Vocal changes can have multiple causes

Dear Dr. Roach: Over the past year, my voice has become hoarse or raspy. I find that I often have to clear my throat while speaking. I’ve had a stomach endoscopy and a colonoscopy done, the results of which were noted as “normal.” Nothing has changed in my life, such as climate, diet, clothing, furnishings, etc. I have never smoked.

I suspect it may be allergies, because antihistamines seem to help somewhat. Is this the best solution? – N.G.

Answer: Vocal changes can be the result of many common conditions. Voice changes lasting more than two or three weeks should be evaluated by an ENT doctor, because there are serious conditions that can manifest in voice changes. In particular, anyone with a history of smoking needs a prompt and thorough evaluation for voice changes, because the nerve to the vocal cord commonly is damaged by lung cancer. Fortunately, alternate diagnoses, such as chronic laryngitis and benign vocal fold lesions (such as polyps) are more common. Reflux disease can affect the vocal cords, which may be why you had the upper endoscopy.

Chronic sinusitis with postnasal drip is one cause of hoarseness that can be improved with antihistamines. However, I would not be comfortable treating this long-term with antihistamines without a more thorough evaluation than you have reported.

Dear Dr. Roach: A recent issue of a popular consumer magazine column states that taking a baby aspirin daily does more harm than good, and it should not be taken unless you have heart disease. I have been taking a baby aspirin daily for 10 years, and now I’m concerned. Your thoughts, please. – G.D.

Answer: There remains controversy about this topic, and experts disagree on the best advice. Some points, however, are not controversial: Aspirin is beneficial for reducing future heart risks in people with established heart disease, but increases the risk of bleeding events, some of which are minor but a few of which are potentially life-threatening. According to a recent review of published studies, in people at higher-than-average risk for heart disease, a daily aspirin reduces the risk of a nonfatal heart attack by about 20 percent, without significantly changing stroke risk or risk of dying from heart disease. Risk of bleeding is increased by 50 percent. Also, newer evidence suggests aspirin may decrease the risk of some cancers, especially colon cancer.

Aspirin is more likely to have net benefit in people with higher risk of heart disease, even if it isn’t diagnosed. The decision of taking aspirin should be made after a thorough review of all your individual risk factors, including heart disease risk and history of bleeding, and possibly colon cancer risk. When I discuss aspirin with my patients, I seldom recommend it to anyone with no known coronary disease who has had a significant side effect (such as bleeding) with aspirin in the past. As more studies are failing to show benefit, these recommendations may change.