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Spinal Cord Disorders Message Board

Spinal Cord Disorders Board Index

Hi all,

I've been away awhile -- I notice how many of us drift away as our problems diminish...

I'm now 7 months postop ACDF. Feeling terrific! No neck pain, no arm/hand/finger numbness/tingling/pain. So, as far as I'm concerned, the surgery was well worth it.

Many moons ago, I posted questions about voice and singing problems. I can't speak loudly -- instead of it getting louder, it just goes up, so my voice sounds like Minnie Mouse. This is especially rough when I'm trying to talk in a crowded room. If I talk for a long time, my voice gets hoarse, which my kids think this is great. But, as a contracting specialist where I have to go into negotiations at times, it affects my work. I'm an alto in my choir, and I lost about 3 notes in both my upper and lower range, so many times I just have to "mouth" a note. I also can't sing out or sustain notes, so I had to give up being a cantor. There are certain sounds I have trouble making, like anything with a long "e", like "each" or "EEEEK!" Hope I don't see any mice anytime soon!

My neuro kept saying to give my voice another month. At the 4-month point, he decided to send me to an ENT who he felt would really check out my problem. There was a 2-month wait for new patients! I decided to hang in there and I'm glad I did -- Dr. Vizor was very thorough, empathetic, listened to all my questions and gave me thorough answers. Anyway, a scope revealed "right true vocal paralysis".

He gave me his opinion regarding how this can occur with ACDF. Apparently, there is a nerve that normally loops down below the spot where the neuro cuts. In about 3% of the population, the nerve doesn't loop down, and so the likelihood of it getting cut is increased. That's about the best I can explain it since I can't draw a picture here! Also, I might be off in some of my descriptions, since I don't know all the medical lingo.

He said the paralysis is permanent -- this particular nerve is too complicated to fully repair itself. The complications of the paralysis vary, due to 2 things. If the left vocal cord is strong, it learns to compensate for the right cord not doing its thing. So, as it compensates more and more, swallowing, speaking, singing, etc, -- all improve, but you can never fully regain what you had before.(I choked a lot in the first couple of months post-op - I rarely choke now.) More important is the position the right cord freezes - open, closed, or in-between. In-between is the best, which is where my scope showed my cord froze. If the cord freezes in the full open position, the left cord can't move far enough over to compensate. If the cord freezes in the closed position, left cord can't open enough to compensate. The ENT said if the cord had frozen in the open or closed position, I would also have trouble swallowing, so speaking would be the least of my problems.

There is a surgery to treat this -- it's called Isshiki Thyroplasty. (ENT Net is another good source of info.) Dr. Vizor only recommends surgery when the cord freezes in the full open or closed position, or if the patient can't talk at all. They reopen your neck scar, remove a piece of cartilege near the cord, and replace it with a "prosthesis" -- all under local anesthesia! EEEEEEK!

Anyway, the doc recommended speech therapy. I've been for an initial evaluation and am waiting to see if my insurance approves the number of visits the therapist recommends. After therapy, the therapist says he knows a voice teacher who specializes in people with voice disorders -- but I'm not sure I'll be able to afford voice lessons.

Anyway, the therapist gave me some things to do now. Forever. He says I've got to protect the good cord.

1. Don't smoke.
2. Avoid concentrated alcohol. Beer or wine with a meal is OK.
3. Avoid clearing your throat. It's one of the worst things you can do. Swallow instead.
4. Avoid coughing. If it persists, take meds.
5. Don't whisper.
6. Avoid strenuous exercise like running, and weightlifting. Light exercise like walking, biking, and yoga is OK.
7. Keep the cords lubricated. Drink at least 8 cups of water a day.
8. Cut out the caffeine -- it dries out the cords. If you have to have it, for every cup of drink with caffeine, add another cup of water to your 8 cups of water a day.
9. Suck throat lozenges, but nothing with menthol, which dries the cords. Read the labels - there are cough drops that don't have menthol.
10. Use a humidifier on dry days.

Sorry to be so long-winded, but when I was searching for info on voice problems via these boards, I found very little. I especially hope this info will be useful to Niki47, BDW2, and sku!

When I start therapy, if I learn anything of a general nature to pass on, I'll add to this thread.

Take Care!

ACDF C5-6, C6-7 on 10/30/02, using donor bone, with titanium plate and screws

[This message has been edited by Niteowl (edited 05-22-2003).]

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