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Conditions We Treat: Chronic Cough and LPR

Chronic cough can result from  irritation or trauma to the voice box that triggers a hypersensitive cough response. . A cough is considered chronic when it lasts for eight weeks or longer. It's important to evaluate and manage all possible causes of persistent coughing. 

Chronic cough is often caused by laryngopharyngeal reflux, commonly known as LPR. The problem starts when acid from the stomach  irritates the voice box and throat. LPR is similar to gastroesophageal reflux disease (GERD) – when stomach acids affects the esophagus and cause heartburn. When acid from the stomach is expelled into the esophagus and into the throat, it can cause significant discomfort and lead to chronic cough. 

Chronic Cough and LPR: What You Need to Know

Father and Son on Laptop

Chronic Cough

  • Causes of chronic cough include

    • Medication side effects

    • Lung issues such as asthma or COPD

    • Environmental allergies causing post-nasal drip

    • Gastroesophageal/laryngopharyngeal reflux

    • Swallowing problems

    • If these problems have been ruled out, you may have sensorineuropathic cough, which results from abnormal throat and voice box sensations from malfunctioning nerves. Symptoms include chronic cough and chronic throat clearing and can affect the voice.
    • Treatment for chronic cough starts with identifying the cause, and managing symptoms through medication and lifestyle or behavioral changes.


    • Symptoms of laryngopharyngeal reflux include

      • A sore, dry, or scratchy throat
      • A sensation of mucus or phlegm in throat
      • Frequent throat clearing and
      • Dry chronic cough and a hoarse voice (especially in the morning)
    • While GERD and LPR are both related to excess stomach acid in the throat, a person can have one problem or the other, or both simultaneously.
    • Treatment for LPR may include limiting acidic foods, caffeine, alcohol and carbonated beverages. Your doctor may also recommend limiting food before bedtime. 

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Why Choose Johns Hopkins for Chronic Cough and LPR?

Johns Hopkins Voice Center Doctors

Comprehensive Diagnosis and Treatment

If your doctor suspects LPR as the reason for your chronic cough, he or she will take a comprehensive patient history and and examine you for signs of reflux such as:

  • Redness or swelling in the back of the voice box
  • Vocal cord pseudo-sulcus (a certain pattern of swelling on the vocal cords)
  • Thick mucus secretions clinging to the vocal cords

To confirm LPR, the doctor may recommend a pharyngeal pH probe. This involves placement of a thin wire which secures behind the ear, enters through the nose, and sits in the back of the throat. The probe measures the acid level in the throat over a 24-hour period and can confirm the presence of abnormal acid levels.

doctor with patient

Our Patient Education

Dr. Lee Akst, Director of the Johns Hopkins Voice Center, answers some of the most frequently asked questions.

Watch our Voice Center FAQ video.