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What Causes Hoarse Voice, Vocal Cord Paresis And Pain Below Jaw?
Question: Dear Dr , Hi,
My father is 86 years old(Weight 75 Kgs, Height 5ft 6in), 4 months back suddenly his voice became hoarse. He was examined by a MD physician, who prescribed an antibiotic, and an anti allergic for 10 Days. There was no improvement. He was referred to an ENT specialist. The ENT Specialist prescribed another set of Antibiotics and anti allergics for 10 days. No improvement was observed. We changed the Physician & ENT, Diagnosis done was he had a Right Vocal chord Palsy and lesion on left Thyroid, He was referred to a Super specialist( Pulmonary medicine, Endocrine Surgeon & ENT Surgeon) FNAC report was -ve, advised surgical intervention for thyroid.( Drs had different opinion on surgery, being Benign & Age advised to leave it as such). Off late about 10 days back he started complaining of pain below the hinge of right Jaw. He had also low grade fever till 101degree F. His blood test was normal (Widal -ve)but ESR was high. Now the Dr has put him on Anti TB Drug with Steroid. Doctor is of the view that either my father has TB or Cancer. My question to him was where? He has been unable to answer. Please advise. Regards, XXXXX, XXXXXXX
My father is 86 years old(Weight 75 Kgs, Height 5ft 6in), 4 months back suddenly his voice became hoarse. He was examined by a MD physician, who prescribed an antibiotic, and an anti allergic for 10 Days. There was no improvement. He was referred to an ENT specialist. The ENT Specialist prescribed another set of Antibiotics and anti allergics for 10 days. No improvement was observed. We changed the Physician & ENT, Diagnosis done was he had a Right Vocal chord Palsy and lesion on left Thyroid, He was referred to a Super specialist( Pulmonary medicine, Endocrine Surgeon & ENT Surgeon) FNAC report was -ve, advised surgical intervention for thyroid.( Drs had different opinion on surgery, being Benign & Age advised to leave it as such). Off late about 10 days back he started complaining of pain below the hinge of right Jaw. He had also low grade fever till 101degree F. His blood test was normal (Widal -ve)but ESR was high. Now the Dr has put him on Anti TB Drug with Steroid. Doctor is of the view that either my father has TB or Cancer. My question to him was where? He has been unable to answer. Please advise. Regards, XXXXX, XXXXXXX
Brief Answer:
Take a biopsy. It is probably not TB. Nor is it an infection.
Detailed Answer:
Dear XXXXX,
1. I am of the firm belief that your father does not have TB and is being given a speculative regimen of anti TB drugs as such.
2. Vocal cord paralysis or paresis as it is called is not only caused by cancer as you so feel, it can be caused by viral and bacterial infections too.
3. For enough secretions to accumalate in the larnyx (voice box), it is neccessary for the vocal cords to be in paresis. If secretions keep on accumalating, you can have a situation in which the voice becomes hoarse.
4. There is a possibility of either a tumor pressing into the recurrent laryngeal nerve or a tumor in the muscles around the vocal cords.
5. The pain behind the Jaw is probably referred pain.
6. Have you done a direct layngoscopy? It is important.
7. Please take a biopsy of both lesions.
We cannot progress until this has been achieved.
I would like your opinion on this.
Regards,
Dr. Neel Kudchadkar
Take a biopsy. It is probably not TB. Nor is it an infection.
Detailed Answer:
Dear XXXXX,
1. I am of the firm belief that your father does not have TB and is being given a speculative regimen of anti TB drugs as such.
2. Vocal cord paralysis or paresis as it is called is not only caused by cancer as you so feel, it can be caused by viral and bacterial infections too.
3. For enough secretions to accumalate in the larnyx (voice box), it is neccessary for the vocal cords to be in paresis. If secretions keep on accumalating, you can have a situation in which the voice becomes hoarse.
4. There is a possibility of either a tumor pressing into the recurrent laryngeal nerve or a tumor in the muscles around the vocal cords.
5. The pain behind the Jaw is probably referred pain.
6. Have you done a direct layngoscopy? It is important.
7. Please take a biopsy of both lesions.
We cannot progress until this has been achieved.
