Vocal Damage - Scratching/Burning Sensation

[timmilesmusic]

Hi there,

I just want to run a scenario i have been experiencing since January this year past you all if possible! I had a very bad bout of Flu in December 2010 and spent about 3 weeks coughing, when it finally cleared up, i had no experience of any throat issues with pain related, just an uncomfortable feeling and weak having had a bad case of flu. I returned to work in a call centre where i worked 2 days a week and my voice began to ache badly, i ignored it at the time but throughout the shift it became worse and started to sting. After my first shift back i actually lost my voice, and if i tried to talk it would be a sharp sensation in my larynx with a hoarse sounding voice. I then left my job. I visited ENT in early Feb, who looked with a camera and advised me they actually couldn't see any issues with my vocal folds, no swelling, redness, it all looked fine. They said the only thing that stood out very slightly is one of the fold didnt quite vibrate properly, but they advised it was nothing to worry about and suggested a further 3 weeks total silence.

To cut a long story short after 3 weeks silence the issue didn't clear up, in fact it didn't clear up until the Middle of April at which point i began lightly singing again, bad idea, it was fine for about 2 weeks and one day i pushed it too hard forgetting my voice was still feeling weak and the issue returned. It has been here ever since, not as bad as previously.

At the moment my voice has a Burning/Scratchy sensation when i talk (i haven't even tryed singing), it is sometimes worse than others but seems to be continuos. My new job is also a call centre but thankfully very very low volume of calls so of my 8 hour day, 85% of it is admin work so i can stay silent. I have another ENT appointment in a few weeks time through the UK NHS system but i guess i just wanted to check whether this could really be vocal damage after all this time?

It seems to recover and get to the weak feeling in my voice but with no paint stage and then take a step back to the scratchy/ burning feeling rather than recovering further. Would really appreciate help in moving forward because i am getting to the point now where it is driving me nuts, and i make noises just to test i can actually still speak because i'm so silent. don't get me wrong i'm not staying completely silent, but as silent as i possibly can. It's affecting both my social life and my music career drastically and i just want to know the best course of action to take!

I do also drink 5 Pints of Water a day, have a humidified room and eat healthily! I also use "Vocal Zone" sweets which are a herbal Soother and do really work. And i also take Omeprozole twice a day for Acid Refluc (Which the doctor asked me to take as a precation, been taking it also since January)

Thanks in advance everyone!

[D.Bond]

That is very weird. id say that it is not vocal damage though... you came down from a flu and were coughing bad but... maybe research about "coughing giving vocal damage" and see if its possible.

If I were you, id be SOOOO frustrated and annoyed id be in the hospital in a sec or at least see my doctor.. You should try some sort of antibiotics prescribed by a doctor.

edit: hey so i found out that coughing involves tissue above the cords and not your vocal chords... just cough a little. Then make the tiniest singing sound and you will feel how much lower your cords are.

Coughing can irritate them but nothing that is permanent damage and cannot be doctored up.

Sing, you will be fine...

[timmilesmusic]

Thanks ever so much for your response and the warm welcome! i will hopefully respond with all the information you need, and i really appreciate your time in reading my post. In answer to your questions:

The pain i experience is very very random, it seems to be aggravated far more by speaking and singing. It certainly isn't aggravated by breathing or poking out my tongue. When it was at its worst, exhaling was uncomfortable, not overly but my breath felt very hot, only way i could really describe it is if i had eaten a spicy meal and the burning you get from the spices were concentrated in my larynx and not in my mouth. Just generally a very uncomfortable feeling. I think other than speaking and singing the only time it is also very slightly aggravated is if i physically move my larynx up and down which i don't do often but have done to test to see if it makes a difference and i do feel a slight scratching sensation but still, if i wasn't thinking about it, nothing that i would really pick up on if i didn't have these other problems.

In answer to your second question, the Burning/Scratchy feeling seems to be located directly in my Larynx, Positioning wise i would say it is almost dead centre, although sometimes the burning and uncomfortable sensation feels as if it can be felt under the larynx ever so slightly but not by much. My neck feels generally free and my tongue seems generally free both normal position and also when i poke it out, again yawning seems fine. With regards to the neck tension, for a long time throughout 2008 and 2009 i had alot of tension in my neck muscles, which again i visted ent about as i felt like i had a very tight neck, felt like i was being strangled and they put it down to stress, Globus apparently and when i forgot about it, it completely vanished, so i can only assume they were correct, but again ENT way back in 2008 put me on reflux meds because of my throat being "Slightly red" But i didn't stay on them long, and they did nothing to help and then the tension cleared up on its own. This current situation however isn't the same it is something completely different as its a case of pain when talking which i wasn't experiencing previously.

The time periods i experience this pain is generally later in the day, after i have used my voice. When i wake in the morning after total silence, i don't feel any pain or anything uncomfortable in my throat, the most i think i have felt is that burning hot sensation when exhaling that i described earlier, again that is only when the issue is at its worst. The issue begins when i start using my voice alot, for example if i go into the kitchen and say "good morning dad, are you working today?" it's fine. But if i'm in work and i get stuck on a call for say 5 minutes, after that call i can feel it beginning. At which point i drink water to keep my throat moist. As i said around 5 pints a day i have.

ENT didn't actually advise me to take the medication, it was my doctor who advised it because they wanted to be on the safe side as i have suffered from heartburn previously when i was about 17. They put be on Omeprazole for a very short time back then and the issue cleared up and i never really experienced it after. They put me back on it, just to be on the safe side but as i said i have been taking 40mg each day for 6 months now and they haven't resolved the issue and 40mg of Omeprazole is a large dose.

i hope i have answered all your questions and hopefully you can clear some things up for me as in what path to take going forward, it is so incredible frustrating, not entirely sure how i still have strength to continue with regards to music because i keep thinking "it'll be better in a few weeks" and then a month later and it's exactly the same if not worse. I have made a decision to not sing atall for the rest of this year, to take a step back from it and concentrate on it next year so i can assure myself i don't have to stress because i can't do my shows, much to my dislike of course because i live and breath music. But whats a guy to do!

