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What Causes Persistent Sore Throat And Feeling Of Lump Inside Throat?
Question: Hello, I suffered a fall in November, 2014 and injured my throat/larynx. I was not seen immediately following the injury. My XXXXXXX apple swelled up some and my voice was very raspy for a few days and I also had trouble swallowing. After a week most of my voice returned and thought that it would just heal back correctly over time so I didn't get it checked out properly, but since then I have not been able to use the upper range of my voice at all. I was sent to an ENT a month ago and they looked at my vocal cords through a tube/scope and I was told that my vocal cords functioned normally. I was then sent for a CT scan with contrast to determine if there was anything out of the ordinary. My doctor told me that the CT scan showed nothing abnormal. I am scheduled to go to speech therapy soon for this as well. My concern is that my throat is still sore on touch when adding slight pressure in the XXXXXXX apple area, it often feels like I have a lump in my throat, I have to clear it often by coughing, my voice is lower/hoarse during regular speech than it was before the injury, my voice goes out quickly and feels strained when I am yelling (I have to basically clear my throat or stop using my voice for a short time), and I still cannot use the upper range/high notes of my voice. Since my symptoms remain and nothing came back on either the scope by the ENT of my vocal cords and the CT scan showed nothing I am concerned as to where the issue lies. Should I seek a different doctor's opinion or possibly suggest something to my current doctor to try to pin down what may be causing it? I would appreciate any advice as this has been frustrating when my voice could possibly remain this way and they can't figure out as to what the problem is. Thank you for your help.
Brief Answer:
Stroboscopy. MRI larynx.
Detailed Answer:
Hi,
Thank you for your query.
1. The vocal cords vibrate at more than a hundred times a seconds and hence fine movements are not visible on a laryngoscopy. Get a Stroboscopy done, if it has not yet been done. Upload the images.
2. Any hematoma would have resolved in this time. An MRI larynx can help assess the larynx better and look for signs of cartilage injury or subluxation. Injury to the cartilage framework of the larynx and dislocation of delicate cartilage units should be looked for on both these investigations. There may be a vertical difference in the levels of the vocal cords. Any compensation of the false vocal cords should be assessed. It will be better if you can upload a video of the Stroboscopy. Bowing of the vocal cords may occur due to nerve injury or deformation of the larynx. The tenderness over the Adam's Apple area may be due to cartilage injury (specifically the thyroid cartilage or the cricoid cartilage). Fibrosis that s significant will impair the vocal movements in some manner. Do you have nay difficulty in swallowing? Reflux should be ruled out. Sometimes the food pipe and pre-vertebral soft tissues are also crushed between the voice box and spinal column. Injury to the hyoid bone and the muscles attached to the larynx should also be assessed.
3. Speech assessment software and Laryngeal EMG (ElectroMyoGraphy) can be done if available.
4. . Ideally, steroids and speech therapy should have been started at the time of the injury. It is not clear if you had a vocal cord dysfunction in 2014. You should start the speech therapy as soon as possible.
5. If all your investigations are normal, it will be a matter of time before your voice heals.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Stroboscopy. MRI larynx.
Detailed Answer:
Hi,
Thank you for your query.
1. The vocal cords vibrate at more than a hundred times a seconds and hence fine movements are not visible on a laryngoscopy. Get a Stroboscopy done, if it has not yet been done. Upload the images.
2. Any hematoma would have resolved in this time. An MRI larynx can help assess the larynx better and look for signs of cartilage injury or subluxation. Injury to the cartilage framework of the larynx and dislocation of delicate cartilage units should be looked for on both these investigations. There may be a vertical difference in the levels of the vocal cords. Any compensation of the false vocal cords should be assessed. It will be better if you can upload a video of the Stroboscopy. Bowing of the vocal cords may occur due to nerve injury or deformation of the larynx. The tenderness over the Adam's Apple area may be due to cartilage injury (specifically the thyroid cartilage or the cricoid cartilage). Fibrosis that s significant will impair the vocal movements in some manner. Do you have nay difficulty in swallowing? Reflux should be ruled out. Sometimes the food pipe and pre-vertebral soft tissues are also crushed between the voice box and spinal column. Injury to the hyoid bone and the muscles attached to the larynx should also be assessed.
3. Speech assessment software and Laryngeal EMG (ElectroMyoGraphy) can be done if available.
4. . Ideally, steroids and speech therapy should have been started at the time of the injury. It is not clear if you had a vocal cord dysfunction in 2014. You should start the speech therapy as soon as possible.
5. If all your investigations are normal, it will be a matter of time before your voice heals.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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