Monday, September 30, 2013

Chronic Cough

My boss is a 63 year old male who has suffered w/chronic cough for nearly 15 yrs. He's seen over a dozen doctors, been through every test imaginable, tried countless medications and nothing has helped. I began researching Vocal Cord Dysfunction about 6 months ago and this last series of tests confirmed that this is most likely the problem. He was advised that raising his pitch will elevate the need to cough. He was also informed that his vocal cords operate backwards? Forgive me because I don't really understand, but apparently upon inhale they're closing and on exhale they're opening? Whatever is going on, it's horrible. He's absolutely exhausted. He's a mental health professional who facilitates workshops to the public. His coughing has become debilitating. Please help!! It's not acid reflux, he's not a smoker, it's not sleep apnea, he doesn't have allergies, not too much mucus. Could a vocal cord problem be causing all of this coughing? How can we fix it? Thanks so much for any help you can offer.

Melissa Kim M.S., CCC-SLP replies... 

To start, I would suggest that he seek out consultation with a laryngologist (an Ear, Nose, and Throat physician who specializes in laryngeal disorders). An accurate diagnosis is necessary to establish an appropriate treatment plan, and this is just not something that is possible via email.

 Speaking more generally, the differential for chronic cough is very broad, including pulmonary disease, medication side effect, acid reflux, sensory neuopathy, and behavioral cough. If cough is related to "irritable larynx syndrome," which can include cough as well as paradoxical vocal fold motion, then relief with is obtained with acid reflux management, expert speech pathology intervention, and use (as necessary) of medications to change the nervous system's threshold for triggering the cough and paradoxical motion. A voice center where a speech language pathologist partners with a otolaryngologist to treat patients in a combined fashion would most likely have a team that is familiar with this disorder.

Best of luck to you!

Wednesday, September 11, 2013

Breathiness and Loss of Lower Range

I am a former professional singer, voice teacher, and choir director. During the last 2 or 3 months, I have experienced increasing breathiness and loss of my lower range. The symptoms seem to moderate some when I sing or talk for a few minutes. However, more recently, I have noticed phonation has not yielded much improvement. I have thought that my voice is simply growing older (I am 65) or that the allergy de-sensitization injections I am receiving may have caused changed some transitory changes. Now, your website suggests that I may be suffering from GERD. If so, I am unaware of it. I sleep on my back with a CPAP machine. In the last year and a half, I lost 150 + lbs. Can you give me any advice?

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

There could be any number of explanations for your symptoms; the only way to determine causative factors and potential treatment strategies is to be evaluated by an Ear, Nose, and Throat physician.

Good luck!

Thursday, September 5, 2013

Something in the Back of my Throat

Hello, for the past three to four months I have noticed the feeling of mucus in the back of my throat. I cough or clear my throat and clear or yellowish mucus does come up, but never a lot. I just feel it there especially in the evenings and mornings. My throat is raspy and my upper register for my singing voice is very thin and almost non-existent. I decided to take out dairy and gluten and stay away from cats but other than that I don't know what to do. I have asthma and allergies, but I have never had drainage for this long. What should I do?

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

There are any number of possible explanations for the sensation of chronic mucous. I would suggest that you see an Ear, Nose, and Throat physician for an evaluation and treatment recommendations.

Good luck!

3 Years of Hoarseness

For over 3 years I have had persistent vocal cord inflammation. Tests have been upper GI, Allergy, Pulmonary, ENT, Rheumatoid and Psychiatry. Also x-rays, CT Scans, and extensive blood work. Laser vocal cord surgery twice with biopsy. The last surgery revealed Strep and now I am taking Augmentin. This condition remains undiagnosed. I am an RN and have not been able to work for over a year. I have no other symptoms. My vocal cords for over 3 years have been a constant source of itchy, irritation and rattle feeling 24/7 resulting in severe, chronic and extreme clearing of my throat that never goes away except when I am asleep. I have an ENT specialist that has been treating me for a year and a half at the University of Michigan hospital. But he has no answers either. Any other perspective would be appreciated. Thank you.

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

It certainly sounds as though you have consulted all of the appropriate professionals, so I don't know that I could offer any additional advice. I will say that in the absence of any possible medical explanation, some individuals suffering from symptoms involving the head and neck area find relief via alternative medicine (e.g., meditation, acupuncture, hypnosis, etc.)

Best of luck to you!