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Suggest Treatment For Chronic Voice Hoarseness While On Nicotine Patch
Question: ENT has told me to quit smoking to help heal chronic hoarseness and painful speaking and throat mucous membrane damage. Questions:
1) I was a heavy smoker. I am using the nicotine patch to reduce 21-14-7 mg weekly. Is this ok for my throat mucous membranes as there is no smoke or am I better to try to wing it cold turkey?
2) I am also taking anti-LPR medicine. Is there a point at which we can rule out GERD/LPR if no improvement in symptoms?
1) I was a heavy smoker. I am using the nicotine patch to reduce 21-14-7 mg weekly. Is this ok for my throat mucous membranes as there is no smoke or am I better to try to wing it cold turkey?
2) I am also taking anti-LPR medicine. Is there a point at which we can rule out GERD/LPR if no improvement in symptoms?
Brief Answer:
Following answers to your questions
Detailed Answer:
Hi,
I have gone through your medical history carefully and understood your concern.
1. As you have a personal history of heavy smoker, and now decided to quit, let me explain that your body is used with high doses of nicotine.
Sudden smoking cessation would cause severe withdraw symptoms.
That's why your doctor prescribed nicotine patches to gradually adopt your body to small doses of nicotine until total cessation.
As you are using patches, and not cigarettes, your throat won't be exposed to fumes as when smoking a cigarette. So, gradually no external factors would affect the throat including vocal cords. In this way, they'll get their time to heal and get back to normality again.
2. With regards to LPR, unfortunately, chronic smoking is associated with LPR. This is also another factor contributing negatively on the normal function of vocal cords apart other symptoms.
Ceasing smoking, and anti LPR meds together with healthy eating will get the symptoms improved.
Apart your symptoms and clinical evaluation, another ENT examination will determine the true betterment of LPR symptoms.
However, time is needed, at least 3 weeks after starting meds, you should notice improvement.
Hope it answered your questions.
Dr. Albana
Following answers to your questions
Detailed Answer:
Hi,
I have gone through your medical history carefully and understood your concern.
1. As you have a personal history of heavy smoker, and now decided to quit, let me explain that your body is used with high doses of nicotine.
Sudden smoking cessation would cause severe withdraw symptoms.
That's why your doctor prescribed nicotine patches to gradually adopt your body to small doses of nicotine until total cessation.
As you are using patches, and not cigarettes, your throat won't be exposed to fumes as when smoking a cigarette. So, gradually no external factors would affect the throat including vocal cords. In this way, they'll get their time to heal and get back to normality again.
2. With regards to LPR, unfortunately, chronic smoking is associated with LPR. This is also another factor contributing negatively on the normal function of vocal cords apart other symptoms.
Ceasing smoking, and anti LPR meds together with healthy eating will get the symptoms improved.
Apart your symptoms and clinical evaluation, another ENT examination will determine the true betterment of LPR symptoms.
However, time is needed, at least 3 weeks after starting meds, you should notice improvement.
Hope it answered your questions.
Dr. Albana
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Doctor that is clear. There was one thing my doctor and I discussed that I would like your opinion on: about 5 months ago I inhaled toxic smoke which damaged the nerve endings in my nose. As a result the nose is partially numb inside. She wondered if this is impacting my ability to speak. To me , while the voice needs the nose for resonance , this seems a bit far fetched. Do you have an opinion on that idea?
Brief Answer:
Inhaling toxic smoke partially explaining vocal cords problems
Detailed Answer:
Hi black,
Now, with your new data of having inhaled toxic smoke, I want to know:
- at what level was the smoke inhaled: just nose? or deeper in the upper airways? or lungs?
Depending on the depth of damages, we can understand the level of respiratory pathways involved.
If you say you experienced only numbed nasal nerves, then I think the smoke as a bit deeper than that. Could have involved the other part of respiratory tract (but not the lungs) although only with a little effect.
If the problem with coarse voice started since the day you inhaled toxic smoke, then this can explain what you experience.
Dr.Albana
Inhaling toxic smoke partially explaining vocal cords problems
Detailed Answer:
Hi black,
Now, with your new data of having inhaled toxic smoke, I want to know:
- at what level was the smoke inhaled: just nose? or deeper in the upper airways? or lungs?
Depending on the depth of damages, we can understand the level of respiratory pathways involved.
If you say you experienced only numbed nasal nerves, then I think the smoke as a bit deeper than that. Could have involved the other part of respiratory tract (but not the lungs) although only with a little effect.
If the problem with coarse voice started since the day you inhaled toxic smoke, then this can explain what you experience.
