To summarize your situation: you have been scoped and pH monitored. You
probably have some reflux but not severe in terms of its effect on your
esophagus, just your voice. You also apparently have at least some degree
of allergy. Acid reduction helped.
It is unfortunate that your doctors did not give credibility to your
singing. You might do well to see if there are any doctors in your area who
deal with singers.
In any case, since you have reflux, you would be well advised to reduce
anything that makes it worse. Remember that reflux is not just acid;
digestive enzymes are more injurious to the vocal apparatus than acid.
Achieving a normal weight (even a 5-10 lb weight loss helps) can
significantly improve symptoms. Avoid large meals, carbonated beverages,
mint, reclining after eating. Alcohol can be a problem for many people. I
assume you do not smoke.
For a short term, you might ask about the use of metoclopramide, an
anti-reflux medication that can be used in conjunction with acid reduction
to reduce the physical act of refluxing. There are some long term safety
issues with metoclopramide, but I am suggesting 4-6 weeks treatment.
For the allergies, if you are not well controlled on your current regimen,
push for more aggressive treatment. See if desensitization would be useful.
Hydrate to the max. Often the mucus is manageable with hydration. If the
vocal folds are a edematous despite all this, inhaled steroids can help.
Now before anyone gets all bent out of shape about steroids, please note
that I am not saying systemic steroids and it is only recommended for a
short time for an appropriate reason. Using it for treatment of overuse is
not a good idea. I have found that inhaled triamcinolone (Azmacort) is well
tolerated by singers. It may not be appropriate for you; your doctor would
need to see the vocal folds to decide.
I believe with aggressive treatment and some management on your part, this
should be manageable.
John
John J. Messmer, M.D.
Assistant Professor, Family & Community Medicine
Penn State College of Medicine
|
|  |
