Brief Answer:
I doubt ALS...

Detailed Answer:
Hi

Thanks for posting the query. I have gone through the history thoroughly and understood the problem. I will try my best to help you with this.

The symptoms described by you seems to related to either Laryngo-pharyngeal reflux (LPR) secondary to acid reflux (GERD) from the stomach into the throat or lower cranial nerve palsy, which requires a thorough examination of the lower cranial nerves and the larynx.

ALS symptoms begin in the hands, feet or limbs, and then spread to other parts of the body. As the disease advances, the muscles become progressively weaker. This weakness eventually affects chewing, swallowing, speaking and breathing. In the history there is no mention about weakness in the limbs hence, this is ruled out.

An apt ENT specialist examines the throat thoroughly and tries to look for any physiological changes. But, in a routine examination, lower cranial nerves are not examined unless there is a strong history suggestive of any neural damage. Request your ENT doctor to examine all the lower cranial nerves and the movement of the vocal cords using an endoscope.

The frequent coughing and hawking could be due to the inflammation on the arytenoids and the posterior pharyngeal. A course of proton pump inhibitors with a prokinetic can resolve this problem. In LPR, the arytenoids and the posterior part of the true cords will be edematous.

Coughing during meals may be related to the superior laryngeal nerve palsy. Superior laryngeal nerve being a branch of vague supplies the sensory part of the larynx. Hence, any weakness in the nerve can cause loss of sensation over the superior part of the larynx and thus aspiration and cough during meals. This can be confirmed by the signs such as pooling of the saliva over the upper part of the larynx and movements of the vocal cords while performing an endoscopy.

If the diagnosis is confirmed, then a thorough evaluation for the cranial nerves has to be done followed by MRI of the brain and CT scan of the thorax.

Hope I have answered the query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Brief Answer:
Cough following meals is because of LPR...

Detailed Answer:
Hi

Thanks for writing back

Laryngeal nerves are the branches of the vagus which innervates muscles and mucosa of the larynx. Any compression or trauma over the nerves can cause varied symptoms depending upon the branch and the level of trauma. Most of the cases can be treated if the location of the trauma or compression is identified.

Cough following meals is related to the acid reflux. When the regurgitated food and acid spill over the larynx, the cough is produced.

Yes, vocal cords are clearly visible while doing the flexible naso-pharyngo laryngoscopy. Congested arytenoids, inter-arytenoids and the posterior part of the true vocal cords are hallmark signs of LPR.

Do not worry! It is a simple and common problem. My suggestions to him are:
1. To drink plenty of warm water
2. Avoid stress/smoking/alcohol/coffee/fizzy drinks/ chilled food & beverages.
3. Try taking proton pump inhibitors such as Esomeprazole or Pantoperazole along with a prokinetics, he will definitely feel better.

Hope this clears your doubts.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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