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Posted 4/9/2008 5:46 PM (GMT 0)
Hi everyone

I've had severe laryngitis for nearly 15 weeks now. The doctor finally referred me to an ENT who I saw last Friday. He told me that my laryngitis was due to acid reflux. He gave me Zoton to take for 6 weeks (30mg once day). He also said that I was to have 6 months of speech therapy but I'm wondering why. Surely if the acid stops my voice will return on it's own? Why would i need speech therapy? And that was it from the specialist - no further information. He said that after that treatment that would be it, back to normal. I spoke to my doctor but she only seemed confused - I have no other symptoms of this condition (no heartburn or burping etc). She couldn't really offer me any further information or advice. The thing is, I'm a teacher and this is having a severe impact on my work - I can't teacher without a voice and have been signed off since Christmas and now for another 2 months at least!

I'm totally confused basically. Without any really help from the specialist or doctor I have done my own research. I am concerned as I have read that I may be on too low a dose of Zoton to work. I have also read about vast lists of food to avoid and that you should test which ones effect you most rather than cutting them all out - but the trouble is I can't really tell as I don't get heartburn. The only symptom is my voice which is consistantly poor. There are too many 'bad' foods to cut them all out - should I bother with any or just rely on the medication? In regards to alcohol, I'm not a heavy drinker and just drink socially about once a month on a night out. Do I have to stopped this forever or is this ok to continue? Would it be a good idea to take an over the counter anti-acid if I know I'm going out for a curry or a drink? Is this ok to do whilst taking the Zoton?

I'm also worried because I've read that if this acid reflux continues it could lead to all sorts of other dangerous conditions. The specialist didn't refer me or ask to see me again. What if my voice comes back but the acid reflux continues without me knowing it? Should I push to have a check up with an ENT at the end of treatment to check it's stopped? What happens if it hasn't? Is there really any danger if it is allowed to continue without any symptoms? Could this be something I have for life or will this really be over after this treatment as the ENT said?

I'm also curious to know what might have caused this to start. I've read that no one really knows. Is stress a contributory factor? I had some time off work last July for stress/exhaustion.

My final question is about orange peel extract. I've read that this can help as a natural remedy. Is this safe to take with the Zoton or should I wait until I have completed the course of Zoton? Does anyone know where I can buy orange peel extract - I can't find it on any UK online shops.

Sorry to ask all these 'medical' questions but I just can't get any straight answers out of my doctor and I can't see the ENT again without a referral (my doctor was very reluctant to refer me in the first place).

If anyone can shed any light on my confusion I would really appreciate it!   

Posted 4/9/2008 7:20 PM (GMT 0)
Kat,

Welcome! I'm pretty new here myself, also recently diagnosed with LPR (laryngopharyngeal reflux). IF, I repeat IF, this is what your specialist thinks you have, it can indeed occur with no heartburn or stomach upset or a lot of the things the average person thinks of when they hear the phrase "reflux."

I don't know anything about Zoton. My ENT prescribed 40 mg of Nexium once a day and 300 mg of Zantac before bed. That is a bit different from what I've read in many sources online, but I'm just starting the treatment and plan to talk with my ENT again soon if my symptoms (still have some in the morning and afternoon) don't go away. My main symptoms were random shortness of breath, recurring tightness in my throat (frightening) and gasping awake at night.

Did your ENT do a scope of your throat? I had one who did not, but suspected LPR; I went to a second one -- my current one - and she saw clear signs of tissue thickening. She referred me too to a voice clinic. In my case, it is because of the terrible muscle tension that I have in my throat due to the reflux.

My doctor also did not specify a time for a followup, but I plan to schedule one with her once the voice folks are done treating me. My meds are good for at least three months. I wonder if you called it a "followup" appointment, would you still need the referral from your primary doctor?

I am sorry for the runaraound you're getting. Unfortunately, I don't know any good ways to get doctors to listen to you when they choose not to. Have you tried calling the ENT's office to request a clarification of your questions? I did something similar: kind of confused after my diagnose, and very anxious, so I scheduled a followup consultation and just went with a big list of questions. I felt much better after that.

Regarding stress, I can't speak for everyone, but stress and anxiety are big factors for me. I also don't know whether it ever really stops. It seems that the damage can be healed, but whether the reflux itself can ever be "turned off", I don't know.

percycat
Posted 4/9/2008 7:34 PM (GMT 0)
Thanks for your reply percycat. It's good to know I'm not the only one!

I really do feel like I was just fed in and out of the system as quickly as possible without a much chance to get the answers I need. It was a scope fed up my nose and down into my throat. He stopped at my larynx to look at my vocal cords and didn't go down any further. He said they were very thick, red and inflammed.

I think I might try your suggestion of calling the ENT's office for a 'follow-up' consultation. They just told me so little and I feel really helpless. I don't feel I'm being told the full story by them and it worries me that my doctor seems so surprised by the ENTs diagnoses. Like you say, it's putting a big 'IF' in my head.

