Wednesday, 1 May 2013

Loss of Voice and Trouble Swallowing

There are many reasons for throat problems beyond the ordinary everyday issues. Lately I have seen blog posts about Rheumatoid Arthritis (RA) affecting the cricoarytenoid joint in the neck. One by Dr Shashank Akerkar and the other by Chronic Curve
                            Frank H. Netter   Atlas of Human Anatomy

It's also a subject that RA Warrior has written about more than once. She focuses more on how it can make your throat feel.  It means a lot to hear about the experiences of others.  I also found another article that states that with RA there is a lot of laryngeal involvement and that almost 13% of patients have dysphonia.

Years ago I was having a lot of trouble with pain in the throat along with choking, dryness, loss of voice and hoarseness.  I spent a lot of time on the Sjogren's World forum talking to others and finally found a person who was having similar experiences.  We thought, based on symptoms, that we might have LPR - that is Laryngopharyngeal Reflux (Silent Reflux).  We thought it was more desirable to have LPR  than Sjogren's because there are solutions to LPR.

We looked for information and good sites were scarce.  The best site we found had detailed information posted by Dr Jamie Koufman on the Wake Forest Baptist Medical Center site. Now she is at The Voice Institute of New York.  She has seen over 250,000 larynges which must be a record. Dr Koufman is very generous with information and comes across as very empathic person. 
I found another paper titled Laryngopharyngeal Reflux- A New Paradigm of Airway Disease which can add more facts for you if you are interested.

Armed with this knowledge I got a referral to an ENT (Ear Nose and Throat) doctor and had a most unsatisfying experience. He did not see inflammation, swelling or nodules when he looked at my throat by means of sending a tiny camera down through my nose for a look at my vocal cords.  So that ruled out RA and LPR both of which are usually visible to the trained eye.  This should have been good news and was since it narrowed the possibilities.

After that I had speech language therapy. The voice exercises and vocal hygiene sessions were some help to my voice which was very faint and undependable.  No shouting for me.

So that left Sjogren's Syndrome to blame. You can often recognize a Sjogren's patient by the bottle of water they almost invariably carry.
With Sjogren's Syndrome the lack of saliva in the mouth is a cause of trouble with the teeth and with throat, swallowing and digestion.

A close friend has been Heimliched in public more than once for this type of choking.  Luckily the first time she was having coffee with her doctor and the situation did not alarm him.

Another time it happened at Costco. She has almost finished shopping when she was tempted by a sample of bruschetta.  When she started to choke she was unable to ask for help.   She couldn't breathe and she had no water.  The demo person and others helped her finally and she felt better but so embarrassed. They told her store policy was to call an ambulance so she asked them to wait and just let her go to the washroom first.  Then she abandoned her groceries and unobtrusively left the store.  She laughs now when she tells the story but then it was a panic situation. 

Luckily for me the problems improved, perhaps because of my use of Salagen.  I didn't find any evidence online that the use of a biologic is helpful for dry mouth, throat and swallowing trouble, but mine is better with Humira than it was without.  

                                         Salagen pills                   A.McKinnon

Other papers about LPR  Centre For Voice & Swallowing at UCDavis Health System  

The paper below sees some benefits of TNF inhibitors in ocular inflammation.     TNF Inhibition for Ophthalmic Indications: Current Status and Outlook.

An Ear Nose and Throat song

1 comment:

  1. This is a really comforting entry for me. Starting in the early 2000s, I had chronic throat clearing problems. It was awful. I mean clearing my throat at least every 10 minutes. It used to make me exhausted and made my throat even worse. I eventually made the discovery that if I avoided foods that were drying to my throat, the problem was much relieved. So I had to say goodbye to my favourite food garlic, which was the worst offender, onions, heavy use of spices, most sulfites (I have sensitivity to those due to the drying effect), and so on. It relieved the problem so that it's much more rare, maybe once or twice an hour. I can live with that.

    I've had a sore throat since 1993. I don't think anyone can comprehend that, but I truly have had an irritated throat all those years. I've always felt like my throat is thick and has a lump in it. I don't choke that often. The most obvious and slightly strange sign of my Sjogren's is hiccoughs. As soon as I eat something dry (usually bread), it seems to stop a bubble of air in my throat, and next minute I'm hiccoughing. My hiccoughs are incredibly violent. Interestingly, they always have been as far back as I remember, which is to about 17 years.

    Thanks for this!