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Spotlight
On: Allergies
and "Postnasal Drip"
 Allergies are abnormal
immune responses to things in our environment that would not otherwise be
harmful. Typical symptoms are itching, eye redness and tearing, nasal blockage,
and production of large quantities of clear mucus by the nose. Allergies can
also result in an altered voice. Most allergic symptoms that affect voice are
nasal and result in an altered resonance or timbre of the voice, but
occasionally, the vocal folds may become swollen or inflamed as well and cause
the voice to become hoarse.
PHOTO: ALLERGIES can
result in a build up of excessive mucus on the vocal folds.
Just as
much of a problem, and not so well-known, is the fact that medicines commonly
used to treat allergies may also harm the voice. Antihistamines aid allergy
sufferers by reducing the amount of mucus the body manufactures and drying out
the body’s mucous membranes. This is very harmful for the vocal folds, which
require a certain minimum amount of lubrication to function well. Since these
medicines are available over-the-counter, people cannot rely on their physician
to watch for these problems. Steroids, taken both in pill and nasal spray form,
help by calming down the allergy-sufferer’s overactive immune system. They can
also result in inadequate immune function, particularly in the throat, and
infections can develop. These infections are usually fungal, and thus are not cured
by regular antibiotics.
“Postnasal
drip” is a term that has more meaning in advertising than in medicine. It is
common to attribute throat discomfort – like a sensation of heavy phlegm –
to “postnasal drip.” Sometimes, inflammation of the nasal passages and the
resulting mucus production does produce these symptoms. But they may also be
caused by a number of other medical disorders. Allergies are usually seasonal or
occur in response to a specific stimulus, like dust or smoke.
If
symptoms are more consistent than this, or if factors that cause the problem are
hard to pin down, or if symptoms fail to clear with adequate treatment of the
nasal passages – measures like saline nasal spray, antihistamines, and steroid
nasal sprays – “postnasal drip” may not be responsible at all. These types
of symptoms can be caused by reflux, by muscle tension dysphonia, by chronic
dehydration or by a number of other medical
conditions.
Voice
changes from allergies or “postnasal drip” do not have to be accepted as
inevitable or untreatable. An evaluation at The Voice and Swallowing Institute, can help
you find out if they are indeed the result of allergies, or from medicines used
to treat them, or from something else entirely.
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SPOTLIGHT
ON: Asthma
Asthma is a disease of the
lungs that causes tightening of the muscles around the airways, and
inflammation of the tissues that line the airways. Both of these events have the potential to
cause considerable difficulty breathing, with symptoms such as wheezing,
sensation of tightness and shortness of breath, and coughing. Anything that
interferes with easy breathing, such as asthma, has the potential to cause
problems with the voice.
This
is especially true for people who have to use their voice loudly or for
prolonged periods of time, such as teachers, salespeople, and performers. There
are two common groups of medications that are routinely used by individuals with
asthma; bronchodilators and steroids. The
bronchodilators relax the muscles around the airway to prevent them from
constricting, and are also used to relax the muscles once they have become
constricted (asthma “attacks”). Therefore, bronchodilators are used as a
means of preventing asthma attacks and to obtain relief once an attack has
occurred.
Steroids manage the inflammation of the
tissues that line the airways, and therefore help prevent asthma attacks from
occurring. Some of these medications can cause voice changes. Rinsing the mouth
after taking these medications, as commonly advised, does not help relieve vocal
symptoms, because the water used to rinse the mouth does not also rinse the
mucosa of the vocal folds. (If it did, you’d quickly begin coughing and
choking!)
If you
have asthma and you are experiencing vocal changes, it is probably a good idea
to be evaluated by a
laryngologist . At The Voice and Swallowing Institute, we will
try to determine whether your voice problem is associated with your asthma, the
medications you are taking to control the asthma, or due to factors un-related
to your asthma. We will work with you and your pulmonologist to help you manage
your asthma and gain relief from your vocal symptoms.
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SPOTLIGHT
ON: The Older Voice
 As we grow older, the
structures of the larynx change, often causing changes in the voice production
system that results in vocal symptoms. Structural changes include loss of muscle
fibers, thinning of the mucosal tissue that covers that vocal folds, and changes
in the proteins and other molecules that make up the mucosal tissue.
PHOTO: ATROPHIC VOCAL FOLDS -
With
advancing age, the vocal fold muscle and mucosal covering can lose mass,
appearing thinned as in the open vocal folds above.
These
alterations can often lead to incomplete closure of the vocal folds during each
cycle of vibration and irregular vibration.
PHOTO: ATROPHIC VOCAL FOLDS - The loss of vocal
folds mass, associated with aging, can result in irregular mucosal wave
vibration during voicing, and a "spindle-shaped" gap during
phonation instead of complete closure, as in the photo above.
The
incomplete closure of the vocal folds can reduce the dynamic range of the voice,
making it difficult to speak sufficiently loud. The irregular vibration can make
the voice sound rough, as if the speaker has a “frog” in the throat. In an
effort to compensate for these changes, many people will contract the muscles of
the vocal tract more, and generally use more effort to speak. This can lead to a
sensation of fatigue.