Dr.Albana
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Doctor here is the whole story:
I had a flare up on chronic sinus infection with my ears filling up. I have a problem with the Eustachian tube in my right ear so pain was severe. Doctor proscribed oral decongestants of which I took 1/2 tablet per day for about a month. After a week I noticed my throat dry and voice hoarse and breaking. Then I got nerve pain in my nose (like ice picks in my nose). Doctor told me it was all in my head. A few weeks later I tried an assign pain killer - smoking dried lotus leaves through a double filtered pipe.i did this for maybe 5-8 minutes u till I felt pain from the smoke/heat in my throat so I stopped. This was the "toxic smoke". Right away the next day I found no sensation in my nose (eg cannot sense steam in the shower) and smell greatly decreased (can smell all but more faintly than before). Now I was diagnosed with depression and continued smoking. Voice getting gradually worse in intervening months. About 5 months now after smoking the leaves and resigned to what appears to be permanent damage so finally quit smoking . So the voice problems predated the "toxic (most likely not toxic but still bad) smoking" episode.Voice has slowly gotten worse. ENT said nose mucosal membrane now dry. I am taking Salegen which seems to help a little. That is the whole sad story. I did not inhale the "toxic" smoke.
I had a flare up on chronic sinus infection with my ears filling up. I have a problem with the Eustachian tube in my right ear so pain was severe. Doctor proscribed oral decongestants of which I took 1/2 tablet per day for about a month. After a week I noticed my throat dry and voice hoarse and breaking. Then I got nerve pain in my nose (like ice picks in my nose). Doctor told me it was all in my head. A few weeks later I tried an assign pain killer - smoking dried lotus leaves through a double filtered pipe.i did this for maybe 5-8 minutes u till I felt pain from the smoke/heat in my throat so I stopped. This was the "toxic smoke". Right away the next day I found no sensation in my nose (eg cannot sense steam in the shower) and smell greatly decreased (can smell all but more faintly than before). Now I was diagnosed with depression and continued smoking. Voice getting gradually worse in intervening months. About 5 months now after smoking the leaves and resigned to what appears to be permanent damage so finally quit smoking . So the voice problems predated the "toxic (most likely not toxic but still bad) smoking" episode.Voice has slowly gotten worse. ENT said nose mucosal membrane now dry. I am taking Salegen which seems to help a little. That is the whole sad story. I did not inhale the "toxic" smoke.
Brief Answer:
A complicated case of chronic sinusitis
Detailed Answer:
Hi back,
Sorry for the late reply due to XXXXXXX clinical overload this weekend.
Indeed, your case is a bit complicated.
Chronic sinus infection(sinusitis) is often associated with blocked Eustachian tube.
If chronic, sinusitis is difficult to treat and would take time.
Now, as your voice got changed although you took the anticongestant med, the infection has spread to vocal cords (trachea).
If you smoked lotus leaves for about 5 mins, you might have caused more damages to the sinuses that are already infected.
This explains why the voice is getting worse.
I advise to:
- continue taking nasal and oral decongestant and antiinflammatory meds
- antihistaminic to use on long term
- keep good oral hygiene
- gargle with warm water and salt
- discuss with your doctor to add prescription antibiotics
- stomach antacids to start as hyperacidity problems would occur when on sinusitis treatment
If still no improvement within a couple of weeks, then, upper endoscopy and laryngotracheoscopy for further evaluation.
All the best.
Dr.Albana
A complicated case of chronic sinusitis
Detailed Answer:
Hi back,
Sorry for the late reply due to XXXXXXX clinical overload this weekend.
Indeed, your case is a bit complicated.
Chronic sinus infection(sinusitis) is often associated with blocked Eustachian tube.
If chronic, sinusitis is difficult to treat and would take time.
Now, as your voice got changed although you took the anticongestant med, the infection has spread to vocal cords (trachea).
If you smoked lotus leaves for about 5 mins, you might have caused more damages to the sinuses that are already infected.
This explains why the voice is getting worse.
I advise to:
- continue taking nasal and oral decongestant and antiinflammatory meds
- antihistaminic to use on long term
- keep good oral hygiene
- gargle with warm water and salt
- discuss with your doctor to add prescription antibiotics
- stomach antacids to start as hyperacidity problems would occur when on sinusitis treatment
If still no improvement within a couple of weeks, then, upper endoscopy and laryngotracheoscopy for further evaluation.
All the best.
Dr.Albana
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor: no problem with the delayed response and thanks for getting back to me.
I will be continuing not to smoke.
May I ask you about the nose?
it seems likely unfortunately that there is damage to the nerves both for smell and other ones. This must have happened from the leaf smoking as it was sudden right after that. If I continue abstaining from smoking is there a decent chance for recovery? If so how long might it take? The leaf smoking was five months ago but I smoked most of that time. Does it seem like there could be another cause for the loss of some smell and loss of sensation in nose? Note I am a 50 year old male.
