Diagnosis of Chronic Night Cough

To the Editor.—  The answer to the question by Franklin Drucker, MD (241:2082, 1979), regarding the diagnosis and treatment of chronic night cough seems incomplete.Consideration should be given to ruling out tracheobronchial aspiration as a presenting manifestation of esophageal disease. Aspiration from pharyngeal or gastroesophageal contents may be the irritant triggering the cough reflex.Not infrequently, nocturnal regurgitation and aspiration may be the most prominent symptoms of a Zenker's pharyngoesophageal diverticulum. A fairly frequent occurrence is the development of pulmonary complications in the presence of exceedingly minor or no esophageal symptoms; thus, the presence of the diverticulum may not be recognized for a considerable period.In addition, regurgitation of gastric contents secondary to gastroesophageal reflux, with or without hiatal hernia, may result in repeated episodes of pulmonary aspiration. Recent reports suggest that as many as 50% of the patients with gastroesophageal reflux may have evidence of respiratory involvement and