Monday, August 6, 2012

Vocal Cords Disorder

I am 79 years old and have had chronic sinusitis since I was 15. I seldom ever have a sinus blockage, but have constant postnasal drip. The chronic sinusitis has been diagnosed and attributed to mild allergies to almost anything and everything to which humans become allergic. About 9 months ago, I had a bout with rhinitis that was confirmed with CT scan as left maxillary, sphenoid and ehtmoid sinus infection. Normally, since I have no success with treatment of these problems, I just live with it and it gets better, with time. But on this occasion it was affecting my vocal chords. For the first time in my life, the post nasal drip was accumulating on my vocal chords, and dramatically affecting my speech. The mucous will build-up to about the size of an almond before I can successfully remove it with several self controlled hard coughing and simultaneous throat clearing exercises. When it comes up, it is extremely thick and light to dark brown in color. I never get complete recovery of my speaking voice after expectoration of the thick, almost hard mucous, but I do get significant improvement. For the last 9 months, when I can speak, I speak either in a very soft (almost whisperlike) voice or a somewhat raspy voice in  a very low register. Although not a professional singer, I have been singing regularly in church choirs for over 50 years.  I have been to a vocal chords specialist and the video of the vocal folds showed it to be inflamed (red in color). The only advice I got from this doctor was to drink lots of water and use Mucinex. I've done both for 3 months with no effect. I am currently seeing a consortium of 3 ENTs in a major medical facility. I spent 6 months taking 5 different antibiotics, with some clearing of the maxillary sinus but no clearing of the ethmoid and sphenoid (confirmed by CT scan with contrast). My consortium is now treating me with steroids for a period of one month. I am now 2 days into 28,21,14,7 (10 mg Prednazone). Of the 3 doctors, 2 specialize in sinus surgery and the other specializes in surgery of the area of the epiglottis / vocal chords (primarily for cancer patients). I had a laryngoscopy for tissue sampling one month ago and both samples were benign. My question to my doctors has been: Why, after 65 years of chronic post nasal drip, am I now experiencing build up of phlegm on my vocal folds? I get no answer. I then ask: Is it not possible to eliminate post nasal drip with sinus surgery? If the post nasal drip was stopped, would not the vocal chords heal? I get a response: "It's not as simple as that. From examination of your latest CT scan of the throat, we think there is more going on in the throat than just post nasal drip."

Where do I go from here? Thank you for your patience from an impatient patient.

Melissa Kim M.S., CCC-SLP replies...

It certainly sounds as though you've contacted all of the right professionals when it comes to your chronic sinusitis... but keep in mind that Ear, Nose, and Throat physicians, while specialists themselves, do further specialize.  There are ENTs who specialize in nasal and sinus surgery, but also those who specialize specifically in the voice and voice disorders.  I would recommend that you seek out an evaluation with a laryngologist, an Ear, Nose, and Throat physician who has completed fellowship training in the care of the voice.  Even if the "vocal cord specialist" that you saw was a laryngologist, a second opinion would certainly be warranted given that it sounds as though you did not receive a diagnosis or effective treatment recommendations.  To seek out a laryngologist, see the American Academy of Otolaryngology website at

Good luck to you.
http://entnet.org/, which allows you to search for an ENT by subspecialty.

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