On the voice...
Is it possible that the dry, somewhat numb nose could affect my voice as well? When I talk at first I am ok then after a few sentences it feels like burning in the back of my throat.
I will be continuing not to smoke.
May I ask you about the nose?
it seems likely unfortunately that there is damage to the nerves both for smell and other ones. This must have happened from the leaf smoking as it was sudden right after that. If I continue abstaining from smoking is there a decent chance for recovery? If so how long might it take? The leaf smoking was five months ago but I smoked most of that time. Does it seem like there could be another cause for the loss of some smell and loss of sensation in nose? Note I am a 50 year old male.
On the voice...
Is it possible that the dry, somewhat numb nose could affect my voice as well? When I talk at first I am ok then after a few sentences it feels like burning in the back of my throat.
Brief Answer:
Time for recovery depends on severity of the damage
Detailed Answer:
Hi back,
If the nose nerve is damaged, we should determine the severity.
Usually, it will take some time to recover including months.
However, in your case, you say everything is OK at the beginning, then you start to have problems with the voice.
That is perfectly normal. When you talk, throat might get sore, and you need water.
Furthermore, the vocal cords will get overload if you keep talking. This explains why your voice gets changed.
So, have more patience and wait a few more months for betterment
Wish fast recovery.
Dr.Albana
Time for recovery depends on severity of the damage
Detailed Answer:
Hi back,
If the nose nerve is damaged, we should determine the severity.
Usually, it will take some time to recover including months.
However, in your case, you say everything is OK at the beginning, then you start to have problems with the voice.
That is perfectly normal. When you talk, throat might get sore, and you need water.
Furthermore, the vocal cords will get overload if you keep talking. This explains why your voice gets changed.
So, have more patience and wait a few more months for betterment
Wish fast recovery.
Dr.Albana
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi doctor:
Thanks for getting back to me. Just two questions:
1) on my vocal cords. Just in the last week -one week after starting the anti-LPR medicine - I notice I really have to clear my voice (which I know hurts the vocal cords) to speak in the morning. Could this be due to the Medicine? Also is it possible my dry nose is affecting my voice?
2) on the nose nerves- how can I learn the severity of the situation? Would an MRI show this?
Thanks
Thanks for getting back to me. Just two questions:
1) on my vocal cords. Just in the last week -one week after starting the anti-LPR medicine - I notice I really have to clear my voice (which I know hurts the vocal cords) to speak in the morning. Could this be due to the Medicine? Also is it possible my dry nose is affecting my voice?
2) on the nose nerves- how can I learn the severity of the situation? Would an MRI show this?
Thanks
Brief Answer:
Another laryngotracheoscopy and SPECT MRI
Detailed Answer:
Hi back,
1. The fact that you need to clear your voice when speaking in the morning is giving signs that :
- you are dehydrated
- acid has irritated the GI mucosa overnight and need to clear first thing in the morning
- you might sleep with open mouth overnight
- if taking PPIs, one of the effects include dry mouth
2. As mentioned earlier, I suggested another laryngotracheoscopy to see changes under the scope,: morphology of the mucosa, movement of the ciliae (local hair), and sensitivity testing.
SPECT MRI is a specific MRI to scan olphactory nerve.
Dr.Albana
Another laryngotracheoscopy and SPECT MRI
Detailed Answer:
Hi back,
1. The fact that you need to clear your voice when speaking in the morning is giving signs that :
- you are dehydrated
- acid has irritated the GI mucosa overnight and need to clear first thing in the morning
- you might sleep with open mouth overnight
- if taking PPIs, one of the effects include dry mouth
2. As mentioned earlier, I suggested another laryngotracheoscopy to see changes under the scope,: morphology of the mucosa, movement of the ciliae (local hair), and sensitivity testing.
SPECT MRI is a specific MRI to scan olphactory nerve.
Dr.Albana
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Doctor I had just one last question. Since my nose is dry and crusted could this be impacting my vocal cords/throat ie can dry nose cause dry larynx or throat?
Brief Answer:
Yes, can...
Detailed Answer:
Hi back,
When an inflammatory process is causing drying of your nose, its effects can be notable on the mucosa of the other parts of upper respiratory tract including throat or larynx.
Hope this answers your questions.
Dr.Albana
Yes, can...
Detailed Answer:
Hi back,
When an inflammatory process is causing drying of your nose, its effects can be notable on the mucosa of the other parts of upper respiratory tract including throat or larynx.
Hope this answers your questions.
Dr.Albana
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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