Ask a doctor on the topic of Otorhinolaryngology

Always mucus in the throat and on the vocal cords.

August 7, 2015 | 15,00 EUR | answered by Christian Welsch

Hello,

I, male (36), non-smoker and non-alcoholic, have been experiencing the following problem for about 3 months:

Although I have a pleasant and deep voice, I have been suffering from mucus on my vocal cords for the past 3 months. Clear to whitish mucus (which I can cough up) repeatedly settles on my vocal cords, causing them to not vibrate properly and making my voice hoarse. When there is no mucus on them, my voice sounds completely normal and pleasant. Unfortunately, it mucus up very often, especially after or during fatty meals or after prolonged use of my voice.

Phoniatrist's findings: Vocal cords are fine, only slightly red, but with significant mucus on them that can be cleared by clearing the throat or coughing. Reflux has been ruled out, and the voice is best in the morning, strangely with no mucus on them (which would go against overuse, as there should be mucus forming overnight to soothe them, right?).

Initially, the phoniatrist suspected vocal misuse, but now he is more inclined to think that a food intolerance or allergy could be the cause. After voice therapy, my voice has become even deeper and more relaxed, but it hasn't changed the hoarseness (the mucus). However, some mucus also appears in the morning when I haven't eaten anything yet.

A note on the thyroid: It has been examined, all free values are within the normal range, only TSH is 4.8. I must say that my TSH has been over 3 or 4 for the past 10 years without any problems/complaints. The endocrinologist believes Hashimoto's thyroiditis can be ruled out (TPO antibodies were always at 0, now at 6, but only above 38 do they indicate Hashi. The thyroid is small, but appears normal on sonography).

Additionally, I occasionally (about once a week) have thick mucus dripping down the back of my throat ("post-nasal drip syndrome") that is difficult to swallow, even though my nose is completely clear and I have no cold symptoms. I have no idea where the mucus is even being produced.

My questions:

- Where could all this mucus be coming from and what do you suspect as the cause?
- Should I get a celiac/gluten test & lactose intolerance test done at the doctor's office?
- In your opinion, could the thyroid still be to blame because the TSH is always elevated?

Thank you for your help!

Christian Welsch

Dear inquirer,

It is a difficult situation to assess from a distance. You are already under the care of a specialist.

If not already done, here are some suggestions for diagnostics:

The following should be done:

Allergy tests (prick test, possibly RAST), particularly to rule out a dust mite allergy.

In cases of postnasal drip, imaging of the paranasal sinuses (CT PNS) is necessary in my opinion. Before that, I would try to see if patients improve with a corticosteroid nasal spray therapy. The use of a nasal douche can also be helpful if the nose is the source of mucus.

I would seek a second opinion from another phoniatrist, as it is a specialized field with different views and therapeutic principles for functional dysphonia.

If you are a snorer, I would recommend undergoing an outpatient sleep laboratory diagnostic (polysomnography).

The whole issue could be completely psychosomatic. When one focuses on a symptom and gives it a lot of attention, it tends to worsen. I see this frequently in my practice, with people constantly talking about their mucus despite no abnormal diagnostics. Mucous membranes produce mucus... it's just how it is. This is often seen in cases of depression, psychosis, or obsessive-compulsive disorder... it's worth considering.

Do you have any questions?

Regards,
Welsch