throat clearing and voice problems

[queenrollo]

Juts posting in case anyone else has experienced this and can offer support or advice.

For about three years now I have had a persistent problem with mucus in my throat. It's thick and sits on my vocal cords and the only way to shift it has been to clear my throat and cough. I HAVE to do this or I cannot talk at all.

I have seen the GP several times. After being treated with antihistamines and then ENT ruling out sinus issues or post-nasal drip I was put on omeprazole which made no difference and then basically I wa told it was 'one of those things' and offered no further investigations or treatment options.
The problem has not gone away and now after all this time it is actually affecting my voice.
I sing for fun with musician friends and in the last few months I have suddenly lost a large part of my range particularly top end and have had to stop.

Then two weeks ago my husband commented that my voice sounds very different. It's haorse/raspy. I find my throat hurts - both sore and muscular when I either talk for a long time or am reading bedtime story.
Mt GP's response to this was to give me antibiotics, which have done nothing - because it's not an infection!

What now? I think I have nodules on my cords from this repeated throat clearing.
I feel very low about this, especially the thought of having lost my singing voice completely.

@CausingChaos2 as it happens my own Trust's ENT is overloaded and so I was asked if I would travel for an out of trust setting. I agreed to this and was therefore refered to a private hospital that also see some NHS caseload.
They are just not scoping at all at the moment, neither their NHS or Private. We do have medical insurance so I had asked but was informed it wouldn't get me seen any sooner, even when things do get going again.

Might have died of throat cancer by then - which I say in jest but actually at 2am in the morning when insomnia strikes it feels almost too real a fear.

@queenrollo That is appalling. It seems all due care and diligence towards anything other than covid has gone out the window. I really hope this ridiculous approach is abandoned and you are seen very soon.

What trust is this? I work in maxfacs and we have scoped the entire time, especially for issues like your own. You can also be referred to maxfacs with this issue, may be worth a try?

I phoned them this afternoon to chase and have been told that I will probably be seen in March but non urgent patients are frequently being bumped off the list by more serious ongoing cases needing review - which I do understand.
I've been told to phone back mid to late Feb if I haven't heard from them by then.

Do you get shortness of breath? My husband is being sent to the Royal Brompton to see a specialist who will put a camera down to assess his vocal cords. They suspect vocal cord dysfunction which is causing constant throat clearing, voice changes and breathlessness. He also has gerd and will be having an op to fix his hiatus hernia.

queenrollo Not sure where in the country you are, but I've recently had a scope up my nose and down my throat. I had to have a Covid test first and then the ENT saw me. He was in full PPE.
This was private though. I'm in the North West. Just wanted to put it out there that they are being done but obviously each hospital/consultant have their own rules.

@bailey999 not so much breathless as a seem to 'run out of breath' when I am talking, especially noticeable when I am reading the bed time story. I have definitely had some reflux, and have omeprazole for that but it hasn't changed the mucus or throat issue.

@augustusglupe thank you for sharing that. I am trying to balance my anxieties and impatience for understanding with the fact that we're all just in an extraordinary set of circumstances.

I know lots of people are finding this lockdown mentally much harder and I am definitely struggling this time. One of my creative outlets is singing, many of my friends are recording stuff for online events and I can't join in and it's very disheartening.

Hmmm, you poor thing. I commented early on, on your thread. You need to be seen. I know you know that.

Have you felt your neck? Are there any changes? They could send you for an ultrasound at the very least, to check out your thyroid. Where I live, they're doing the 2 week referral for ENT. I think you need to phone your GP and be more insistent. I love the NHS, but you do, sometimes, need to be forceful or at least persistent.

Please make an appointment.

@DonLewis There are no obvious changes - there are thyroid issues in my family so I have had my T3/T4 etc tested and they came back fine.

I know all about having to be the squeaky wheel with the NHS, but it's exhausting and I think my apathy is definitely because I'm worn out fighting the system for my kids/husband. Once the pandemic hit I really couldn't face this battle for myself.

Someone I know has got wind of what has been happening, they are in a position to ask questions about why these services are not running fully here when they are elsewhere. Will be interesting to see what the Trust response is....

