Brief Answer:
Avoid using any medications with codeine...

Detailed Answer:
Hi

Thanks for posting the query.

The symptoms you have described could have been secondary to the upper respiratory tract infection probably of viral origin. CPAP machine usage can contribute to dryness in the throat.

Even though the CPAP machine can humidify the air which it releases into the nose and throat; the excess inflow of air can lead to dryness.

Codeine is usually given for dry cough which is not relieved by routine medications. Basically, as a cough suppressant. If you have a productive cough, then you would require either Ambroxol or Bromhexine.

Codeine is not given in obstructive sleep apnoea because it can depress the respiratory center furthermore.

The post-nasal drip can be secondary to the GERD as well; the proton pump inhibitors would be beneficial in this condition.

Drink frequent sips of lukewarm water. Avoid coffee.

I hope this answers your query. Revert if you have any follow-up queries.

Thanks and regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon

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Brief Answer:
Whitish or yellowish phlegm denotes mild or resolving infection

Detailed Answer:
Hi

Welcome back

My sincere apologies for the delay in the response.

Does this indicate ongoing or returning infection in the respiratory tract?
A: Whitish or yellowish phlegm denotes mild or resolving infection. The black-colored sputum could be a mixture of the old blood clots in the sputum.

Or is it expected that sometimes the phlegm will be yellow with a postnasal drip?
A: Yellowish phlegm can also be seen in allergic nose conditions, which is normal.

Is there any difference between codeine and dihydrocodeine in terms of acceptable usage?
A: The efficacy of dihydrocodeine is twice as compared to that of codeine. Both are used in various conditions depending upon the symptoms and their severity.

For my cough, how can it be determined if it needs to be treated with antibiotics?
A: If the cough is noticed for more than 4-5 days and not relieving with simple measures, then the antibiotics are started after doing a blood test. The first 4-5 days of the upper respiratory tract would be viral in origin and hence doesn't require any antibiotics. Later on, it may become bacterial, requiring basic investigations and antibiotics accordingly. In your case, antibiotics would give you relief from the cough and expectoration.

I hope this clarifies your doubts. I wish you good health and a speedy recovery.

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

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Brief Answer:
A complete blood count would help in identifying the bacterial infection

Detailed Answer:
Hi

Thanks for writing back

1. Even though Dihydrocodeine and Codeine belong to the same family the former has relatively fewer side effects compared to the latter. On the efficacy front, Dihydrocodeine is better than codeine.

2. A complete blood count would help in identifying the bacterial infection. The increase in White Blood Cells (WBC) indicates a bacterial infection.

I hope I have answered your queries. Wish you good health.

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

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Brief Answer:
Laryngopharyngeal reflux is a silent regurgitation of the acid from stomach

Detailed Answer:
Hi

Welcome back

Laryngopharyngeal reflux is a silent regurgitation of acid from the stomach into the throat leading to mucosal inflammation of the latter. The reflux of the acid can reach up to the back of the nose in the lying down position. The body secretes excess saliva or thick discharge (phlegm) to alleviate the mucosal inflammation, which is perceived in the throat as post-nasal drip.

The symptoms worsen when there is an attack of upper respiratory tract infection or nasal allergy.

The best way to eliminate this issue is to make lifestyle modifications and take a few medications to prevent Laryngopharyngeal reflux.

My suggestions to you are:
1. Drink frequent sips of warm water
2. Take medications for acid reflux, such as Proton pump inhibitors.
3. Avoid coffee, chilled food, and beverages
4. Avoid stress, do exercises regularly

I hope your doubts are cleared. I wish you good health.

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

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Brief Answer:
During sleep, the swallowing effort would be less...

Detailed Answer:
Hi

Thanks for writing back

During sleep, the swallowing effort would be less compared to that when we are awake. Normally, when there is inflammation in the mucosa of the nasopharynx (back of the nose) and oropharynx (throat) we make a constant effort to relieve the discomfort. This causes friction of the soft palate and the back of the tongue over the pharyngeal wall irritating the mucosa further. The constant friction stimulates the mucosa to enhance the secretions thereby increase in the post-nasal discharge.

The irritation gets relieved when we drink warm water and thus a reduction in the quantity of the secretions. Similarly, the proton pump inhibitors reduce gastric secretions alleviating acid reflux and throat irritation.

Hope this explanation clarifies your doubts. God bless you with good health.

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

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