What could cause fatigue in the vocal cords?

Question

Hi doctor,

I had some vocal fatigue for a while and I have been resting my voice for pretty much one month now. I was not so sure if I should start speaking again or not. I am a bit afraid that it is going to affect my singing voice. Either way, the first time I consulted an ENT they said I had hemorrhagic patches on my anterior one-third of both of the vocal cords. I have been drinking a lot of water and also I took some proton pump inhibitors. I also have a phonatory gap but I do not think that is the problem here really. Anyway, I was just wondering how much time you think I still have to keep resting.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I assume that these videos are one month prior to today's condition (attachment removed to protect patient identity).

I see some amount of interarytenoid pachydermia (suggestive of acid reflux and associated changes in the posterior part of the vocal apparatus) and an anterior phonatory gap. Although I cannot see the anterior one-third of the vocal cords clearly, I understand that your ENT has found that those portions had some hemorrhages. He was right in advising you to voice rest and proton pump inhibitors. Ideally, a week of absolute voice rest is sufficient. Followed by voice restriction, vocal hygiene, antiallergic treatment, nasal sprays (based on nasal symptoms), and increased hydration.

Now, considering you have taken a month of voice rest, I think it is sufficient. But do you have any symptoms whatsoever now? Any nasal symptoms or allergic symptoms? Any history of substance abuse? Do you suffer from diabetes or hypertension? In my practice in addition to antireflux (PPI tablets), antiallergics (antihistamines like Fexofenadine and Desloratadine), hydration, voice rest, dietary and lifestyle changes. I added some voice therapy. Probably you should explore some vocal hygiene tips from a speech-language pathologist or voice therapist.

I hope this has helped you. Please feel free to reach out to me again in case of further queries.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I super appreciate the laryngoscopies that you are doing yourself (attachment removed to protect patient identity).

Your vocal cords look fine to me. The pearly white color is typical, but they could be a bit more moist. Do you take steam inhalation?

Since you have started making money with your voice, you could resume singing mildly without straining. Keep sipping water regularly and avoid anything that could trigger acid reflux or allergies. Stay away from dust, smoke, pollen, pollution, cold winds, direct air conditioning, and fans. I hope you do not smoke or drink.

When you restart singing, make sure you don’t experience vocal strain, pain, or fatigue. If you do, take it slow. Avoid high-pitched or low-pitched singing, and avoid raising your voice or whispering. Try to sing only in the most natural frequency for your vocal apparatus. Be very careful not to strain at all. If you feel any strain, stop singing and wait until you're ready.

You did not mention if you have any of the other symptoms I asked about. What is your weight and height? Any medical conditions? I assume you don’t have any due to your young age.

It is said that drinking a glass of warm water mixed with two tablespoons of honey as soon as you wake up is very good for the vocal cords. Never let them go dry.

I hope this has helped you. Please feel free to reach me again, in case of further queries.

Thank you.