Kat
Posted 4/9/2008 7:49 PM (GMT 0)

Good for you, Kat.

Regarding the scope, there are two kinds.  I've had both.  There is a scope done by a gastroenterologist that is performed under general anesthesia.  For this one, they run a camera on a tube down your entire esophagus, through your stomach and just into the small intestine.  Your digestive system is pumped up with air to make it easier to see the features.  I've had this -- it's called an EGD -- done twice, and NO SIGNS of reflux showed up.  In fact, two weeks ago, my GI doctor told me not to worry, that I didn't have reflux and so it must just be anxiety.

Then there's the throat scope.  This is done in en ENT's office, and there's only a local numbing agent.  For this one, they do just run the camera tube through your nose as far as your vocal cords.  They're checking your throat on this; the EGD doesn't even pay attention to your throat - it moves right on past.  It was only after the throat scope that I got a definitive diagnosis -- AFTER my GI doctor -- that I do indeed have reflux.  My ENT was very clear that my symptoms are all consistent with reflux.  I have never had heatburn or upset stomach at all -- it's strictly throat issues.

So what I'm saying is that it is possible for reflux to show up under one test but not the other.  One theory I've heard/read is that for folks like us, the acid doesn't really hang out in the esophagus long enough to do damage, but that it does get trapped atop the upper esophageal sphincter, near the vocal cords, and that they are more sensitive to the acid than the esophagus is.  Maybe other folks here will have better, or different, information.

Good luck with the followup.  I hope you'll get some clear explanations.

percycat

Posted 4/10/2008 11:53 AM (GMT 0)
You see this is the kind of information I need from my doctors! It's made me feel a lot better. It sounds like quite a hard condition to diagnose beyond any doubt. But my ENT did sound certain. I suppose there aren't many other explanations for why my voice has gone for so long. Everything else that I know of has been ruled out - infection, voice abuse and viruses.

Please keep in touch and let me know how you're treatment's working over the next few months. Good luck.

Kat
Posted 4/10/2008 12:18 PM (GMT 0)
Oh I forgot to ask you Percycat, what are you doing about food and drink? Have you cut anything out or are you just carrying on as normal?

Kat
Posted 4/10/2008 1:03 PM (GMT 0)

Kat,

My first ENT suspected reflux, although he didn't see any (didn't do a scope), so he put me on Nexium for two months.  During that time, I didn't change much about food, just tried to cut back on carbonated drinks, caffeine, and alcohol.  After stopping the Nexium, my symptoms started coming back -- in fact, some came back a time or two on it - so that's when I went to the second ENT, the one who did the throat scope and saw the laryngeal swelling.  She was quite clear about her diagnosis and treatment instructions, so I've been following them to a "T": NO alcohol at all, NO caffeine, NO sodas, and (sigh) NO tomato products (or citrus).  I don't know that these foods are really that bad a trigger for me, but I plan to follow her instructions carefully until she says otherwise.  I hope to be able to reintroduce those foods later.

There was a really helpful pamphlet that she gave me specifically about how reflux affects the throat.  I think it was produced by some professional medical group called ENT.org, but I don't recall for sure.  I'm at work now, but when I go home tonight, I'll look it up and post the URL (assuming that's allowed with the forum rules).

Good luck!

percycat

Posted 4/10/2008 4:32 PM (GMT 0)
Kat,

I think these two fact sheets from the site of the American Academy of Otolaryngology are transcripts of the pamphlets my ENT gave me:

http://www.entnet.org/HealthInformation/laryngopharyngealReflux.cfm

and

http://www.entnet.org/HealthInformation/gerdLPR.cfm

I hope they help.

percycat
Posted 5/8/2008 2:07 AM (GMT 0)

Kat-

I understand you voice problems.  I was diagnosed with GERD three years ago.  I have had all the tests done, tubes down my nose to look at the vocal cords, tubes down the nose into the stomach, barium test, ph tests, and even surgery.  My only symptom was loss of voice and a sore throat.  Lets say, none of the procedures worked.  Medicine has healed my esophagus but I still have the sore throat and loss of voice.  Most of the time the loss of voice is only for a few weeks or months.  This last round though, I have not had a voice for 10 months.  I have been told it is probably a combination of acid reflux in the upper esophagus, allergies, and stress.  I know by altering your diet, it does help sometimes.  I don't have to strain or push my voice so much.  It is pretty easy to figure out what to alter, if it is harder to talk after certain spices, just limit those spices.  I see a speech pathologist now weekly to be taught new techniques for dealing with stress and hoepeful that someday my voice will come back.  Speech therapy is actually a time for me to relax as my job is stressful and so are my personal commitments.  Just ask lots of questions.  I actually have learned the most about the voice problems related to acide reflux and stress from the speech pathologist.

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