I would like your opinion on this.
Regards,
Dr. Neel Kudchadkar
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dear Dr.,
Thanks U for reply.
I have still some doubts, I am placing them bullet wise, please do answer them.
a)Why the Dr has prescribed Steroid? Inspite of taking Steroid +paracetamol 650mg BD, he still gets fever in the range of 100deg Fahrenheit.
b) Attaching his FNAC report for reference, is there any difference between biopsy & FNAC.
c) In point no 6 of your reply, You have asked if laryngoscopy was done, Yes IDL was done & viewed by team of ENT Specialist.
d) In point no 7 of your reply, You have asked for biopsy of both lesions, please indicate where(which part) the biopsy is needed.
Regards XXXX, XXXXXXX
FNAC Report has been uploaded
Thanks U for reply.
I have still some doubts, I am placing them bullet wise, please do answer them.
a)Why the Dr has prescribed Steroid? Inspite of taking Steroid +paracetamol 650mg BD, he still gets fever in the range of 100deg Fahrenheit.
b) Attaching his FNAC report for reference, is there any difference between biopsy & FNAC.
c) In point no 6 of your reply, You have asked if laryngoscopy was done, Yes IDL was done & viewed by team of ENT Specialist.
d) In point no 7 of your reply, You have asked for biopsy of both lesions, please indicate where(which part) the biopsy is needed.
Regards XXXX, XXXXXXX
FNAC Report has been uploaded
Brief Answer:
FNAC is one of the many techniques of performing a biopsy.
Detailed Answer:
Dear XXXX,
Pardon me for the delay. I was carefully going through your reports.
1. Your father has been prescribed steroids with acetaminophen because, in cases of pyrexia, a steroid can help by modifying immune system reponses. Despite this, there may be fever, as the dignosis may not have been exact.
2. The term FNAC means Fine needle aspiration cytology. This is slightly different from the term biopsy because an FNAC is a technique of taking a biopsy, whereas there are many different methods of taking a biopsy from different sites in the body.
3. I kindly meant that you might want to take the biopsy of both the thyroid lesions and the larynx. You must not ignore his thyroid gland. Despite this, lesions in the thyroid gland often overlooked. Kindly investigate.
4. I have indeed noted that IDL has been performed.
Thanks,
Dr. Neel Kudchadkar.
FNAC is one of the many techniques of performing a biopsy.
Detailed Answer:
Dear XXXX,
Pardon me for the delay. I was carefully going through your reports.
1. Your father has been prescribed steroids with acetaminophen because, in cases of pyrexia, a steroid can help by modifying immune system reponses. Despite this, there may be fever, as the dignosis may not have been exact.
2. The term FNAC means Fine needle aspiration cytology. This is slightly different from the term biopsy because an FNAC is a technique of taking a biopsy, whereas there are many different methods of taking a biopsy from different sites in the body.
3. I kindly meant that you might want to take the biopsy of both the thyroid lesions and the larynx. You must not ignore his thyroid gland. Despite this, lesions in the thyroid gland often overlooked. Kindly investigate.
4. I have indeed noted that IDL has been performed.
Thanks,
Dr. Neel Kudchadkar.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Dr XXXXXXX
Hi,
FNAC of Thyroid lesion was done, pl refer attached report, No biopsy of Larynx was done. Do you feel that it is needed?
Kindly suggest your view, with respect to diagnosis.ie what could be wrong with my father?
We are perplexed for last 4 + months, as no confirmative diagnosis has been done nor any line of treatment established.
my expectation from you is that please indicate confirmative diagnosis, as well as give suggestive treatment so that he is in comfort.
I will be obliged if confidently medical fraternity confirm diagnosis & does not speculate.
Regards
XXXXX, XXXXXXX
Hi,
FNAC of Thyroid lesion was done, pl refer attached report, No biopsy of Larynx was done. Do you feel that it is needed?
Kindly suggest your view, with respect to diagnosis.ie what could be wrong with my father?
We are perplexed for last 4 + months, as no confirmative diagnosis has been done nor any line of treatment established.
my expectation from you is that please indicate confirmative diagnosis, as well as give suggestive treatment so that he is in comfort.
