InHealth: Dr. John Paul Gniady

When should I see a doctor about the frog in my throat?

By John Paul (J.P.) Gniady, MD, FACS

Nearly all of us have been there before: The phone rings. You lift it to your ear and go to say a simple “hello.” What comes out, however, is a sound more closely akin to that of a small green amphibian than your normal voice. The person on the other end of the line double-checks to confirm they have the right number. Then they ask if you’re sick. Maybe you had been. Or maybe you were just fanatically cheering your team to victory the night before. Then again, maybe you weren’t. And maybe you’re getting tired of friends and family not recognizing your voice. The question is: When does an annoying change in the voice represent a genuine health concern? When is it time to see a doctor? And what type of doctor do you see?

The answers may differ based on the person and the situation. The threshold is likely to be lower for a Principal artist with the Sarasota Opera than an aspiring author working in isolation at their beach house. The health risk is likely higher for someone who’s been smoking for decades than for an eleven-year-old on the cheer squad. The short answer is that persistent changes in or loss of voice is never normal. It may or may not represent a serious health concern, but either way the problem is almost always fixable. 

The American Academy of Otolaryngology – Head and Neck Surgery gives us guidance on this matter with their Clinical Practice Guideline on Hoarseness published in March. In this evidence-based document, it is recommended that anyone with hoarseness persisting for more than four weeks be evaluated by a physician who can perform direct visualization of the vocal cords. Ideally, this would be by a laryngologist––an ear, nose, and throat doctor who has undergone further subspecialty training in voice and swallowing disorders. The Guideline further advocates for earlier evaluation in certain scenarios. These include patients who have had recent surgery (particularly of the head, neck, or chest), those who rely on their voice for their livelihood (over 30% of all workers), those with a history of tobacco use, or anytime there is associated difficulty breathing or a palpable lump in the neck.

The hardest part for many patients is making that first decision to come in for an evaluation. Some are genuinely afraid of what we may find. Others think their problem isn’t serious enough to warrant “wasting the doctor’s time.” Still many others think that voice loss is just a normal part of aging and that there’s nothing that can be done. As I mentioned above, whether we find something concerning like a cancer or something as mundane as vocal abuse, there is almost always something that can be done to alleviate the situation. The voice evaluation includes a detailed history of the problem and background including other medical conditions, medications used, and history of smoking or other irritating exposures to the vocal cords. Your doctor will then perform a thorough examination of the vocal cords and should be able to review that examination with you to help you understand the problem. Together, you can decide on an appropriate course of treatment, but the first step is picking up the phone and saying “hello.” 

John Paul (J.P.) Gniady, MD, FACS
Florida Voice and Swallowing Center
Silverstein Institute
1901 Floyd St.
Sarasota, FL 34239
(941) 366-9222