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Old 05-22-2003, 03:38 PM   #1
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Niteowl HB User
Unhappy Voice, Speaking, and Singing Problems Due To ACDF

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!

------------------
Adele
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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Adele
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Old 05-22-2003, 04:32 PM   #2
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TropicalFox HB User
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thank you so much for your post...

i am now 8 weeks post-op (tomorrow), and still suffering from throat complications...
there has been great improvement, but i still don't speak with my normal voice, and i can't sing ecept for a very narrow range that leans more toward a baritone... i am a soprano, and i sing i church, to my grandchildren and at any given moment just because it gives me so much pleasure to praise my Lord and lull my babies...

as you must imagine, i am going through some very hard times thinking i may never sing again... i am depressed because of this and often find myself crying while listening to songs i used to sing and can't even try to sing along because i can't reach the notes an octave lower...

i try not to try to sing, and always stop myself before the song reaches a part where i'm sure i can't reach it, but it's very hard for me to quiet myself after a lifetime of expressing myself in song...

i pray i won't need the operation you described but i'll have it if there is no other way...

in the meantime i will give myself 4 more months to see if it gets better... and i will ask for prayer from everyone i meet because i truly believe that God would not give me the gift of song if i was not going to be able to use it...

either He will fix it, or guide the hands of the surgeon to do so...

once again, i thank you for this information... it's come at a moment when despair was about to win...

thank you for helping me not lt that happen...

hugs http://www.healthboards.com/ubb/love2.gif

sandra

------------------
" In the middle of every ocean of difficulty is an island of opportunity."
Author Unknown

 
Old 05-22-2003, 05:08 PM   #3
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Thank you so very much for your info. I am 8 weeks now and my voice is trying to get better. I was taking valium as a muscle relaxer and quit them cold turkey, so I could prepare to go back to work. My voice went out 2 days later. I did go to my PCP and he told me valium was the best drug for that particular nerve. He looked in my throat and asked me if I was breathing alright. Don't know if I liked that question. So I cut the valium in half and take 1 or 2 a day. My voice did recover a couple of days later. I do notice the same thing you are describing. Talking low is OK. When I try to talk louder the pitch goes up. Swallowing and burping is difficult sometime. Anyway NS says no ENT until at least 3 months, PCP agreed. I am in PT now and it's going slow. Still some pain issues. I have good days and bad, but am trying not to beat myself up to much at this point. My NS first said 2 months out of work but I see now it may be a little longer. Somebody told me there was a 6-12 month recovery for this surgery and I am begining to believe it. Thanks again and stay in touch, I will keep you posted as well.
P.S. How long did it take your pain to go away?

------------------
ACDF C6-7 with plating and donor bone (3/28/03)

[This message has been edited by BDW2 (edited 05-22-2003).]
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ACDF C6-7 with plating and donor bone (3/28/03)

 
Old 05-22-2003, 05:10 PM   #4
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winged phantom HB User
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Hi Adele,
Thank you so much for your informative post. We've had a few posters here recently, like Sandra, who have not regained their voices... much. I knew it was because of the cut nerve, but I did not know the rest of it. Now we can point anyone with similar problems to this post. Only I wish it hadn't actually happened to you: that must be devastating, especially if you are a singer.

Welcome back; hope you'll stick around. Maybe you'll recognize some of the old gang.
wr

------------------
  • 12/29/89 C5-6 Microdiskectomy (no fusion)
  • 4/9/03 ACDF C4-7 with plating and donor bone
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  • 12/29/89 C5-6 Microdiskectomy (no fusion)
  • 4/9/03 ACDF C4-7 with plating and donor bone

 
Old 05-22-2003, 05:45 PM   #5
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Hello Niteowl,
I also had ACDFc 5-6-7 in October and experience some of the problems you have. Still to this day I cannot reach my high notes. I used to sing in a wedding band now they wouldn't hire me for a funeral....lol. I will look into it further like you did. Thanks for all the information. Very Helpful.

Lori
Laminectomy L4-5 2001
ACDF C5-6-7 2002
Posterior Foraminotomy June 4, 2003
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lami L4-5, ACDF C5-6-7, post. lami-foraminotomy c6-7, staph infect. revision acdf c4-5-6-7 new c4-5 2004. STILL IN PAIN 24/7

 
Old 05-22-2003, 06:25 PM   #6
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wing, i haven't had much hoarseness, just lots of difficulty swallowing... does this mean that mine was cut also? wouldn't my ns know if he did?

------------------
" In the middle of every ocean of difficulty is an island of opportunity."
Author Unknown

 
Old 05-22-2003, 07:32 PM   #7
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winged phantom HB User
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Actually, Sandra, I should edit my post... Sorry. I knew it had something to do with the nerve, and since it's so close to the surgery site, I had heard that sometimes it's injured or stretched too much, etc. I really don't know much more about it than that, unfortunately. My voice is doing pretty good, but it does sometimes sound way too gravelly and rough~~~~~ like deep and sexy, huh? rofl! NOT!
wr
__________________
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  • 4/9/03 ACDF C4-7 with plating and donor bone

 
Old 05-22-2003, 09:15 PM   #8
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PsychLea HB User
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ADele,

Thanks for the info. Hope your voice recovers.

