Hoarseness: Causes, Treatments, and When to Seek Help

Hoarseness issue

Hello Dr.
Zheng, on November 10th, I visited a clinic due to a cold, but the doctor mistakenly prescribed me medication that I am allergic to.
I started experiencing palpitations on the 11th.
On the 12th, I returned to the same clinic and consulted the same doctor to change my medication, at which point I discovered the prescription error.
However, after changing the medication, my condition did not improve; instead, my voice became hoarse, I felt a sensation of something stuck in my throat, and at times, I experienced wheezing or difficulty breathing.
On the 14th and 15th, I went to the emergency room, where I was treated with steroids and epinephrine, which provided immediate relief, but once the medication wore off, all my symptoms returned.
The doctor noted on the prescription: stridor and other allergies.
On the 17th, I returned to the clinic to see the same doctor, who performed a rigid laryngoscopy and found no issues with my vocal cords or trachea.
However, on the 18th, I experienced the same symptoms again and immediately went to the emergency room and the ENT outpatient department for further examination, but no problems were found.
The ENT doctor suggested it might be asthma.
As of now, my voice has not fully returned to its previous state, and while using epinephrine provides some improvement, I cannot rely on it long-term and need to find a solution.
Currently, I am taking the following medications: 1.
Cetirizine 5mg & Pseudoephedrine 120mg SRM tab 2.
Procaterol HCl hemihydrate 25mcg tab 3.
Salmeterol 25mcg & Fluticasone Propionate 125mcg/PF 120PF/bot (inhalation aerosol) 4.
Ambroxol HCl 30mg tab 5.
Prednisolone 5mg tab 6.
Oxethazaine 5mg, Polymigel (Aluminium hydroxide, calcium carbonate, and magnesium carbonate) 244mg tab 7.
Fenoterol Inhaler 100mcg/puff, 200puff/bot.
I would like to ask: 1.
Given my current situation, what should I do? 2.
Which specialty should I consult first? 3.
Based on my symptoms, do I have a drug allergy, asthma, or another issue? 4.
Are there any physical therapies available to assist or alleviate my current symptoms?

Xiao Tian Shi, 10~19 year old female. Ask Date: 2019/11/19

Dr. Zheng Jueyi reply Otolaryngology

Hello,
1.
It is recommended to continue monitoring based on the current medication usage during outpatient follow-ups.

2.
It is advised to continue follow-ups at the Otolaryngology and Pulmonology outpatient clinics.

3.
Drug allergies are usually transient symptoms and should improve within a few days.
As for asthma, you can visit the Pulmonology clinic for evaluation and determine if long-term medication is necessary.

4.
If your voice does not improve, it is recommended to seek voice rehabilitation therapy at the Otolaryngology or Rehabilitation Medicine department.

Wishing you peace and health,
Director of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare,
Dr.
Zheng Jue-Yi

Reply Date: 2019/11/19

More Info

Hello! Thank you for sharing your experience and concerns regarding your hoarseness and related symptoms. It sounds like you've been through quite a challenging time, and I appreciate your detailed account of your medical journey. Let’s break down your questions and provide some guidance based on your current situation.

1. How should you handle your current condition?
Given your symptoms of hoarseness, throat discomfort, and breathing issues, it's crucial to continue monitoring your condition closely. Since you've experienced temporary relief with medications like epinephrine and steroids, it indicates that there may be an underlying inflammatory or allergic component to your symptoms. Here are some steps you can take:
- Continue Medication as Prescribed: Ensure you are taking your medications as directed by your healthcare provider. This includes antihistamines (like Cetirizine), bronchodilators (like Procaterol and Fenoterol), and inhaled corticosteroids (like Salmeterol and Fluticasone). These can help manage your symptoms.

- Hydration and Humidification: Drink plenty of fluids to keep your throat moist. Using a humidifier in your living space can also help alleviate throat irritation.

- Voice Rest: Try to minimize talking or whispering, as this can strain your vocal cords further. If you must speak, do so softly and avoid shouting.

- Avoid Irritants: Stay away from smoke, strong odors, and allergens that could exacerbate your symptoms.

2. Which specialist should you consult?
Given your symptoms, it would be advisable to see an Ear, Nose, and Throat (ENT) specialist if you haven't already. They can perform a thorough examination of your vocal cords and throat to rule out any structural issues or other underlying conditions. If your symptoms are related to asthma, a pulmonologist (lung specialist) may also be appropriate, especially if you have a history of asthma or respiratory issues.

3. Are your symptoms related to a drug allergy, asthma, or something else?
Based on your description, it seems that your symptoms may not be solely due to a drug allergy but could be related to asthma or an allergic reaction. The fact that you experienced relief with bronchodilators suggests that asthma could be a contributing factor. However, it’s essential to differentiate between an allergic reaction and asthma exacerbation, as they may require different management strategies.
A thorough evaluation by an ENT or allergist can help determine if your symptoms are due to an allergy, asthma, or another condition. They may perform tests such as allergy skin tests or pulmonary function tests to clarify the diagnosis.

4. Are there any physical therapies that can assist or alleviate your symptoms?
While there are no specific physical therapies for hoarseness, some general recommendations may help:
- Voice Therapy: Working with a speech-language pathologist who specializes in voice therapy can be beneficial. They can provide exercises to strengthen your vocal cords and improve your voice quality.

- Breathing Exercises: If asthma is a concern, pulmonary rehabilitation or breathing exercises can help improve lung function and control symptoms.

- Relaxation Techniques: Stress can exacerbate respiratory symptoms, so practices such as yoga, meditation, or deep-breathing exercises may help manage anxiety and improve overall well-being.

Conclusion
It's essential to keep an open line of communication with your healthcare providers about your symptoms and any changes you experience. If your symptoms worsen or do not improve with current treatments, do not hesitate to seek further medical advice. Remember, managing respiratory and vocal symptoms can take time, and finding the right treatment plan is crucial for your recovery. I wish you the best in your journey toward better health!

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