(it's also been pointed out to me that some of this issue could be due to peri-menopause so i am going to read up on that and tackle my GP about options, because I have other peri stuff going on too)

Ah, you poor thing. Such a lot going on.

A hoarse voice should absolutely trigger a 2 week referral. I think you need one. Hope it's nothing.

Yes, all this Lockdown definitely makes you realise how accessible most things are normally.
I agree with DonLewis I think with an ongoing hoarse voice, you need to be seen and investigated, even if it's for some peace of mind.
Hope you get sorted soon.

Just in case anyone was wondering about this - I still haven't been seen.

They have contacted me twice in recent weeks with an appointment, both times at a week's notice and with a requirement for me to shield for 3 days prior. Due to existing committments I can't do this, I need more notice than that to be able to shield. I also need someone to drive me there and back, of which I actually have few available options. And again, this requires notice to plan.

I have just explained all of this to the appointments clerk who rang me to be told he will put a note on my file to this effect but that they are simply not scheduling any further in advance.

So basically I'm not going to be able to take up a scoping appointment.

Update: After several more failed attempts at booking short notice someone finally managed to give me an appointment with enough notice for me to make arrangements.
I'm going this Friday, but have no idea what to expect as I have no info other than shielding/PCR test stuff and my time and which entrance to use!

It sounds like silent reflux (GERD). I have had exactly the same thing with the mucus sitting on vocal cords and my voice deteriorating. I do audio for a living so it was a big problem. My voice became weak and hoarse.

The solution for me was a book called Dropping Acid written by a doctor who specialises in this problem. Basically, you have to change what you eat and drink but you can see results in as little as two weeks.

I highly recommend that book as your symptoms sound so similar to mine.

By the way, if you have silent reflux, omeprazole makes the problem worse in the long run. It can bring about changes to the small intestine/stomach that make reflux more likely to occur in future.

Good luck for your appointment and thank goodness they finally sorted it out. Honestly, it's awful your having to wait this long. Pls update when you've been seen? Fingers crossed for you it's an easy fix.

I'm sorry you've had to wait so long. I've had a scope done a few times during covid. The ENT just wore PPE and the scope was disposable. This was private though. Its awful how long you've been waiting. Hope you get to the bottom of it on Friday.

Chocaholic9 I suspect GERD too for various reasons. I'm trying to manage it the best I can myself with diet and for the most part it is settled. I have to say that finally getting my GP to give me HRT has settled lots of digestive issues I was having, and my voice has actually recovered a little.
I know all about the problems of omeprazole and how it is used long term when it shouldn't be from family members experience.
(and I know I should really be having an endoscopy but my GP said a referal will be knocked back at the moment as my symptoms don't present me as an urgent case)

Piapiano This is NHS in a private hospital. I even asked about going Private (we have insurance that would cover it) and was told it made no difference to time-scales. I could have opted to go Private elsewhere and travelled but with the whole shielding required etc I just decided to go with the option which was logisitcally easiest for me. This is only because through other means I have managed to make some improvement myself, so the discomfort and impact on daily life has reduced.

anotheronenow I will update when I have news.

I had to do the PCR test yesterday, and as I have a chronic pain issue in my face it set that off. So now I am expecting the scope will do the same. Clearing my plans for the weekend as am likely to spend it in pain/medication fog!

Well the good news is that there is nothing nasty going on.

Other than that the Consultant says that some sort of reflux is the most likely culprit along with the natural deterioration of age and a little overuse.

Consultant asked me if there was a reason it had taken so long for me be seen since my phone Consult and so I explained that they would have to take that up with their own hospital administration as it was definitely not down to lack of me trying to be seen. It's fair to say they were actually quite cross.

We discussed what I have been doing in the meantime (singing lessons) and they said that continuing with that and the associated vocal exercises was probably best. They also agreed with me about some possible muscle tension dysphonia, and that the online stuff I have sourced is appropriate for me to use to address that.
I'm not really sure a SALT referal is worth it as the waiting lists for that are so long.

I'm happy that I know there are no nodules etc and nothing else nastier. Now to work on sorting out this reflux.

OP it's great news that there is nothing sinister going on. You must be so relieved.
I've been following your story with interest as I have exactly the same problem and am at my wits end with it all.

