflamed when I see him. My peak flow rate is normal and consistent. I've used a neti pot but not consistently; my husband says it helps, but I've lived with a cough for so long that I'm used to it, I guess.

I have good insurance. What can I do to combat this? What kind of doctor should I see (and, if applicable, recommendations for Tucson, AZ)?

I'm 24, female, in reasonably good health besides all this.
posted by bookdragoness to Health & Fitness (19 answers total) 2 users marked this as a favorite
Internal Medicine Specialist (aka an Internist)
posted by radioamy at 4:29 PM on January 15, 2010

You need an otolaryngologist, most likely-- they specialize in sinus disease and nasal problems. I have no specific experience of ENTs in Tucson, but I'm sure someone else here does.
posted by fairytale of los angeles at 4:48 PM on January 15, 2010

yep, an Ear, Nose, and Throat doc should be your next stop. (Sorry I don't have any specific recs for Tucson, though.)

Anecdotally, my tendency to get endless colds/respiratory infections/sinus stuff was improved dramatically after I got jaw surgery about five years ago -- turns out I had rather serious sinus polyps, and so my jaw surgeon figured he'd just cut them out as a little surgical bonus since he was already poking around in there. If I had to estimate, I'd say my tendency to get colds, sinus infections, etc. has been reduced by at least 80% since then.
posted by scody at 5:02 PM on January 15, 2010

Oh, and this is less likely, but it might still worth putting out there as a possible consideration: sometimes a persistent cough can be indicative of acid reflux, independent of any respiratory issues going on.
posted by scody at 5:05 PM on January 15, 2010

Otolaryngologist, definitely.

And I don't think that neti pots are as effective as positive-pressure irrigation with something like a nasal rinse bottle or even a nasal irrigator.
posted by Sidhedevil at 5:05 PM on January 15, 2010

Seconding Sidhedevil on the Neti Pot. I used my neti pot and really really liked it- until I tried the nasal rinse bottle. The difference was astounding, and has really helped relieve some of my daily allergies/sinus pain.
posted by headspace at 5:18 PM on January 15, 2010

As for the "what to do to combat this:"

I've tried Neti pots, I've tried the nasal rinse bottle. Neither has worked as well as the twelve-dollar vaporizer I got at Target.

When I have post-nasal drip going on, I sleep with a vaporizer in my room -- my sinuses get particularly sensitive when the air is especially dry, for some reason, and get stuck in a loop of "dry air = ooze out some mucus = post-nasal drip = I start coughing". Usually a few nights of sleeping with the vaporizer going, to put some humidity back into the air, makes a huge difference.
posted by EmpressCallipygos at 5:58 PM on January 15, 2010

Both otolaryngologists (ENTs) and pulmonologists will see you for chronic cough. Otolaryngology is a branch of surgery, while pulmonology is a branch of internal medicine.
posted by Wordwoman at 6:29 PM on January 15, 2010

I do nasal irrigation (usually with the Water-Pik) and constant humidification and two Zyrtec a day and an herbal medication (with real active ingredients in it, not a homeopathic thing) and manage to keep the sinus infections down to one or two a year. Bad sinuses are bad, and it's a lot of work.

Back when I was having four or five sinus infections a year, I saw a Really Big Deal ENT who said "I could do surgery and it probably wouldn't fix it. Some people's sinuses just don't work right."

Start with the ENT if post-nasal drip is a constant in all your infections; if it's a lung problem rather than a sinus problem, the ENT will refer you to a pulmonologist.
posted by Sidhedevil at 7:15 PM on January 15, 2010

Nthing the recommendation of a pulmonologist. I had similar symptoms and was found by the pulmonologist to have something I would not have thought of. A pulmonologist will start with a complete work-up, some tests and some life-style questions that will lead to a solution. Although a chronic asthmatic, I have been symptom-free since he sent me in the proper direction two years ago.
posted by Old Geezer at 7:31 PM on January 15, 2010

Since you mentioned AZ, I am going to mention Valley Fever. After reading all the symptoms, I don't think you have it, but it's worth reading/knowing about, just in case.
posted by CathyG at 8:10 PM on January 15, 2010

Pulmonologist, absolutely. If you have asthma or chronic bronchitis, it can magnify small symptoms into biiig ones. I have pretty bad asthma, and little sniffles or minor chest colds turn into ER trips and weeks of recuperation. Or, at least it did before the doc put me on Advair and allergy pills. Not recommending a specific medicine, just pointing out that controlling your asthma can probably help... and getting the lungs in order really seems to have helped my sinuses, too.
posted by Slap*Happy at 8:16 PM on January 15, 2010

Response by poster: Thanks for all the responses! CathyG - I asked about Valley Fever last year sometime and my doctor said it didn't match the symptoms.

So, it sounds like I should see an ENT or a pulmonologist. Should I start with an ENT since it tends to start in my nose and migrate downward?
posted by bookdragoness at 8:51 PM on January 15, 2010

FYI a pulmonologist is also called a respirologist.
posted by weapons-grade pandemonium at 9:23 PM on January 15, 2010

The only thing that helps me is eating raw garlic. Whenever I feel a cold coming on, I have some right before bedtime, so that it's out of my system after I shower in the morning. I would say a minimum of two cloves, but if you can handle more, then 4-5. Try eating them with a slice of heavily buttered bread to make it more palatable.

When I do this, by morning my symptoms are completely gone.
posted by fairywench at 6:01 AM on January 16, 2010

Yes, I would start with an ENT. They can always refer you to a pulmonologist (or a different specialist if they have another idea based on your exam).

In the meantime, I completely agree that a sinus rinse (or a Neti pot, but I also think the squeeze bottle is easier) of some sort should be a huge help, and as simple as it sounds, Vicks Vaporub on my nose and chest makes a huge difference for me when I'm having sinus and/or bronchial issues. It relaxes the muscles, helps me breathe so much better, and though I have no science to back this up, I think I heal faster when I use it. I would also consider investing in a humidifier and the vaporizer sounds like an excellent idea as well. Good luck!
posted by katemcd at 7:35 AM on January 16, 2010

I second Scody - go to an ENT and ask about acid reflux. It was contributing to my every 2-3 months upper respiratory infections for years, though I never would have suspected it.
I hope you are able to find an effective solution as soon as possible.
(And if you do end up on omeprazole (generic Prilosec), and have insurance, get a prescription, as it's way cheaper to get the generic from the pharmacist than buying it over the counter, even though it's the exact same drug.)
posted by queseyo at 8:44 AM on January 16, 2010

ENT, I think.

And for fun, try an over the counter antacid like Prilosec. Take it every day. Take anti-reflux precautions. It could help a LOT. Acid reflux can be very irritating to all those membranes in your throat/sinuses. It doesn't have to hurt--mine can be quite severe but it doesn't actually hurt in the classic "heartburn" sense.
posted by kathrineg at 11:01 AM on January 16, 2010

Mod note: Final update from the OP:
As a final update, I saw an ENT and had an MRI done of my sinuses. No abnormalities were found. He gave me a steroid shot, which helped for a couple months but wore off sooner than he was comfortable re-dosing. I saw an allergist, who after performing an inconclusive allergy prick-test diagnosed me with non-allergic rhinitis and gave me various inhalers which didn't really help.

Ultimately, I moved out of the southwest desert region and my symptoms largely resolved themselves in the moister air.
posted by mathowie (staff) at 12:52 PM on December 5, 2014

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