Q: Although I have never suffered from allergies before, since relocating I am fairly certain that I have allergies to the indigenous trees around here. I find that the walls of my throat and vocal folds are covered in a thin, clear, and quite pesky mucus. My teacher has suggested Claritin to help with the congestion that has also been a problem of late. I have heard that these newer antiallergy medications are not as dehydrating and wondered what you thought about them.
Dr. Jahn: My suggestion is first to be tested for allergies and find out whether you can avoid any of these allergens. Then, if you plan to stay in your current location, think about desensitization. The newer antiallergy meds include Claritin, Allegra, and Zyrtec, and each person reacts differently to these. You need to try them. Stay well hydrated, including using saline spray to wash the pollen out of your nose. Finally, I recently heard from one of my patients that holistic MDs are using stinging nettle capsules to reduce allergies. This may be worth a try, since this would certainly be nondrying.
Q: I have sung professionally for the past nine years (I am now 37). Three years ago I had vocal cord surgery to remove a cyst on my right cord. Due to a resulting “stiffness” on the cord, my voice hasn’t been the same since (inconsistent, occasional crackling in certain areas–I can eventually work through the trouble areas once I get really warmed up and get the stiffness to loosen up). I do battle acid reflux, for which I’ve been on high doses of medication for two years now, and persistent postnasal drip that I cannot seem to get stopped. I recently started studying with a wonderful teacher, who has me singing very well technically, but in the last three months, I haven’t been able to get my voice to clear itself of the crackling again, no matter how long I sing. So back I went last month, and lo and behold, my doctor now says I have a plugged mucus duct, which has manifested itself into a large raised area exactly over the last surgical site. He told me earlier that microscopic mucus ducts can be severed during surgery and may not drain well after that–thus creating my current problem. He says he typically has to do surgery to remedy this type of situation.
I am terrified at the thought of another surgery, since I didn’t do so well with the last one. Have you dealt with plugged mucus ducts before, and if so, were you able to remedy the situation without surgery? I am very open to suggestions (exercises, medications, rest, no rest), as I’m looking at the end of my professional singing career otherwise.
Dr. Jahn: You present a difficult problem. Vocal fold cysts are difficult to remove, since they are in the substance of the fold rather than on the surface (like polyps or nodules). Their removal, no matter how expertly done, always leads to more scarring than surface lesions. It is not always possible to remove the cyst intact, and if even a tiny bit of the cyst lining remains, it can cause regrowth. The plugged mucus duct your doctor referred to is most likely some regrowth, with reaccumulation of mucus material. There is unfortunately no medical therapy to make this go away. The best treatment is removal, since mere drainage may allow it to reaccumulate. You could ask your doctor whether some cortisone could be used postoperatively to reduce scarring, but I would leave this to his discretion. Lasers would not be used for this kind of surgery.
As far as postnasal drip, my treatment is hydration (8_10 glasses of water a day), a mucus-thinning medication such as Humibid or SSKI drops, and nasal irrigation. Find a yoga shop and buy yourself a Neti pot, which is a device for washing your nose out. Do this twice a day. Good luck!
