Tracking down the cause of a cough, throat tickle

Dear Dr. Roach: I am 74 and in very good health. I’m active.

A few times a day I get a tickle in my throat that causes me to cough. If I suck on candy or take a drink, it is soothed. I take amlodipine, levothyroxine, Zyrtec and pantoprazole. I had my thyroid out. I have a hiatal hernia and pre-Barrett’s esophagus. — D.M.

Dear D.M.: The throat tickling sensation and cough have several possible causes, and you have three or four of them. It may be a combination.

The first is gastroesophageal reflux disease. This is when acid from the stomach goes into the esophagus and causes damage. It often causes a heartburn sensation and cough is a symptom. Too much acid for too long can cause damage to the esophagus, a condition called Barrett’s esophagus. This is dangerous because it predisposes to cancer of the esophagus, and people with Barrett’s esophagus need screening. The pantoprazole you are taking may help prevent further damage to the esophagus. The amlodipine you are taking makes GERD more likely, since it relaxes the lower esophageal sphincter, the muscular valve that is supposed to keep acid in the stomach. I suspect this is the main cause in you, as you seem to get relief from swallowing.

A hiatal hernia, where the stomach partially goes into the chest, may also cause cough.

Postnasal drip is another cause of cough and throat tickling. You are taking Zyrtec, an antihistamine, so I suspect you may have some issues there.

Finally, thyroid surgery can cause damage to an important nerve, and cough is a symptom. If the cough started after surgery, it would be appropriate to do an evaluation.