Struggling with Speech Clarity and Throat Pain: When to See an ENT?

Slurred speech, articulation difficulties, and experiencing hoarseness and throat pain after speaking for a short period?

Dear Dr.
Chi, I experience similar sounds when pronouncing certain phonetic symbols, such as ㄢㄤ, ㄣㄥ, and ㄙㄕ.
Additionally, I always need to clear my throat, similar to a phlegm-clearing action, before I can produce sound.
Since puberty, my voice has been consistently hoarse and deep, and I struggle to speak long sentences without feeling short of breath.
I also find it difficult to speak for extended periods or project my voice, which results in throat pain.
My lifestyle is normal, and I do not smoke or drink alcohol.
Recently, I visited a rehabilitation department, but after the consultation, I was referred to a speech therapist.
It has been some time, but the aforementioned symptoms have not improved.
Should I consider visiting an otolaryngologist or another specialist for my condition? Thank you!

Chen, 20~29 year old female. Ask Date: 2022/12/15

Dr. Ji Zhaoyun reply Otolaryngology

Hello, based on your description, there are many potential causes for hoarseness, including laryngitis, vocal cord edema, vocal cord nodules, and poor vocal cord function.
It is advisable to first visit an otolaryngologist for an endoscopic examination to identify the exact cause.
For daily care, consider the following: 1.
Voice rest, and try to "avoid" breathy sounds, loud shouting, and high-pitched noises; make sure to rest your voice and drink plenty of water.
2.
Do not smoke.
3.
Avoid coffee, tea, cigarettes, alcohol, fried foods, and spicy foods, as these can help improve symptoms.
If vocal cord nodules are present, the treatment usually depends on the size of the nodules.
Larger nodules typically require microlaryngeal surgery under general anesthesia for removal, while smaller nodules are usually managed with conservative medical treatment and lifestyle modifications.
If you are experiencing these issues, it is recommended to seek medical evaluation.
Additionally, based on your description, it would be best to consult both an otolaryngologist and a neurologist simultaneously.
Wishing you peace and good health.

Reply Date: 2022/12/15

More Info

It sounds like you are experiencing a complex set of symptoms related to your speech clarity and throat pain, which can be quite distressing. Based on the information you provided, it would be advisable to consult an Ear, Nose, and Throat (ENT) specialist for a thorough evaluation. Here’s why:
1. Voice Changes and Throat Pain: The persistent hoarseness and low-pitched voice you describe, especially since puberty, could indicate underlying issues with your vocal cords or larynx. Conditions such as vocal cord nodules, polyps, or even laryngitis can lead to these symptoms. An ENT can perform a laryngoscopy to visualize your vocal cords and assess their function.

2. Difficulty with Speech Clarity: The specific speech issues you mentioned, such as producing similar sounds for different phonemes (like ㄢㄤ, ㄣㄥ, ㄙㄕ), could be related to muscle control in your throat or vocal cords. This could be a result of muscle tension dysphonia or other functional voice disorders. An ENT can help determine if there are any anatomical or functional issues contributing to these speech difficulties.

3. Throat Clearing Before Speaking: The need to clear your throat before speaking could indicate irritation or inflammation in your throat, which might be due to allergies, acid reflux, or other irritants. An ENT can evaluate your throat for signs of inflammation or other conditions that might require treatment.

4. Breathlessness When Speaking: Feeling short of breath while talking can be concerning. This symptom could be related to vocal strain or even respiratory issues. An ENT can assess your breathing and voice production to determine if there’s a connection.

5. Previous Treatments: Since you have already seen a rehabilitation specialist and a speech therapist without improvement, it’s crucial to rule out any physical causes that might be affecting your voice and speech. An ENT can provide a more specialized examination and may recommend further treatments or therapies.

6. Normal Lifestyle Factors: It’s good to hear that you maintain a healthy lifestyle, avoiding smoking and alcohol, which can negatively impact voice health. However, other factors such as hydration, vocal hygiene, and even stress can also play significant roles in voice quality and throat health.

In summary, given your symptoms of speech clarity issues, throat pain, and the lack of improvement with previous treatments, it would be prudent to see an ENT specialist. They can conduct a comprehensive evaluation, including a physical examination of your throat and vocal cords, and provide you with a tailored treatment plan based on their findings. Additionally, they may collaborate with speech therapists to ensure a holistic approach to your voice and speech concerns.
Remember, early intervention can often lead to better outcomes, so don’t hesitate to seek the care you need.

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