Q & A

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Is there a way to treat a recurring tightening of the muscles around the voicebox?

QUESTION: Please help if you can! Several years ago I had laryngitis and had to continue talking (retail work). As a result, I ended up with muscle tension dysphonia that went incorrectly diagnosed for several years. Finally, I got a diagnosis and 2 years of speech therapy have improved things, but I still can’t sing and, at the end of each day, my throat is tight and painful. I desperately want to be able to sing again. There MUST be a way to reverse what is really just a habitual muscle tightening around the voicebox. Can you suggest anything? Hypnotherapy? ANYTHING. Please.

Thanks, Arjun Johnston

ANSWER:
Thank you for your question.

There are many different factors that are important in allowing us to have full use of our voice. Obviously, overuse, either through yelling or speaking incorrectly is one major factor.

However, in order for one’s voice to be normal, it is important to look at hormonal factors (thyroid functions and well estrogen/androgen) as well as the possibility of inflammation from reflux, chronic sinus infection and scarring of the thin layer protecting the vocal fold muscle.

Lastly, there can be damage to the nerves controlling the voice box- either after an upper respiratory tract or other throat infection.

It seems unlikely that muscle tension is the only cause of your problem. This frequently will be a counter-productive adaptation that you are doing because of another underlying issue.

I hope this clears things up.

Robert L Pincus MD
NY Otolaryngology Group

Q & A

My 5 month’s voice has gone hoarse after a long crying episode

Question: My 5 month’s voice has gone hoarse after a long crying episode. It happened about two days ago and I think his voice sounds raspy now and not as hoarse. He seems to have a hard time making the same high pitched sounds he used to be able to make during spontaneous vocalizations and during vocal play. What should I do, is this kind of hoarseness in infants common? Any help from your specialists would be greatly appreciated. Thank you!

Answer: Thanks for your question. Hoarseness for infants is not uncommon. It i quite comon for anyone, babies included, to develop hoarseness after vocal abuse. Certainly a long crying episode would fit.

When we breath- our vocal cords open to allow air to pass. When we speak or make noise, the vocal cords come together. They must come together smoothly for us to have a normal voice. However, when we speak loudly, or yell (or cry) – we are often banging the vocal cords together. This causes swelling, so that the closure becomes uneven and we percieve hoarseness. Most often, this is temporary, until the swelling goes down. Sometimes, we can develop a nodule or a polyp from this- which is really like a callus on the vocal cords. This would cause the poor voice to persist.

Using your voice minimally (modified voice rest) would help in the healing process. However, it is really impossible to get your baby to do so.

Almost always, his voice will come back to normal over the next few days or a week. If not, he should have an ear nose and throat doctor take a look at the vocal cords, (laryngoscopy) to make sure there has been no significant damage.

I hope this clears things up.

Robert Pincus MD

Associate Professor Otolaryngology NY Medical College

NY Otolaryngology Group

Q & A

My throat closes and I have difficulty breathing in

Question: I am a 56 yr old female in healthy condition. I stopped smoking 25 yrs ago. I have noticed that my throat feels like it is closing and I have difficulty breathing in. It seems like I am smelling a smoking type smell. I have had this happen in the car, lying in bed and even at my workplace. No one is either around or smoking when this occurs. I have asked people at work if they smell anything and they say no. I do have a sensitivy when someone is smoking my throat closes up and feels like I can’t breath.

Any recommendations or suggestions?

Answer:

When we breath our vocal cords open, to allow air to pass through. They close when we speak. Difficulty breathing in implies that the vocal cords are closing when you inhale, instead of opening. With asthsma, one tends to have trouble breathing out. The vocal cords can close inappropriately from reflux- when acid gets up from the stomach to the level of the voice box- as well as from nerve injuries that cause the vocal cords to not work correctly. (paradoxical vocal cord motion). Mucous dripping on the vocal cords can cause them to close as well. Finally, a growth on the vocal cords may present like this.

This type of problem really requires a thorough ear nose and throat examination and visualization of the vocal cords (laryngoscopy) to determine the cause and treatment.

I hope this helps clear things up..

Robert Pincus MD

Co-Director NY Sinus Center

NY Otolaryngology Group

Q & A

Hoarseness for a Month — Should I See a Specialist?

Question: I had a cough during the first week of the New Year and I lost my voice for about a week. Since then, I get my voice back very slowly and it had been exactly a month now but I still don’t have my full voice. My current voice sounds like I smoked for that last 30 years (I never smoked) and it faded when I try to raise my voice or say something at a higher pitch. Other than the voice change, I feel no other symptoms, even during my cough. I just have had this hoarseness for a month now.

Is this something I should check with a specialist?

Answer:

After experiencing hoarseness for a month, you should visit a doctor to have an examination. While everyone has experienced hoarseness at some point in their life, usually the problem goes away with some rest and self-care after several days. Current guidelines state that anyone with hoarseness that persists for more than two to three weeks should have an evaluation to find the root cause. While hoarseness is often a result of numerous treatable conditions, it could also be a sign of cancer. While cancer isn’t as likely, it is still wise to get checked out. Early detection will always improve your odds of successful treatment.

Some of the common causes of having a hoarse throat for an extended period of time include:

Vocal cords losing fullness and tension due to age.
Chronic irritation of vocal cords, caused by smoking, allergies, GERD, etc.
Spasm of the vocal cord muscle
Cancer
Complications from other diseases such as MS, hypothyroidism, rheumatoid arthritis, etc.

Rather than repeating the entire discussion here, let me send you to the part of our web site that discusses this problem so you can get more information.

www.nyogmd.com/library/hoarseness/