The Adventures of Arganoid and Bongle Twonker

The story so far: throughout January and February, my voice deteriorated, to the point where I could no longer work. By the end of Feb, my throat was sore all the time, and seemed to be producing excessive amounts of mucus.

The next time I saw a doctor, I asked to be referred to an ENT specialist to have my throat examined. I also asked to see a speech therapist.

I saw the ENT specialist on the 18th of March. He did a nasal endoscopy, i.e. sticking a tube up my nose in order to look at my vocal cords. His diagnosis was that my problem was caused by excessive post-nasal drip (i.e. mucus coming into the throat from the nose). This didn’t make much sense to me since the problem of excessive mucus in the throat hadn’t started until after my voice problems had begun. Also, it didn't feel like the mucus was coming from the nose. Since it happened such a long time ago, I can’t remember for certain if I raised these issues with the specialist – I think I did, briefly, but he didn’t seem to be paying much attention to what I was saying. He prescribed me Beclometasone (an antihistamine nasal spray, more widely known as Beconase). When I next saw a GP, and told him about the appointment with the specialist, I was also prescribed Sudafed Plus, a decongestant.

I started taking the medication I had been prescribed, but it was hard to tell how much difference it made, since a few days later I got a cold. This led to even more mucus, and thus more coughing and throat-clearing. However, I was becoming increasingly aware, due to reading web pages on the subject, that coughing and throat-clearing were a bad thing to be doing – they could be exacerbating the problem by irritating the vocal cords. This was confirmed when I read a book called "The Voice and Its Disorders". This book is aimed at medical professionals, but I felt I needed to read it since I needed information and wasn't getting much from doctors or the internet.

Of all the conditions described in the book, there were two which seemed to be a fairly close match for my symptoms. The first was 'Muscle Tension Dysphonia' (in which Dysphonia means a change in how the voice sounds). The other was Laryngopharyngeal Reflux (LPR), in which the larynx is damaged by stomach acid.

Of most interest to me was Muscle Tension Dysphonia (MTD), which at one point the book refers to as being synonomous with "vocal strain", which is how I had been describing my problem all along. I already knew that I had excessive muscle tension elsewhere in my body - see the previous chapters on RSI. So it seemed eminently plausible that muscle tension in my neck could be causing problems with my voice.

Around this time, I also started trying steam inhalation to see if that had an effect on my symptoms. I would fill a bowl with near-boiling water, put a towel over my head and breathe in the vapour for about 10 minutes. At first I would usually see a small improvement in my symptoms, but as time went on the benefits seemed to diminish. (Months later, I was advised by a speech therapist to resume daily steam inhalations, which I have done).

On the third of May, I spent the evening with some old friends, and did more talking than I had done in a long time. This made my voice feel even worse than normal. Since late March I had been making graphs to track the severity of my symptoms, along with when I talked, ate, cleared my throat and took medication. As with the RSI symptom ratings I've mentioned in previous posts, I rated my discomfort on a scale of 1 to 5. The graph for this particular evening shows my sore throat as being rated as above 4 at times - the worst it had been since my problem first started.

I had my first session with a speech therapist on the 6th of May. By this point the mucus problem had diminished somewhat. The speech therapist advised me that taking Sudafed Plus may not have been good for my condition, as it could cause the throat to dry too much. By this point I had already stopped taking the Sudafed, and I now also stopped the nasal spray. The speech therapist also suggested that I may have LPR (see above). She explained that people could have this condition without realising, as the acid could travel from the stomach to the larynx fairly quickly, without lingering in the oesophagus, and therefore not causing noticable heartburn symptoms. This is sometimes referred to as 'silent reflux'. I didn't have heartburn symptoms, but I had on rare occasions experienced symptoms which could be a sign of reflux - e.g. trying to burp but instead feeling vomit in my throat. The speech therapist suggested that this could be the reason why I had a sore throat even when I didn't speak for days, and recommended that I start taking anti-reflux medication as a precaution. The medication I was prescribed was lansoprazole, a proton pump inhibitor (PPI).

Over the next few weeks, I had a number of sessions with the speech therapist. I was given a number of vocal exercises to do, which often involved saying certain silly phrases in a specific way. However, I was seeing little or no improvement in my voice. The only thing I could say for sure was that it was somewhat better than it had been two months ago. In retrospect, it seems likely that my voice was improving, but the rate of change was so slow, and the symptoms were so variable, that it was impossible to tell. I remained very demoralised about my situation.

Around this time, I started to try a number of other things alongside the PPIs, voice exercises and steam inhalations:

- I started using chewing gum, since I'd read that this could reduce acid reflux. On the other hand, other sources said it could make it worse.

- I was advised by my speech therapist to switch to eating lots of very small meals each day, rather than a few big ones. I tried this for a while, but I often just ended up feeling really hungry and eating lots at once, which probably defeated the whole point. Since then, I've tried to spread out my eating throughout the day as much as possible.

- Raising the head of my bed, so that reflux at night is less likely. I started out by putting about 5 inches worth of magazines under the top legs of the bed. I've recently increased the height to 11 inches.

- I started taking various types of Gaviscon - particularly Gaviscon Advance - after most meals.

- I stopped eating various types of foods which various reputable sources (including the book "The Voice and Its Disorders") suggest may exacerbate reflux - e.g. tomatoes, dairy products, chocolate.

- I made sure that I didn't eat anything within 3 hours of going to bed.

I'd like to say that some or all of these things had a noticable effect on my symptoms, but there was no clear breakthrough. What I can say is that after about two or three months had passed, there was a small improvement in my symptoms, but progress was very bumpy, and it was impossible to attribute the improvement to any one thing. During this time I spent a lot of time wondering what proportion of my symptoms (if any) were due to reflux, and what proportion were due to MTD. I found the uncertainty very frustrating - especially as I wasn't entirely sure if I had reflux at all, and the lansoprazole tablets I was taking for this theorised reflux were giving me diahorreha. I was also concerned as to whether they might stop me digesting my food properly (a GP later reassured me that this wasn't the case). After a while, I cut down from two lansoprazole tablets per day to one.

As I mentioned just now, progress was extremely bumpy. As usual, this bumpiness consisted of both fluctuations over the course of a day, and occasions when things would get quite a bit worse than normal and remain so for days at a time. One such occasion was on the evening of the 6th of July. My graph of this day shows that over the course of about half an hour, starting from 11pm, my symptoms quickly became much worse than normal (4.5/5) - almost the worst they'd ever been. The soreness continued to be just as bad for the whole of the next day, accompanied by quite a bit of coughing, and even difficulty swallowing at one point. It took over a week for my symptoms to return to the same level they had been before the worsening.

On another occasion, I had to look after a child and read him a bedtime story. This tired out my voice quite a lot. I then ate quite a lot of bowls of corn flakes, with normal milk (which I had been trying to avoid) as opposed to the soya milk which I have switched to. Again, my symptoms got a lot worse and took days to settle down, but as usual I couldn't be sure if it was down to reflux, talking too much or both.

In the next part I'll write about my return to work and more hospital appointments, including some tests that are due to be carried out on me in a few days time.