I will be obliged if confidently medical fraternity confirm diagnosis & does not speculate.
Regards
XXXXX, XXXXXXX
Brief Answer:
A very, very difficult case.
Detailed Answer:
Dear XXXXX,
I am very sorry for the long delay. These are the modern problems faced by both patients and doctors who practice telemedicine via computer networks, upon whose functioning everything relies upon. These internet issues were resolved and we have sent you the answer. If you have any further issues, please write to YYYY@YYYY , these issues will be taken care of.
1. The growth in your fathers thyroid is not cancer. 100%.
2. The vocal cord palsy was differentially diagnosed and treated with medication.
3. This has failed. So, we must be vigilant about the vocal cord issue.
4. In my 11 years of experience, I have seen cases where IDL did not reveal any
cancer, though there was. There is a possibility of cancer somewhere else that has reached the vocal cords at a cellular level.
5. If we face the worst with preparation and courage, luck will smile on us.
6. I am confident that there is no TB or any other nerve issue.
7. We need a biopsy of the Larynx.
8. If we have cancer the affected larynx can be removed. We have special devices that surgically implanted into the voice box can give a perfectly normal voice, albeit a bit machine link. Google "Silent Sound" device for those cancer patients who had to have their voice boxes removed, yet they can still speak and function normally.
I am confident of this decision and diagnosis of mine.
I ask you to get a biopsy of the larynx done and immediate surgical intervention.
Remember,
Cancer, nowadays...
1. Caught in the early stage is just like another chronic disease like diabetes.
2. It is indeed hard today, in 2015 to die or suffer badly from CA Larynx. Or be permanently disabled in some way.
3. In 1912, if a person got a simple cold and lung infection, or if a person had an accident and had an infected injury, that person certainly suffered and died. Then in the 1920's antibiotics were invented. Today if you get a cold, you simply take antibiotic tablets and get better in 3 days. Before this millions died of common colds. This is a historical fact.
4. So, despite your fathers age, there is no earthly reason he should suffer rather
badly upon a diagnosis of cancer.
I stand by my diagnosis. This is final. No more speculation.
Dr. Neel Kudchadkar.
A very, very difficult case.
Detailed Answer:
Dear XXXXX,
I am very sorry for the long delay. These are the modern problems faced by both patients and doctors who practice telemedicine via computer networks, upon whose functioning everything relies upon. These internet issues were resolved and we have sent you the answer. If you have any further issues, please write to YYYY@YYYY , these issues will be taken care of.
1. The growth in your fathers thyroid is not cancer. 100%.
2. The vocal cord palsy was differentially diagnosed and treated with medication.
3. This has failed. So, we must be vigilant about the vocal cord issue.
4. In my 11 years of experience, I have seen cases where IDL did not reveal any
cancer, though there was. There is a possibility of cancer somewhere else that has reached the vocal cords at a cellular level.
5. If we face the worst with preparation and courage, luck will smile on us.
6. I am confident that there is no TB or any other nerve issue.
7. We need a biopsy of the Larynx.
8. If we have cancer the affected larynx can be removed. We have special devices that surgically implanted into the voice box can give a perfectly normal voice, albeit a bit machine link. Google "Silent Sound" device for those cancer patients who had to have their voice boxes removed, yet they can still speak and function normally.
I am confident of this decision and diagnosis of mine.
I ask you to get a biopsy of the larynx done and immediate surgical intervention.
Remember,
Cancer, nowadays...
1. Caught in the early stage is just like another chronic disease like diabetes.
2. It is indeed hard today, in 2015 to die or suffer badly from CA Larynx. Or be permanently disabled in some way.
3. In 1912, if a person got a simple cold and lung infection, or if a person had an accident and had an infected injury, that person certainly suffered and died. Then in the 1920's antibiotics were invented. Today if you get a cold, you simply take antibiotic tablets and get better in 3 days. Before this millions died of common colds. This is a historical fact.
4. So, despite your fathers age, there is no earthly reason he should suffer rather
badly upon a diagnosis of cancer.
I stand by my diagnosis. This is final. No more speculation.
Dr. Neel Kudchadkar.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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