Medical Articles

Many people complain: "I often feel like something is stuck in my throat, especially when I'm upset." This common complaint usually does not indicate a serious medical condition.

The patient should consult both a gastroenterologist and an ENT specialist. If the examination results are normal which is often the case then the patient can be reassured that it is a common and harmless condition triggered by stress or emotional distress.

However, if an actual condition is found, such as chronic pharyngitis, hiatal hernia, or acid reflux, appropriate treatment should be administered and the patient can rest assured.

But if the sensation appears specifically after eating, it may indicate a more serious underlying issue. Diagnosis can be more difficult in such cases, and specialized swallowing studies like FEES (Fiberoptic Endoscopic Evaluation of Swallowing) or VESS (Video Endoscopic Swallowing Study) should be conducted for accurate diagnosis and treatment.

Persistent and worsening throat lump sensations that are unrelated to emotional stress often indicate a more significant medical condition.

Sometimes a person may feel as though something is choking them, and the harder they try to breathe deeply, the worse it gets—their breath becomes louder and breathing more difficult, even though their pulmonologist confirmed their lungs are healthy and they do not have asthma.

This is likely due to a condition known as laryngeal spasm, which often occurs when a person is emotionally upset, or after choking on food, drink, or even saliva. Often, the exact cause is hard to determine.

If a laryngeal spasm occurs, the patient should breathe in slowly and exhale quickly—slow inhale, fast exhale. This is the opposite of the instinctive deep and fast inhalation that actually worsens the condition due to increased laryngeal closure (based on physics).

The patient should be reassured that this is a generally benign condition and does not lead to actual suffocation. Still, an ENT consultation is recommended to rule out other causes.

Sometimes, the vocal cord becomes paralyzed, causing changes in voice and breathing. The vocal cords serve several vital functions:

• Producing sound: The two true vocal cords come close together and vibrate rapidly (like clapping) to generate sound, which is then transformed into speech by the palate, tongue, and lips.
• Allowing airflow: During breathing, the cords separate to let air in and out.
• Protecting the airway during swallowing: The larynx tightly closes to prevent food and liquids from entering the airway.

If one vocal cord is paralyzed, it remains distant from the other, preventing proper vibration and resulting in:

• Weak or hoarse voice
• Air leakage while speaking
• Choking on liquids due to improper closure during swallowing

If both vocal cords are paralyzed, they stay in contact and cannot separate, causing severe breathing difficulty.

The nerve that controls the vocal cords travels a long path from the brain, down to the chest or lower neck, and back up to the larynx—making it vulnerable to damage from:

• Brain, neck, lung, or thyroid diseases
• Surgeries in those areas
• Infections and neurological disorders

There are also other types of vocal cord paralysis that do not cause typical hoarseness but other voice changes. These require advanced diagnostic expertise.

Treatment varies depending on the underlying cause, and in most cases, can significantly improve the patient's condition.

Many of us are familiar with recommendations for maintaining heart, skin, and digestive health, as these topics are frequently covered in media. However, we rarely hear or read about how to take care of our voice—even though it's our primary tool for communication.

In this article, we aim to highlight the most important recommendations for keeping the vocal cords in good condition.

1. Vocal Rest

Avoiding vocal strain is the first and most important recommendation. Many of us have experienced hoarseness or voice loss after yelling, so it’s crucial to avoid shouting—especially when emotionally agitated or stressed.

But shouting isn’t the only thing that stresses the voice. Any attempt to alter your natural voice tone is also straining. Examples include children mimicking adult voices, men imitating women’s voices, whispering, or mimicking others. Talking in noisy environments, like concerts, weddings, or sports events, is especially harmful because people tend to raise their voices or shout without realizing it.

Those who use the phone for long periods should be careful as well. On the phone, we rely on our voice to express emotions normally conveyed through body language. Many people also change their natural voice when speaking on the phone, which can strain the vocal cords.

2. Avoid Irritants

Irritants can be gases or foods. Gases and strong odors travel through the respiratory tract and hit the vocal cords directly, causing irritation. The biggest offender here is smoking, whose negative impact on the larynx deserves an article of its own.

Other irritants include environmental pollutants, cleaning chemicals, dust, and even some perfumes. As for irritating foods, they include spicy foods, cold drinks, and alcohol.

3. Hydration

Drinking plenty of fluids—especially water—is one of the most vital recommendations for vocal health. A person should drink about 3 liters of fluids per day, with increased intake during hot days or heavy physical activity.

The body secretes a protective oily substance to lubricate the vocal cords, and dehydration reduces this secretion. Note that certain fluids actually dry out the vocal cords, such as tea, coffee, alcohol, and cola—so these should be limited.

Dry air also harms the voice, so it's advised to humidify your environment by using a humidifier or placing a bowl of water on a heater—especially in homes and offices.

4. Additional Tips

• Warm up your voice before using it for long periods (e.g., humming softly before singing or speaking).
• Avoid unnecessary throat clearing. (This includes the mild coughing people do to clear mucus from their throats.)
• If you suffer from acid reflux or heartburn, avoid triggers like eating large meals before bedtime or consuming fatty foods, as acid reflux can damage the vocal cords.
• When experiencing hoarseness or voice loss—such as during a cold or chest infection—avoid talking or even whispering as much as possible.
• If hoarseness lasts more than three weeks, consult a doctor immediately, as it may indicate a more serious condition. Early diagnosis is the key to successful treatment—even for serious conditions like vocal cord tumors.

No-burp syndrome (medical name: Retrograde Cricopharyngeus Dysfunction (R-CPD)) is a condition where a person is unable to burp, even when air builds up in the stomach. This happens because a muscle at the top of the food pipe does not relax properly to allow trapped air to escape.