Mine started around 18 months ago, with occasionally finding I couldn't speak clearly and having to clear my throat. This progressed until I knew I couldn't wait any longer and had investigations done that all came back clear. I had a camera down my throat and up my nose and a thorough check up with an ENT consultant. He advised that I reduce the omeprazole and sit out the re-bound reflux that would happen.
I tried this but became so distressed at the problems with my speaking voice and constant post nasal drip that sits on my vocal chords that I'm now throwing everything at it in an attempt to break the cycle.

I wonder if there's anything I'm missing that you have found helped?

In no particular order this is my regime: omeprazole twice daily, gaviscon advance after meals, beconase nasal spray twice daily, probiotic daily, liquid aloe vera daily (I've only just added this in).

I've read 'Dropping Acid' which was recommended on either this thread or another one I'm following and tomorrow when the grocery shop arrives I'll be following that diet as everything in that book makes sense so is worth trying out I think.

I'm waiting for help in raising the bed too - it's too heavy for me so that's also something that I hope will make a difference.

The only relief from feeling that I have something stuck/dripping in my throat is when I sleep at night, then lo and behold the next morning within about 20 minutes of getting up it all starts again. I'm clearing my throat so often that it's now almost always sore. It's so distressing.

Wishing you well OP and if there's anything you've found to be successful I'd love to swap notes.

Hi @ThisOrdinaryLife sorry it's taken me ages to get back to you.

I'm really avoiding the omeprazole because I have a family member affected by one of the issues that can present from long term use. In their case (it is a parent) I do feel this is because they were put on this drug many years ago when long term implications weren't known.
I do take it, but only when I am having a flare up. I will use it for two weeks then taper off.

In all honesty I am certain that this problem is partly ageing for me, in particular one of the issues of peri-menopause. Since I started HRT my gastric issues seem to be settling. I still have reflux if I eat too much of the things that set it off (tomato based sauces are a real problem for me) and I have found that switching to eating little and often is a win for me. I avoid eating after 7pm if I can (if we're going out for a meal, so eating later, then I use gaviscon advance)

And one very simple trick is that I put bicarbonate of soda in water to sip all day. I actually don't mind the taste, but you might need to experiment if you decide to try this. Do read up on safe levels/contraindications with meds etc
There are instructions online for doing this as an indigestion remedy. I use far less than they state in larger amounts of water to sip. I first did this when the pain from the reflux was making me very sore, and by the end of the day I noticed a big difference.

I tried very, very hard to stop clearing my vocal cords off by force. It is not easy to adjust to this. But the more you do it, the more damaged they are the more mucus your body produces to soothe them. It's a vicious circle.

I hope you can find answers. I am much better than I was when this whole sorry saga started!

'Might have died of throat cancer by then'

If it was anything sinister then the MRI you had months ago would have picked it up.

I'm sorry that you've had such a lengthy carry on but anyone reading this should know that as long as an MRI or ct is done to rule out a tumour then you can relax a bit whilst finding a treatment that works. I would get a humidifier, whatever the cause of a hoarse voice moisture in the air helps as does drinking plenty of water. Vocal cords are very receptive to increased hydration.

@JaniieJones the MRI was 3 years go though (I have looked back and realise I never stated when that was) and they only did my head as they were investigating as a sinus issue. They didn't scope or examine my throat once. They ruled out post-nasal drip as the cause of the mucus then passed me back to my GP on the issue. In all honesty I felt fobbed off at the time.

I had an escalation of existing symptoms and presentation of new ones during last year which is why I was becoming worried about what it was.
They were not scoping due to Covid, and refused me an MRI or CT because scoping is their first line of diagnostic and I couldn't 'jump the queue'...

My DM had this. Push for a referral. In her case nothing wrong but they looked at her throat to make sure. Advice was when you want to clear your throat to drink water and do your best not to! It got better.

'the MRI was 3 years go though'

Omg! That is terrible some presenting with ongoing issues such as a hoarse voice should of course have a CT or mri. How can the consultant say there isn't anything going on if thy haven't scanned you.

Push for another scan. It isn't queue jumping, it is an investigation that is needed and relevant with your symptoms .