Persistent Throat Pain: Struggling with Voice Issues After Overuse

Experiencing abnormal soreness in the throat, making it difficult to speak normally?

Due to work-related reasons, I often speak a lot.
Six months ago, after overusing my voice, I woke up one day and felt a pain in my throat as if I had strained a muscle.
It was extremely painful, and my voice became hoarse.
I immediately consulted an otolaryngologist, who performed an endoscopy and diagnosed me with a vocal cord gap and mild atrophy, along with some redness and swelling possibly due to gastroesophageal reflux.
The doctor prescribed medication for my stomach and muscle relaxants, but I explained that my discomfort felt like having a sprained calf that made it impossible to walk normally, and in my case, I couldn't speak normally.
The doctor then prescribed steroids.
I returned for several follow-up visits, but the symptoms persisted.
I was referred for a stroboscopy, yet the cause of my severe pain remained undetermined.
I continued taking the prescribed medications and took a significant amount of time off work, but the swelling in my throat persisted.
Some doctors suggested it might be pharyngitis, but after multiple follow-ups, the swelling and pain remained severe, and the doctors were unsure of the condition.
After resting for a while, the swelling slightly decreased, but any slight speaking, exposure to tea, smoke, or polluted air, or eating fried foods would cause my throat to swell again, leading to pain.
The swollen area in my throat felt as fragile as glass, creating an endless cycle, akin to a cash card where I only pay interest and never pay off the principal.
I took steroids and muscle relaxants for a month and stomach medication for four months before switching to traditional Chinese medicine, which suggested that my repeated colds had not fully resolved and that the virus lingered in my throat.
I also experienced headaches, which improved after two months of herbal treatment, but my throat symptoms persisted.
I might have some mild pharyngitis; I used to have a slightly hoarse voice, but it was not to the extent that I couldn't speak normally.
It has now been six months since my symptoms began, during which I have taken countless breaks and undergone numerous treatments, yet I still cannot speak normally.
This has severely impacted my daily life and work, and I have started to avoid conversations with others.
For the past six months, every time I visit the otolaryngologist and undergo an endoscopy, the only answers I receive are mild atrophy and slight redness, with advice to rest more.
My symptoms may differ from others; the doctor mentioned that my vocal cords were not coming together properly.
At one point, my voice was somewhat normal and less painful, but upon returning for another endoscopy, the doctor noted that the closure of my vocal cords was better.
However, after a subsequent deterioration, the vocal cords showed atrophy again, leading me to wonder if this is related to the muscles controlling the vocal cords.
Despite enduring this for six months, my symptoms remain severe, feeling as if I were injured just yesterday.
After speaking only a few sentences at work today, I began discussing with my supervisor the possibility of taking another extended leave, feeling very helpless.
I live in Taichung and hope that someone can see my post and recommend a more detailed examination.
I would appreciate any guidance from a doctor.
(My mental state is good.)

Mr. Chen, 20~29 year old female. Ask Date: 2016/09/17

Dr. Ji Zhaoyun reply Otolaryngology

Hello Mr.
Chen, based on your description, there are many potential causes for your poor voice and throat discomfort, including vocal cord atrophy, vocal cord inflammation, vocal cord edema, vocal cord nodules, impaired vocal cord movement, and chronic pharyngitis, among others.
It is advisable to first visit an otolaryngologist for an endoscopic examination to identify the exact cause, followed by appropriate medication.

For daily care, I recommend the following:
1.
Voice rest, and try to avoid producing breathy sounds, shouting, and high-pitched noises.
Make sure to rest your voice and stay well-hydrated.
2.
Do not smoke.
3.
Avoid coffee, tea, cigarettes, alcohol, fried foods, and spicy foods, as these can help improve your symptoms.
If you have been experiencing these issues for a long time and have been taking medication but your symptoms persist, it is crucial to strictly adhere to the daily care recommendations and consider a follow-up consultation for further examination.

Wishing you peace and health.
Please note that this is purely an exchange of ideas, and everything should be based on the actual consultation with your physician.

Sincerely,
Dr.
Chi Chao-Yun, Head of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/09/17

More Info

Persistent throat pain, especially after overuse, can be a complex issue that often involves multiple factors. Based on your description, it seems you have been dealing with significant throat discomfort for an extended period, which has severely impacted your ability to speak and your overall quality of life. Your symptoms, including hoarseness, pain, and swelling, suggest that there may be underlying issues that need to be addressed more thoroughly.

Firstly, it’s important to understand that the vocal cords (or vocal folds) are delicate structures that can be easily injured or strained, especially with excessive use. This can lead to conditions such as vocal cord nodules, polyps, or even muscle tension dysphonia, where the muscles around the vocal cords become tense and contribute to pain and dysfunction. The fact that you have been diagnosed with mild atrophy and some inflammation indicates that your vocal cords may not be functioning optimally, which could explain the persistent pain and hoarseness.

The mention of gastroesophageal reflux disease (GERD) is also significant. Acid reflux can irritate the throat and vocal cords, leading to inflammation and discomfort. It’s crucial to manage this condition effectively, as untreated reflux can exacerbate throat pain and vocal issues. The medications prescribed, such as proton pump inhibitors, are typically effective in reducing stomach acid and should be taken as directed. However, lifestyle modifications, such as avoiding spicy foods, caffeine, and smoking, can also play a vital role in managing GERD symptoms.

Since you have already seen multiple specialists and undergone various treatments without significant improvement, it may be beneficial to consider a multidisciplinary approach. Here are some recommendations:
1. Voice Therapy: Consulting with a speech-language pathologist who specializes in voice therapy can be incredibly beneficial. They can provide exercises to strengthen your vocal cords and teach you techniques to reduce strain while speaking. This therapy can help you regain control over your voice and alleviate some of the discomfort.

2. Further Evaluation: If you haven’t already, consider seeking a second opinion from a laryngologist, a specialist in voice disorders. They may perform more advanced imaging studies or functional assessments to evaluate how your vocal cords are functioning during speech.

3. Allergy Testing: Given that you mentioned sensitivity to certain environmental factors (like smoke and certain foods), it might be worthwhile to explore whether allergies are contributing to your symptoms. An allergist can help determine if you have any underlying allergies that could be exacerbating your throat pain.

4. Psychological Support: While you mentioned that your psychological state is good, chronic pain can sometimes lead to stress or anxiety, which can further exacerbate physical symptoms. Engaging in stress-reduction techniques, such as mindfulness or cognitive behavioral therapy, can be beneficial in managing the emotional toll of chronic pain.

5. Dietary Considerations: Since you noted that certain foods trigger your symptoms, keeping a food diary to track what you eat and how it affects your throat may help identify specific triggers. This can guide dietary changes that might alleviate your symptoms.

6. Regular Follow-ups: Continue to follow up with your ENT specialist and keep them informed about any changes in your symptoms. Regular monitoring can help catch any potential complications early.

In conclusion, persistent throat pain and voice issues can stem from a combination of factors, including vocal cord strain, reflux, and possibly allergies. A comprehensive approach that includes voice therapy, further evaluation by specialists, and lifestyle modifications may provide you with the relief you need. It’s essential to remain proactive in seeking care and advocating for your health, as chronic throat issues can significantly impact your quality of life.

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