Age-related
changes in the way the nerves and muscles function can result in a wobble, or
tremor to the voice. The pitch of the voice may be raised in men, or lowered in
women, and the overall range of pitches at which an individual is capable of
speaking may be reduced. It may be that some of these vocal changes are
associated with menopause in women, or changes in the breathing capacity or
circulatory changes.
As
a group, however, these voice changes have come to be referred to as
“presbyphonia” and are often dismissed as the inevitable result of growing
older. But some of these voice changes can be
overcome, usually with
voice
therapy. If you have been
experiencing bothersome vocal changes, and feel that they may be a result of
aging, make an appointment at the Institute to learn more about your larynx and
voice, and what can be done to alleviate your vocal symptoms.
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SPOTLIGHT
ON: Gastric
Reflux
Gastric reflux, called laryngopharyngeal
reflux when it rises up to affect structures in the throat, is the
backwards flow of stomach juices, including acid and digestive enzymes, up the
esophagus. In the past several years it has become apparent that it can affect
the voice, sometimes profoundly.
To
learn more about this disease, its potential effect upon the voice, and ways to
manage it, read about laryngopharyngeal
reflux and see our Reflux
Precautions (PDF) suggestions.
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SPOTLIGHT
ON: Smoking
We know how hard it is to
quit smoking. But the fact remains that the inhaled irritants and super-heated
air from smoking cause irritation and swelling of the larynx and vocal folds and
put you at risk for developing vocal
fold cancer. Smoking causes other
voice problems as well, such as Reinke's
edema. There is no safe amount to smoke. Even if you just smoke a
little, you are at risk for voice problems and serious disease.
Hoarseness
can be an early sign of vocal fold cancer. Smokers who are hoarse for more than
a week or two need to have their vocal folds checked, whether or not they
consider the voice quality a problem. An evaluation at The Voice and Swallowing Institute can address this, or see your local otolaryngologist (ear, nose & throat
doctor). The most important thing is not to delay a visit to the doctor.
Identifying cancer early is very much a matter of life or death.
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SPOTLIGHT
ON: Acute Laryngitis
When the temperature drops, the weather changes and we all begin to get colds or the flu. With these upper respiratory infections come fatigue, muscle aches, sneezing, coughing and often laryngitis. The laryngitis may be the most debilitating aspect of the illness because it can be painful and rob us of our ability to communicate, socialize and work.
What is Laryngitis?
Laryngitis is an inflammation of the vocal folds of the voice box. They can become inflamed due to infection, overuse or irritation. When your vocal folds are inflamed they do not vibrate smoothly and you develop a hoarse, strained and sometimes barely audible voice.
Laryngitis can be short lived (acute) or long lived (chronic). The typical laryngitis should be acute and last less than two weeks. When symptoms are present longer than two weeks, there may be a more serious problem.
The symptoms of laryngitis can be caused by numerous factors. The most common cause is a viral upper respiratory in infection. Vocal abuse in the form of smoking or yelling commonly leads to laryngitis. The medical condition of laryngopharyngeal reflux is also a well known cause of laryngitis. This occurs when stomach acid refluxes into the throat and irritates the vocal folds. Most people with this condition actually do not have any symptoms of heartburn or indigestion.
Generally, laryngitis should resolve in a few days and certainly within two weeks. The symptoms often improve by themselves. Your symptoms can initially be treated with voice rest, conservative voice use and general rest to get your whole body stronger. Drinking water and throat lozenges may also be helpful. Mentholated cough drops should be avoided as these can be extremely irritating to the vocal
folds.
Danger Signs
If you have laryngitis for longer than two weeks or you are a professional voice user you should seek the opinion of an Otolaryngologist. The doctor will listen to your voice and should then look at your vocal folds with an endoscope. The endoscope may be a flexible fiberoptic tube that is passed through the nose or a rigid endoscope passed through the mouth. A superior instrument for evaluating the vocal folds is a laryngovideostroboscope. This uses a rigid endoscope and a strobe light to view the vibration for vocal folds in slow motion through the mouth. This is essential because it is the vibration that creates your voice. If the vibration is abnormal you will sound hoarse. The entire examination is quick and pain free.
Treatment
Treatment for laryngitis depends on the cause of the problem and the speed at which your voice needs to return to normal. If the laryngitis is due to a viral infection supportive care is the best treatment. Use your voice more conservatively, do not clear your throat, avoid whispering, rest, drink lots of water, use a humidifier at home, avoid smoke and limit alcohol and caffeine intake.
If you are a professional voice user, such as a singer or lawyer, you may need your voice to return more quickly for an important engagement. In that case, discuss this with your Otolaryngologist as treatment with steroids may be warranted. For more chronic laryngitis the underlying cause must be determined and then that needs to be treated. The list of causes may range from laryngopharyngeal reflux, which is treated medically, to a vocal fold polyp which is treated surgically.
If you are a smoker you should stop smoking and see an Otolaryngologist to make sure cancer is not involved. When vocal fold cancer is detected early, it can usually be treated successfully with surgery or radiation.
Prevention
Often prevention is the best course of action. When you are sick or you feel laryngitis developing the best thing to do is take care of yourself and your voice. Use your voice only when you need to and follow the steps mentioned above. Hopefully this will keep you from losing your voice and keep you out of the doctor’s office.
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