Sign-in to Ask A Doctor - 24x7
OR
Sign in with GoogleGet your health question answered instantly from our pool of 18000+ doctors from over 80 specialties
What Causes Change In Voice And Sore Throat?
I am a 71 year old female. I weigh 130 and am 5 6 and have been in pretty good health and exercise regularly and stay busy with an active social life. I am married..my husband is 74 and in good health. Since about May, 2016, I have felt like I ve had a voice change and at that time no other symptoms...maybe a slightly sore throat. I was starting to worry a little about this so I went to an ENT in July. He checked my throat and vocal cords, voice box, etc. and found nothing suspicious and attributed the voice change to aging of possibly allergies. About a month or 2 later I started feeling like food was getting stuck in my esophagus. I could breathe and didn t need a Heimlich maneuver of course, but the feeling that food was kind of stuck around my sternum area happens fairly often, to the point that I m getting kind of afraid to eat...like meat or anything that might stick . I get very light-headed when this happens and I have to burp a lot for the feeling to go away. I saw my gastroenterologist in September, had a barium swallow done in late September and it was negative...other than my esophagus narrows a little when swallowing. No procedure was recommended. She only said to drink more liquids when I eat and that does not seem to help. I had an endoscope done about 5 years ago and it showed a small hiatal hernia...and nothing significant enough to warrant anything but occasional anti acids over the counter meds...which I take occasionally..not often though. I have no heartburn or pain. I do have anxiety and it seems if I take a .25 mg of Xanax an hour or so before I eat, I don t have too bad of a problem swallowing food. Is there anything that could be causing food to stick, lightheadedness, if the barium swallow was negative and my ENT saw nothing to cause my voice change and dysphasia?
Mon, 14 Nov 2016
Hi there,
Thank you for the detailed explanation of your symptoms and investigations done. It is good that the ENT and gastroenterologist have ruled out the most worrying problems associated with voice change and difficulty swallowing, which is vocal cord growths/cancers and oesophageal cancers, so we can now safely look at other causes.
The investigations that have been done appear to suggest something functional, which means that something causes the problem at the moment that you swallow, instead of something structural, which refers to something that is permanently blocking the oesophagus. It is quite telling that it improves with Xanax, which would be unlikely to happen if there is something physically blocking the food.
The barium swallow suggests a narrowing during swallowing, which might point to something called oesophageal spasm. It is quite possible that the gastroenterologist made the same conclusion, but did not fully recognise the discomfort that it is causing you. That was why she suggested simple steps like increasing fluids with food, hoping that it will improve enough not to need further management.
Another important point that you mentioned is that you were found to have a hiatal hernia during your last endoscopy. This matters because it makes you more likely to develop acid reflux, or GERD, which might both explain the hoarseness of voice and also worsen the symptoms of oesophageal spasm. I understand that you don't feel the typical heartburn or pain, but many patients don't have those symptoms despite having recurrent acid reflux.
I would advise for a trial of anti-acid medication like omeprazole 40mg once a day for at least 2 weeks, and cut down on things that worsen acidity and reflux, like coffee, alcohol, smoking, carbonated drinks, spicy and sour foods. Try to take smaller more frequent meals, and make your last meal about 4 hours before bedtime so that the acid doesn't creep up when you lie down. Make sure your anxiety is well-controlled on a day to day basis, because it can also make the acid reflux and oesophageal spasm worse.
If it doesn't improve further, talk to your gastroenterologist about the possible oesophageal spasm, and whether she would like to conduct further tests like an oesophageal manometry. She might not think it necessary and might suggest just trying other medication, which is fine as well. Let her know how much it is affecting you, and that it is making you fearful of eating certain foods. Communication is key here.
Hope this helps, and all the best to you.
Regards,
Dr. Teh
Thank you for the detailed explanation of your symptoms and investigations done. It is good that the ENT and gastroenterologist have ruled out the most worrying problems associated with voice change and difficulty swallowing, which is vocal cord growths/cancers and oesophageal cancers, so we can now safely look at other causes.
The investigations that have been done appear to suggest something functional, which means that something causes the problem at the moment that you swallow, instead of something structural, which refers to something that is permanently blocking the oesophagus. It is quite telling that it improves with Xanax, which would be unlikely to happen if there is something physically blocking the food.
The barium swallow suggests a narrowing during swallowing, which might point to something called oesophageal spasm. It is quite possible that the gastroenterologist made the same conclusion, but did not fully recognise the discomfort that it is causing you. That was why she suggested simple steps like increasing fluids with food, hoping that it will improve enough not to need further management.
Another important point that you mentioned is that you were found to have a hiatal hernia during your last endoscopy. This matters because it makes you more likely to develop acid reflux, or GERD, which might both explain the hoarseness of voice and also worsen the symptoms of oesophageal spasm. I understand that you don't feel the typical heartburn or pain, but many patients don't have those symptoms despite having recurrent acid reflux.
I would advise for a trial of anti-acid medication like omeprazole 40mg once a day for at least 2 weeks, and cut down on things that worsen acidity and reflux, like coffee, alcohol, smoking, carbonated drinks, spicy and sour foods. Try to take smaller more frequent meals, and make your last meal about 4 hours before bedtime so that the acid doesn't creep up when you lie down. Make sure your anxiety is well-controlled on a day to day basis, because it can also make the acid reflux and oesophageal spasm worse.
If it doesn't improve further, talk to your gastroenterologist about the possible oesophageal spasm, and whether she would like to conduct further tests like an oesophageal manometry. She might not think it necessary and might suggest just trying other medication, which is fine as well. Let her know how much it is affecting you, and that it is making you fearful of eating certain foods. Communication is key here.
Hope this helps, and all the best to you.
Regards,
Dr. Teh
I find this answer helpful
Disclaimer: These answers are for your information only and not intended to replace your relationship with your treating physician.
This is a short, free answer.
For a more detailed, immediate answer, try our premium service
[Sample answer]
Related questions you may be interested in
Loading Online Doctors....