Although many people may have experienced occasional difficulty burping, individuals with R-CPD are typically unable to burp at all, which can lead to a variety of uncomfortable symptoms.

Common Symptoms

• Feeling bloated or swollen after eating

• Excessive gas (passing wind)

• Gurgling or croaking noises in the throat or chest

• Chest discomfort or upper abdominal pain

• Difficulty vomiting in some individuals

These symptoms can significantly affect daily comfort and quality of life, particularly after meals or when consuming carbonated beverages.

What Causes R-CPD?

R-CPD occurs when the cricopharyngeus muscle, located at the upper end of the esophagus, fails to relax appropriately in response to trapped air. As a result, air remains trapped in the digestive tract instead of being released through burping.

Is It Dangerous?

The good news is that R-CPD is generally not considered a dangerous medical condition. However, the persistent symptoms can be frustrating and may have a considerable impact on a person's physical comfort and social confidence.

Treatment Options

Effective treatments are available for R-CPD. The most common and successful treatment involves a small Botox injection into the affected muscle. The injection helps the muscle relax, allowing trapped air to escape normally and relieving symptoms.

If you suspect you may have R-CPD, consult an ear, nose, and throat (ENT) specialist or a healthcare professional experienced in diagnosing and treating swallowing and upper esophageal disorders.

Spasmodic Dysphonia

An article written 2008

A long-standing disorder that finally found an effective treatment

By Dr. Redwan Kalash

Consultant in Laryngology, Voice, Swallowing Disorders, and Laryngeal Surgery

For decades, hundreds of thousands of people have suffered from this condition, living with a severely impaired voice throughout much of their lives. Whenever they sought medical advice, many were told that their voice problem was psychological. As a result, patients were often left without an explanation or an effective treatment.

Although spasmodic dysphonia was first described nearly a century and a half ago, effective treatment has only become available in recent decades. Even today, it remains a challenging diagnosis for many physicians, including some otolaryngologists.

What is Spasmodic Dysphonia?

Spasmodic dysphonia is a disorder of voice production. It is important to distinguish between voice and speech. Speech refers to the articulation of sounds, words, and sentences, while voice is the sound generated by the larynx (voice box). Disorders affecting speech are known as speech disorders, whereas disorders affecting voice are called voice disorders or dysphonias.

Many people have experienced temporary forms of dysphonia. During periods of stress, fear, or anxiety, the voice may become interrupted, strained, distorted, or even disappear completely despite a perfectly healthy larynx. This occurs because of abnormal muscle activity affecting the vocal folds.

However, other forms of dysphonia occur independently of emotional stress. Each type has its own underlying cause and requires a different treatment.

How is the Voice Produced?

The human voice is produced when the two true vocal folds come together and vibrate as air from the lungs passes between them during exhalation.

Any disease that interferes with the normal vibration of the vocal folds—such as vocal fold nodules, polyps, cysts, or vocal fold paralysis—can result in hoarseness or other voice abnormalities.

What Happens in Spasmodic Dysphonia?

In patients with spasmodic dysphonia, the vocal folds usually appear completely normal. There are no lesions, paralysis, or structural abnormalities. Consequently, conventional laryngeal examination may appear entirely normal.

The abnormal voice results from involuntary spasms affecting specific muscles that control the movement of the vocal folds during speech.

To diagnose the condition, videolaryngoscopy with detailed assessment of vocal fold motion is often required. In selected cases, laryngeal electromyography (LEMG) is used to identify the abnormal muscle activity and determine which laryngeal muscle is responsible.

Why Are Only the Laryngeal Muscles Affected?

The abnormal muscle contractions seen in spasmodic dysphonia belong to a group of neurological movement disorders known as dystonia.

When dystonia affects multiple muscle groups throughout the body, it may be associated with broader neurological diseases such as Parkinson's disease.

However, when dystonia affects only a single muscle or muscle group, it is called focal dystonia. Spasmodic dysphonia is a focal laryngeal dystonia in which one or more muscles controlling the vocal folds are affected.

Examples of other focal dystonias include:

Hemifacial spasm, characterized by repeated involuntary contractions affecting one side of the face.

Cervical dystonia (spasmodic torticollis), causing involuntary turning of the head to one side.

Blepharospasm, characterized by involuntary repetitive eyelid closure.

Spasmodic dysphonia, resulting from involuntary spasms of the muscles controlling the vocal folds.

How Does the Voice Sound?

Patients typically have a persistently strained, tight, and interrupted voice. The voice may sound as though someone is choking the speaker while talking or as though the speech is being forced out with great effort.

One of the interesting features of this disorder is that the voice often improves temporarily when the patient speaks in an unnatural voice, shouts, laughs, or sings.

Because the vocal folds appear normal during routine examination, many patients are incorrectly reassured that nothing is wrong with their larynx and are sometimes told that their symptoms are psychological.

Treatment of Spasmodic Dysphonia

Medication

Unfortunately, medications have little or no benefit in treating spasmodic dysphonia.

Voice Therapy

Voice therapy performed by a speech-language pathologist may provide limited improvement in selected patients but is generally insufficient as a sole treatment.

Surgery

Several surgical procedures have been developed and may improve voice quality in carefully selected patients.

The Most Effective Treatment

The current gold-standard treatment is the injection of botulinum toxin (Botox®) into the affected laryngeal muscle(s).

This is a simple office-based procedure performed under local anesthesia. A fine needle connected to a laryngeal electromyography (LEMG) system is used to accurately identify the target muscle. Once the needle reaches the affected muscle, botulinum toxin is injected.

The medication temporarily relaxes the overactive muscle, relieving the abnormal spasms and allowing the patient's voice to return to a much more natural quality.

For the majority of patients, botulinum toxin injection remains the treatment of choice and has dramatically improved the quality of life of individuals living with spasmodic

It's an article limited to arabic