Hi

Thanks for the query and a detailed history.

First of all, I would like to reassure you that this is not a major problem. It can be controlled with appropriate intervention.

The cough could be due to post nasal discharge (PND) from the nose and the paranasal sinuses. The PND can carry the infective material from the nose and the sinuses causing Eustachian tube (the tube connecting nose and the ear) secondary the nasal congestion.

My suggestions to you are:
1. Drink plenty of warm water and not hot water. Hot water will burn the already inflamed mucosa of the throat, thus worsening your problems.
2. Use saline nasal spray 3-4 times a day followed by steam inhalation. This will help in keeping the nasal mucosa moist and relieving the Eustachian tube block.
3. Try taking a mucolytic such as bromhexine or ambroxol, this will reduce the consistency of the secretions and control the cough and PND.
4. You will require antibiotics, because your mucus is greenish in color, which denotes an ongoing infection. Try taking antibiotics such as a combination of amoxycillin and clavulanic acid or cefuroxime.
5. Anti-inflammatory medicines such as diclofenac or ibuprofen will reduce the soreness in the throat and glands.
6. Avoid pseudophedrine; this will increase the consistency of the nasal secretions and worsen your problems.
7. Avoid coffee/smoking/alcohol/chilled beverages and food.
8. Avoid water getting into the ear; there could be a chance of perforation in the ear drum which can lead to infection in the middle ear.

Hope with the above measures, you should have a quick recovery.

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

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Hi

Thanks for writing back

Many a times, the initial phase of an upper respiratory tract infection start with cough; this is due to throat irritation and mild PND. The early stage of infection is usually viral in origin and self limiting, with other symptoms adding on to it gradually. According to the description, at present you seem to be having acute bacterial infection (presence of greenish mucus) involving both the upper respiratory tract as well as the lower respiratory tract partially, which will require antibiotics.

Secondly, if it were to be a mere dry cough, then the ramipril could have been the causative agent. But, the cough seems to be productive in nature which could be due to the PND. The cough usually worsens in the night because the discharge from the nose and paranasal sinuses will trickle down into the throat and cause irritation of the throat.

Finally, the yellow color in the eye towards the nasal side could be pinguecula, a fatty deposition in eye. It is a normal feature in many individuals to have this fatty deposition, which usually goes unnoticed. You might be noticing the yellowish discoloration now, because the fatty deposition gets more pronounced due to congestion in the eyes. If you can mail us an image of the lesion we can tell you what exactly it is and help you in a better way.

Please follow the instructions as mentioned in my previous response, you will definitely recover soon.

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

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Hi

Welcome back and thanks for posting the images.

I have gone through the images and also discussed with reputed ophthalmologist; it is a pinguecula. As mentioned in my previous response this is a yellowish patch or bump on the white of the eye, most often seen on the side closest to the nose. It is an alteration of normal tissue resulting in deposition of protein and fat. The lesion can appear in one or both the eyes.

Even though the lesion would have appeared long back, because the color of the lesion used to merge with that of white sclera, it went unnoticed. It is clearly visible now because of the background congestion of the eyes, secondary to symptoms of irritation in the eyes.

I wish you good health.

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

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