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Suddenly soft voice (on ventilator)

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    So I'm still having trouble with my voice. Sometimes it seems stronger, other times, clearly not. I'm blessed that my microphone still picks up my voice well, so I can operate my computer well, but conversations are considerably more difficult than they used to be.

    My first ENT eval showed slightly inflamed vocal chords, which I took prednisone for. The follow-up ENT eval showed normal vocal chords, but inflammation in my airway/throat. My ENT also said my airway seemed dry and suggested increasing my sterile saline usage.

    But for the throat inflammation, my doctor has me back on Prilosec to see if acid reflux is the cause. I tried Prilosec earlier but perhaps not for long enough, or with a strong enough dose. I have taken the standard (20mg) dose for 5 days now, and am going to take 20mg twice a day for two weeks starting today. Then I see my ENT for another eval, and hopefully acid reflux is the problem and my voice will be good by my next eval in two weeks.

    I don't know how or if it's possible to change the i/e ratio on my vent, so we didn't try that. My ENT wrote a prescription for speech therapy due to hoarseness, which was rejected by my insurance. I need to find out whether it was rejected because hoarseness isn't a valid reason for speech therapy, or if speech therapy isn't covered for any reason.

    I'm also going to inquire about getting evaluated at Shepherd Center in Atlanta if the Prilosec doesn't solve my voice problem. Shepherd is where I did my rehab over 15.5 years ago. I'm planning to attend my graduation in May in North Carolina, and we could stop by Shepherd on the way back to Florida.

    That's the latest. I'm still open to ideas and suggestions.
    Wheelchair users -- even high-level quads... WANNA BOWL?

    I'm a C1-2 with a legit 255 high bowling game.


      A belated update...

      My voice is some better, but still not as strong as it was before it suddenly went soft in December.

      For comparison purposes, the "Meet Bill Miller" video I linked in the first post of this thread (so you can hear how I talked with a strong voice) is quite a bit different, voice wise, than this video that a student reporter did a couple months ago, when my voice was worse (I posted it on my blog):


      But I am able to talk louder and better than I did in the above video.

      Acid reflux doesn't appear to be an issue. My ENT had me undergo a video stroboscopy to better examine my vocal chords. I actually will discuss the results of that diagnostic exam with my ENT in two days (June 18th) but the speech therapist said she thought my vocal chords looked good (my insurance will cover a diagnostic speech therapy eval, but not speech therapy itself). I had mentioned to her that I'd had a bit more difficulty swallowing than I used to, and she recommended a modified barium swallow test. I'll talk with my ENT about that in two days also. But I think I'm swallowing more easily (like I used to) so I'm not sure the test would be helpful.

      I think it's more of a vent / dryness / humidity issue, or it's part of the problem. When I'm not wearing a PMV (i.e. in bed) I can choose to not let any air exhale out my mouth and/or nose. That forces the full exhale back out the vent circuit via the exhale valve. When I do that, there's greater "two-way flow" with the vent circuit's humidifier (inline HME -- Heat and Moisture Exchanger) and condensation will begin to develop in my vent circuit (as long as my body temperature isn't too cold).

      I've noticed that when I do keep my mouth & nose closed and give the HME a chance to help humidify my airway, I can talk better. Or I can choose to exhale some air while the vent is giving me a breath, which decreases the amount of air that goes back out the circuit, and the humidity / condensation will not build up in my vent circuit at all. And I usually notice my mouth gets very dry doing so as well. I can elaborate on these topics, but I don't want this to get too long.

      God bless all.
      Wheelchair users -- even high-level quads... WANNA BOWL?

      I'm a C1-2 with a legit 255 high bowling game.


        Hey Bill, I'd been wondering how you were doing with the voice issues.
        Glad you followed up with the ENT.
        Dave has had granular (?) tissue removed twice this year from trach stoma. We were fortunate to find a good ENT that does not freak out if he spasms. One refused to treat him!
        His voice softer because part of vocal cord paralyzed, but when he can tolerate the passey muir valve it is strong some days. He is only on the vent at night or during the day if needs a rest.
        Not your topic, but I have a question. The last few weeks Dave's breathing has improved quite a bit. Where we used to be suctioning many times a day-we are only doing it a couple times along with the cough assist AM and PM. He is wearing passey muir most of the time. It is much easier when he has a voice!
        There seems to be no rhyme or reason we can figure out. Hope it lasts!
        Any vent or trach tube users have feedback?
        Thanks for the update Bill.


          Thank you for your thoughts Linda.

          My secretions are reduced by wearing the PMV also. I think it's because there's less humidity in the vent circuit for one, due to the PMV. Just don't get overly dry. Hydrate well and use saline bullets if necessary to help remove secretions that may get too dry. At least, that's what we try to do.
          Wheelchair users -- even high-level quads... WANNA BOWL?

          I'm a C1-2 with a legit 255 high bowling game.


            Hi all,

            I have been meaning to update this thread for some time now.

            To make a long story shorter, I eventually discovered that it seems secretions can really affect my voice, even relatively minor secretions.

            After having a pretty soft voice for roughly a year, one morning while doing a nebulizer treatment with sterile saline (which we actually do twice daily) something apparently started getting loose in my throat.

            So we used the CoughAssist like we normally do, except we left it on inhale quite a bit longer than normal, so that I could use the extra air to cough with (I have a cuffless style trach, so the air can flow up and I can use it for coughing). And after several cycles, I finally coughed up what I thought was a fairly minor secretion, but immediately my voice was much stronger.

            And in the time since, I have noticed that when my voice gets soft, typically it's due to secretions. So now, when we use the CoughAssist, I make a point to kind of make a humming noise, which vibrates my vocal cords, and seems to help loosen up any secretions that may be in my throat.

            Humidity and having a moist airway also helps my voice, but secretions are a big factor.

            I did not realize this partly because when my voice was soft, we had my ENT doctor look for secretions on more than one trip to his office, and he never found anything that he thought might be a problem. And it seems like when I do cough something up that results in a stronger voice, usually the secretions seems like a pretty small amount of mucus. But the difference is very noticeable with my ability to speak.

            By the way, we recorded a video of how we use the CoughAssist machine:

            In the video, you can kind of hear me "humming" while the machine is on inhale, vibrating my vocal cords to help loosen secretions.

            I'm just trying to share knowledge in case anyone else is in a similar situation.
            Wheelchair users -- even high-level quads... WANNA BOWL?

            I'm a C1-2 with a legit 255 high bowling game.