[DYSPHAGIA] coughing while eating

[cslewis@isugw.indstate.edu (Jeffrey Lewis)]

Dear Sharon:

Just an idea:  What about post-nasal drip?  We all have seen the "runny nose" syndrome in some older adults.  Well, if that stimulation by food causes PND, it would explain: (1) the spicy food report; (2) the delayed onset of coughing and (3) the unremarkable findings on the VFSS.  Of course, the robustness of the explanation doesn't mean it's correct!  However, if it is, a FEES might be a better way to see it than a VFSS.

Just an idea.

Sincerely,
Jeff Lewis

<<< <Ssbmd@aol.com> 10/ 9  8:12p >>>
Can you help with ideas?  I did an MBSS today on a 50yr old woman with 
complaint of coughing while eating  every meal for the past 6-7 yrs.  She 
said that she has been to many different MDs (referred to me by GI 
specialist) and nothing has been found.  She stated that her mother had the 
same problem, that it happens with all food and liquid, but she "can't even 
get close to spicy foods" and she is embarassed to eat in public.  Medical 
history is non remarkable.  

MBSS showed normal swallow.  After about 10 trials, she did begin to cough- a 
small, irritant dry cough, but NO pen/asp.  So, I went through the video with 
her and showed her the normal results.

I figure that she either has a very hypersensitive cough reflex OR this is a 
learned behavior, and/or hysterical reaction.  

Question- would it be possible that  EMG biofeedback training might help her 
unlearn this behavior- if that is all it is?  Would a referral to a 
neurologist help rule out a hypersensitive reflex?  What about a referral to 
Dr. Sonies at NIH for evaluation?  (We live closeby).

Thanks- Sharon Kreps
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