Just quickly i thought i'd also add, when i do speak my voice is very quiet, and if feel if i try and speak at my normal volume that i could speak at before this issue began, it would push it too far, same with laughing and trying to project voice, can't do it, i've had to change the way i do both because if i push it, i get a sensation that feels as if the Larynx or muscles stretch like a physical stretch sensation and then the next day they are back to being much worse for weeks.

Thanks ever so much again for all your help! hopefully you can guide me in the right direction.

[henriettamckeecarter]

You might have developede some compensatory behavior as the result of the coughing and subsequent hoarseness. Since the ENT has said they see no visible damage, you might consider requesting a referral to a voice therapist.

[Joanna]

more clarification questions from the resident speech therapist:

-when MD said one vocal cord wasn't "moving" completely, did that mean not vibrating completely, or not moving into position well? Those are very different phenomena.

Second is a muscle weakness that sometimes occurs after a flu/cough, and can be improved with therapy; the first usually means stiffening or micro-scarring inside the cord, much harder to fix. Did you get a complete exam with videostroboscopy? If not that is an important next step. I might have further suggestions on how to approach one or the other of the problems, but not without clearer diagnosis.

The pain symptom is somewhat more likely with the muscle-weakness scenario, but could occur with both. One of the more brilliant, "holistic" ENTs, Benjamin Asher in NYC, has lectured on throat pain that feels like an acute injury (internal/burning/stabbing ) -- actually being referred pain from neck muscles.

Even with a very pin-point sensation, what we feel inside the voice box is just not always real (although any discomfort is a real signal that something's wrong. It just might be something other than the obvious. If that makes sense.) This neck connection is always the case, but if reflux meds aren't helping, and you've been anxious about your voice, with a history of neck tension, it's a possibility.

What I would recommend:

get to a voice clinic with top-of-art diagnostics;

get deep-tissue massage to neck (ask for "trigger point myofascial release of SCM and scalenes");

and look up Ingo Titze's straw exercises on YouTube, as the gentlest, safest warm-ups I know (he's a Real voice science guru).

If diagnosis confirms a weakness (rather than stiffness) on one side, and the pain starts to ease up, I can help with strengthening/balancing exercises.

Stay hopeful & take care --

Joanna

[timmilesmusic]

Incredibly sorry Joanna for not getting back to you in July, i have only just gone through my "junk email" folder on my email account and noticed your reply, i really should update my email on here to one i use regular.

Just an update on everything, I'm currently have speech therapy and also regular visits for an endoscopy to keep a eye on my throat. The situation hasn't really improved. When i had the scope i was advised that my one vocal cord is appearing normal and the correct shape but the other vocal cord, the one on the right is very thin and a completely different shape. The doctor described it as some what "Dog leg" shape, very skinny and jagged looking but with no signs of any vocal nodules or polyps. The cords are working together properly, just the closure between them isn't perfect due to the one cord being skinny. The doctor doesn't know what to suggest either as he said he is unsure what has caused it and also unsure why i experience so much of a burning/scratching sensation when talking, he said he would expect a weak voice but not sure about the pain. There was some slight redness at the top of the right vocal fold also but he said he couldnt see anything like a bleed into the cords.

Speech therapy are keeping an eye on me and i have been asked to do tube resistance exercises through a straw 3 times per day for 5 minutes and slowly begin vocalising again, not resting as much and i have noticed a small improvement but nothing drastic. It's tempting to stay silent as it still hurts to talk!

Other than this i use steam before i do the exercises and after so my throat is clear and relaxed so i benefit from the full movement of my vocal folds when doing the exercises and soothing the scratching sensation after.

any suggestions that anybody could put forward for me?

I dont have a video of my folds but what i will have in 2 weeks time is a photo of them which i will attach when i get it!

Thank you for your support everyone!

[random1destiny]

A thin cord like that could be sulcus vocalis or it could be from muscle atrophy. A sulcus is basically the surface getting scarred and ends up concave, which could have happened if there was a hemorrhage in the tissue during all that coughing. It's pretty rare to happen just from coughing but certainly a possibility to ask about. Hopefully it will thicken a bit as you start re-strengthening. With one cord thin you may be having to squeeze everything together harder to get contact, which combined with that irritation redness could cause some pain. Is your ENT a voice specialist?

[timmilesmusic]

That certainly what it sounds like, and certainly what the doctors have advised me it could be. Relating to some form of a Hemorrhage at some stage, It was quite a bout of heavy coughing followed by a lot of talking in a call centre for 8 hours that triggered it the first time and the second time it was a high note when i began singing again that made it bad once again. I sure hope it's something that i can recover from, thanks so much for your input i really appreciate it. My ENT is a voice specialist but not a singing specialist, so he only deals with the speaking voice.

[LUKEP]

Hi I have been experiencing very similar symptoms after a bout of the flu 3 months ago. Whilst I was recovering from my flu I did try to sing a little bit and that is when the problems started with a light burning sensation in my larynx after talking and heartburn like chest pain. I have recently had a gastroscopy to assess for GERd or reflux but this presented nothing. I have also had an echocardiogram to assess my heart and all is normal. Blood tests and chest xrays present nothing. I have been eating healthy, maintaining fluids and getting plenty of sleep but have seen no improvement. It does cause me anxiety in having to avoid conversations to rest my voice. I can see this thread started 7 years ago and was wondering if you found a solution?