I too am a singer, and used to sing professionally. It would have been devastating to me not to be able to sing. I am so sorry you are having to go thru this.

Sandra,

I'm like you. I love to praise the Lord and singing is the most intimate form of worship I know. Fortunately,my voice was not affected at all. You might as well shoot me if I can't sing. I'll be praying that your voice is fully restored. A prayer for all of you going through this horrible situation.



------------------
God bless,

Lea

C4-5 noncompressive disc displacement
C5-6 compressive disc displacement
C6-7 broad based disc protrusion encroaching on the anterioposterior aspect of the spinal canal.
DDD
ACDF C6-7 5/13/03 with titanium plate,4 screws, and no collar postop.
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God bless,

Lea

 
Old 05-23-2003, 04:58 PM   #9
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Niteowl HB User
Talking

Wow, this board sure is busier than it was last fall and winter! I can't believe all the topics and posts in just one day! And thank you to all who have posted to this thread!

Let me start on the cut nerve part. I didn't mean to scare anyone! This is a rare complication. Before the surgery, my NS explained that the vocal cords get moved some during the surgery, so hoarseness and other complications are common at first. That's why he wouldn't even consider sending me to an ENT until I was 4-months post. So, PLEASE don't fear the worst until you give your cords time to heal!

Thyroplasty. From what I've read about it, it won't improve your singing. It just improves on the hoarseness and other qualities of the speaking voice. And, there can be complications. I think it's too risky to try just so I can regain my former singing voice.

Speech therapy. My insurance company only had one therapist listed within a 50-mile radius of Oklahoma City! Then I thought about who often needs speech therapy - stroke patients! And, my insurance listed several rehab centers! So, that's how I found my therapist.

Pain and gong back to work: I was on oxycodone before and after the surgery. I only needed it for about a week. However, I've always had a pretty high tolerance for pain. I used OTC pain meds until about 2 weeks before the surgery. I was supposed to be off work for at least 2 months. At the 3-week post-op visit, the NS said I didn't need the collar any more, and said I could return to work if I felt up to it. I worked half-days for 2 weeks then went full-time. I have an office job and coworkers helped me if I needed to pull a large file. Never a problem. I did rest a lot after work and didn't do any fall gardening.

Singing. KEEP IT UP!!! My therapist told me it was OK that I've kept up my singing -- it gave my left vocal cord an early start on learning to compensate for the right cord. So, don't stop singing! Find songs to sing that have a short range. If you want to sing along with a song, switch from high to low! Sometimes I'll sing the verse in one octave and the refrain in another. In a choir setting, who cares? Well, actually, some choir directors may care, but I thank God I have a director who pushed me to come back and sing as best as I could. Isn't that what singing to God should be?

Or sing harmony. If you're singing along with the radio, make up a harmony. In the choir, try switching to alto -- the range is usually shorter. There's less vibrato with altos, too, and the paralysis takes away the ability to vibrato like you did before.

I also play the xylophone for the choir and can strum some chords on a guitar, so my director gave me some percussion instruments to play, like finger cymbals, tambourine, sticks, and chimes. It keeps me active when I can't hit all the notes. So, maybe you could take up a musical instrument. I've also filled in for the director twice since the surgery. Directors don't have to be able to sing, and I know some who can't sing worth a lick. So if you can't sing any more, maybe you could do some directing!

As you can see, I'm determined not to let my singing problems let me down. I probably will never cantor or do funerals anymore (I never achieved the level of wedding singer like Lori!), but I did a duet verse for an Easter hymn. My choir director found me a part with a short range, and made sure I stood next to a mike (again, she's a peach!). I listened to a tape afterwards, and it wasn't my best work, but I wasn't off-key! Just don't give up!

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

 
Old 05-17-2007, 03:28 PM   #10
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julyg HB Userjulyg HB User
Re: Voice, Speaking, and Singing Problems Due To ACDF

can you update us as your problem more recently is mine?

 
Old 06-05-2007, 03:33 PM   #11
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TropicalFox HB User
Re: Voice, Speaking, and Singing Problems Due To ACDF

It's been 4 years and 2 months since my surgery...

I still can't sing, but at least i'm not constantly choking...

I still have difficulties swallowing, with bread and chocolat being the hasrdest to swallow without a glass of water close by...

I'm under treatment with other issues and hope to see an ENT after I'm done...

I wish I had better news...

God bless,

Foxy

 
Old 06-08-2007, 08:19 PM   #12
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julyg HB Userjulyg HB User
Re: Voice, Speaking, and Singing Problems Due To ACDF

Hi again

I know you said you had other issues before you saw ent but my questions are....

1) Did you consider thyroplasty?

2) Have you had the temporary "fill" on your vocal cord? I have done it 2x.

3) Do you have pain on 1 side of throat after speaking (vocal cord strain)?

I have gotten to the point where I beleive my nerve will not heal and my vocal cord paralysis is permanent,

It is so frustrating not to be able to sing at all or speak after a short period, Cannot socialize if there is background noise such as others speaking or background music as I cannot speak over noise without suffering from throat pain for days.

I still practice speech therapy exercises eventhough results are dismal.

July

 
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