Hello,
I have had reoccurring laryngitis for approximately 3 years now. Because most episodes lasted for just several days and I had no pain or other symptoms, I didn't see a doctor until October of '95 (after having laryngitis for almost 6 weeks straight). At that time, a tube was inserted through my nose and my vocal chords were checked for polyps or tumors (I presume). The doctor prescribed Guaifenex PSE 60, Beclovent 42 MCG, and Beconase AQ. As I was leaving her office, I mentioned that I was still able to sing and yell without any trouble. The following day, before using any of the medication, my voice returned to normal and I was trouble-free for many months. (I didn't use the medication, nor did I see any need to reurn to the doctor).
The laryngitis returned off and on several times since then. It comes and goes for no apparent reason, irregardless of weather or temperature. (I've ruled out the heating system as it's occured when we aren't using any artificial heating or cooling). I have not returned to that particular doctor because, even though she came highly recommended through Dr. Jack Gwaltney at UVA, she seemed almost at a loss to explain my case. Also, it's hard to make an appointment when I never know from one day to the next whether or not I'll have a voice that day. Now I'm wondering what my next step should be. i hate to bother a doctor (if not necessary), but I'm wondering whether this can cause any permanent damage to my vocal chords. Also, these days it seems to come on more suddenly AND I'm experiencing a feeling as of late that my air passage seems to be constricting too.
What would you recommend my course of action to be? I live in central Virginia almost equa-distant between Richmond, Fredericksburg and Charlottesville and could go to any of those three cities for help. Thank you. Micheline Canty
Reply: --------------------------
Possible causes for a recurrent vocal disturbance such as you have described could include allergy, rhinitis/sinusitis, gastro-esophageal reflux, vocal abuse/misuse, environmental irritants, first or second-hand cigarette smoke exposure, subtle abnormalities in the vocal cord lining that might not be seen without more sophisticated endoscopic techniques, etc.
A special comment regarding gastro-esophageal reflux: This is a common condition and frequently is associated with throat or voice symptoms - often throat and voice symptoms may be the only manifestations of gastro-esophageal reflux. In other words, one can have throat or voice symptoms due to gastro-esophageal reflux in the absence of heartburn or dyspepsia. GE reflux is often implicated in the development of certain laryngeal lesions such as vocal nodules, contact ulcers of the vocal cords, vocal edema, vocal granulomas, etc. Common throat or vocal symptoms of GE reflux include complaints of "phlegm" accumulation in the lower throat; the frequent need to "clear" one's throat; the senstation of a "lump" in the throat; fluctuating dysphonia (voice disturbance); dry cough; chronic mild sore throat; etc. Findings on physical examination may be very subtle - slight redness and swelling of the lining in the posterior aspect of the larynx (vocal cord area). Stroboscopic laryngoscopy should be performed in the evaluation of this type of voice disturbance to rule out subtle lesions beneath the lining of the vocal cords which may elude visualization with non-stroboscopic endoscopy. Occasionally, more sophisticated tests are recommended such as swallowing x-rays, pH monitoring, esophageal manometry, etc. The treatment of GE reflux can range from simple measures such as head of bed elevation at night, avoidance of meals within a couple of hours of bedtime, occasional use of antacids, and basic vocal hygiene measures such as avoiding excessive use of voice, avoidance of "clearing" the throat, adequate fluid intake, etc. to more complicated therapies including prescription medications (Prilosec, Prevacid, Pepcid, Zantac, Propulsid, Reglan, etc.) In severe cases of GE reflux that fails aggressive medical therapy, there are new surgical options including laparascopic surgery for reflux.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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