ONWARD ~ and ~ UPWARD Judith Florian, R.N.

Featuring articles and discussion of diverse topics, including:

Issues concerning Disabilities, Home Health Care, Sexual Abuse of Children, and Advocacy.

SPEECH & VOICE PROBLEMS

Alternative names   

Laryngitis, Hoarseness, Voice Strain; Dysphonia; Loss of Voice 

"It's not what you say, it is the WAY you say it! And HOW you say it!"

CAUSES OF LARYNGITIS 

This article does not focus on causes or treatments.  But generally, laryngitis does not have one specific cause.  Some possible causes are:

viral upper respiratory infection, bronchitis, pneumonia, influenza, pertussis, measles, diptheria, excessive use of the voice, allergic reactions, gastric reflux (gastric fluids coming up the esophagus and irritating the vocal cords, chronic cough (from irritants, from asthma, from gastric reflux), and inhalation of irritating substances (like cigarette smoking), acute or chronic ear infections, sinus drainage, throat surgery for adenoids, thyroid disorders,  throat cancer, chemotherapy to the neck, and some diseases of the elderly and neurological diseases.  (Also temporary causes from tests or medical procedures.)

Laryngitis may be painless or may be accompanied by pain, depending on the cause (see above).

Just as there is no one specific cause, there is also no specific treatment.  Steam, rest for the voice, therapy for underlying causes, treatment of allergies, reduction of irritating substances including environmental allergies or cigarette smoking.  

Depending on the cause, a person may have other symptoms of illness -- and the person could be quite ill.   If the cause is an illness, such as a viral or bacterial infection, they may be irritable, grouchy, tired, fatigued, feverish -- all the things common to having a cold or flu.  If the cause is an inner ear infection (otitis media), the fatigue may be accompanied by dizziness and tinnitus (ringing or swooshing or other sounds in the ear).   With any infection, the person may have anorexia (not eating as they normally would), and be dehydrated (not drinking fluids as they normally would).  A reduction in fluids actually makes sinus drainage worse, because the mucous gets thicker - water, juice, broth, or tea will help thin the mucous. 

Sometimes though, laryngitis may have few other symptoms, especially when the underlying condition is chronic.  Cancer and chemotherapy patients may only have loss of voice.

LARYNGITIS - DEFINING THE PROBLEM

WHAT CAREGIVERS AND HOME HEALTH AIDES NEED TO KNOW

ABOUT LOSS OF VOICE AND LARYNGITIS 

Do NOT take it personally if your patient nods, or makes a sound instead of speaking.

                                It may be easier to not speak at all, or to just make one sound, rather than speaking.  Uh-huh may be used a lot.

Do NOT talk to the person from across the room, making them speak louder for YOU to hear THEM.

                                Do get close enough to hear the person, and reduce the stress they must put on their vocal cords.

Don't rush the patient.

                        The patient may be searching their mind to form the shortest sentence they can, using the fewest words, but still be able to give you a good (clear) answer or clear directions about what they need you to do.

Do NOT ask the person to "speak up".  

                                If they could speak up, they would naturally be using a normal voice.  But with laryngitis, it is recommended that the person speak softly (but don't whisper, because that can be hard on the vocal cords).

Do NOT try to hear the person over the television, radio, fans, air filter fans, air conditioning motor/fan, or other conversations in the room.

                            Make the room as QUIET as possible while the person is speaking.

Don't "disappear" into another area of the house - or be gone long periods of time - requiring that the person must try to YELL to make you hear them.

                                Check on the person frequently enough that they can communicate their needs to you without trying to yell for you.  Usually every 20 minutes or so is an acceptable period of time -- time enough to do dishes, put a load of laundry in the washer or dryer, run the vacuum in a few rooms....

Don't ask lots of questions.

                                    Ask YES - NO questions instead !

Don't expect the person to always respond verbally!

                                    Have the person use pencil & paper, or an erasable board, or small chalkboard -- anything a person can write their replies to you.

Don't get upset if the person resorts to pointing to what they want or need.

                                    To rest the voice, ANYTHING a person can do other than speaking OR making ANY sound will be helpful to them and will help recover their ability to speak.  [Note: Except those who have had throat surgery, cancer, neck chemotherapy, etc.]

Don't react to the quality or tone of voice -- don't read into or attach meaning to "how" a person with laryngitis may sound.  

                        The voice with laryngitis may have different qualities of "sound."  The voice may sound scratchy, raw, rough, squeaky, breathless, husky, airy, cranky, very low pitched or very high pitched -- all in one day, or even in one sentence!!    Others may attach emotional meanings to the voice quality or "tone" by thinking the person is bitchy, angry, irritable, rude, dismissive, demanding, or a whole range of other "meanings."  In fact, the person may feel in a good mood -- other than being irritated and frustrated with the fact that they cannot speak normally!  But that does not mean they are irritated, frustrated, or angry at YOU!

DO encourage them to:

Rest their voice

Speak quietly, without whispering

Drink lots of fluids

Write notes to communicate

For more information, see these articles:

Medline Plus Medical Encyclopedia

American Cancer Society 
National - 800-ACS-2345 or 800- 227-2345
Canfield Ohio Chapter Office  330-533-0546 

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