Do you ever find that you’re feeling a tightness in your voice that won’t go away, or pain or tenderness? Or feel almost as if you have food caught in your throat?

You may be experiencing vocal strain.

Vocal strain is relatively common and could be caused by a wide range of issues, from illness to excessive cheering at a sporting event or concert.

In most cases, it is temporary and not a cause for concern. But persistent strain and prolonged changes in voice quality should be assessed by a laryngologist, says Benjamin M. Laitman, MD, PhD, Assistant Professor in the Department of Otolaryngology-Head and Neck Surgery in the Mount Sinai Health System.

Benjamin M. Laitman, MD, PhD

“There is always a risk that when you use your voice, you might use it in an inefficient manner or activate the wrong muscles to increase volume in certain situations,” says Dr. Laitman, a member of the Grabscheid Voice and Swallowing Center of Mount Sinai and Mount Sinai’s Institute for Airway Science.

“That can cause phonotrauma, or trauma to the vocal cords, which may be similar to having a callus or blister or even small scar. It can affect the quality of your voice, and that is something that we can address.” In this Q&A, Dr. Laitman explains what you need to know about vocal strain and treatment options.

How do I know if I have vocal strain?

Vocal strain is often associated with a change in the quality of your voice, such as hoarseness. In some instances, that change may be accompanied by a feeling of strain or soreness when speaking and tenderness or pain in the throat when touched. You may also experience a sensation akin to having food caught in your throat. This is a sign of muscle strain or tightness.

Vocal strain can often be treated by resting the voice and speaking at a lower volume for a few days, which will help prevent significant damage to the vocal cords. But it is best to schedule an appointment with a laryngologist if symptoms persist for several weeks.

Are polyps, nodules and cysts caused by vocal strain?

In some cases, polyps, nodules, orcysts may be caused by continuous inefficient use of the voice and associated trauma. This may result in a cycle in which patients compensate for strain, causing further trauma. The presence of a polyp, nodule, or cyst is not necessarily a cause for concern, but it is best to consult with a laryngologist in cases of prolonged hoarsenss to confirm that it is not a cancer.

How can a laryngologist help me?

We typically start by looking at your medical history and then making a recording of your voice so that we have a baseline for analysis and measuring improvements. We will also conduct a stroboscopic examination of the larynx either via the nose or the mouth. This examination involves using an endoscopic camera equipped with a strobe light, which enables us to see the movement of the vocal folds and assess closure patterns, gaps, and the presence of lesions, polyps, or scars that we would otherwise miss. Based on what we observe, we will then discuss possible treatment options.

What are treatment options for vocal strain?

There are two main therapeutic approaches we recommend for patients with vocal strain: 

• Voice therapy: We will recommend voice therapy with a speech language pathologist for patients, which may help reduce muscle tension. This may not only provide symptomatic relief but also may shrink the size of benign phonotraumatic lesions, as their cause is often inefficient voice use. Therapy may include techniques such as laryngeal massage or water resistance therapy. This approach can help reduce inflammation and restore normal voice quality. 

• Surgery: We will recommend surgery or office-based procedures in cases where we observe a large polyp, lesion, or blood vessel that is contributing to hoarseness, or when patients are not satisfied with the outcome of voice therapy.

We typically perform surgery in an outpatient setting using general anesthesia and microscopic surgical tools to prevent trauma to healthy surrounding tissue. However in cases where the lesion or polyp contributing to vocal strain is very small, we may elect to perform surgery in-office using a laser-equipped scope.

We recommend that patients who undergo surgical treatment rest their voices for a week to promote healing and then follow-up with us to arrange postoperative voice therapy with a speech language pathologist.

Both approaches to treatment are often effective in addressing vocal strain. Regardless, patients should to monitor their health following treatment and contact a laryngologist if they experience recurring or other symptoms of concern. Our goal for patients to be happy with their voices. Whether it is vocal therapy or surgery, we will meet them where they are and work with them to get them where they want to be.

You may have seen recent news reports about a rise in measles cases. While there have been a small number of cases, the risk of a widespread outbreak is low due to high vaccination rates in the United States. However, measles can be a concern for people who are unvaccinated, especially children traveling abroad to countries where immunization is low.

According to the Centers for Disease Control and Prevention (CDC), measles cases in the United States originate from unvaccinated international travelers. If you plan to travel internationally, you should ensure you and your loved ones are protected against measles before departure, no matter where you are going.

Kristin Oliver, MD, MHS

In this Q&A, Kristin Oliver, MD, MHS, Associate Professor, Pediatrics, Environmental Medicine and Public Health, and Global Health, Icahn School of Medicine at Mount Sinai, discusses the recent uptick in measles and explains new federal guidelines allowing children to get vaccinated as early as six months if traveling abroad.

Why are measles cases higher than usual?

There are several reasons. First, unvaccinated people who are traveling to and from countries with low immunization are likely catching measles and bringing it to the United States. Second, rates of measles vaccination have declined since the COVD-19 pandemic. Some parents were unable to get their children properly vaccinated during the pandemic or lack access to vaccines; others are hesitant about getting kids vaccinated. Some people may be unaware that their child needs to get a second dose of the vaccine to be fully protected.

What are the symptoms?

The first stages of measles look like many childhood illness: A cough, runny nose, high fever, and red eyes. After a few days, patients develop a red rash on their face that spreads to the rest of the body—the telltale sign of measles.

Who is most at risk?

Most people in the United States received the standard two-dose measles vaccines as children and are immune. If an unvaccinated person comes in contact with an infected person, their chances of catching measles are extremely high. According to the CDC, children less than five years old and adults older than 20 (especially those who are immunocompromised or pregnant) are more likely to experience complications. These include diarrhea, ear infections, pneumonia, and swelling in the brain. About one in five unvaccinated people in the U.S. who get measles is hospitalized.

When can I get my child vaccinated?

In general, the measles vaccine is a two-dose series. Children get the first dose between 12 and 15 months, and the second dose between four and six years old. However, the CDC recently changed its guidelines for parents with children who plan to travel internationally.

Under these guidelines, the recommendation is for kids to get early vaccines before they travel. Babies who are six to 11 months old are eligible for their first dose before travel. Children over 12 months old who have already received their first dose should get a second dose before travel. For example, if you plan to travel abroad with a two-year-old who received their first dose at age one, you should get them a second dose before you leave. Check with your pediatrician before you travel to learn about when your child should be vaccinated.

How can I get my child vaccinated?

Schedule an appointment with your child’s pediatrician. If you plan to travel abroad, let your pediatrician know so they can schedule the vaccines appropriately. If you are unsure about whether your child is up-to-date on vaccines, speak with their pediatrician. If you do not have a regular pediatrician, low- or no-cost immunizations are available through the New York City Department of Health and Mental Hygiene.

How can I protect my baby if they are too young to be vaccinated?

The best way to protect a baby too young to be vaccinated is to make sure you, your friends, and family are up to date on vaccines. If your baby is unvaccinated and you are traveling in a region where vaccination rates are high, the risk of exposure is low. If you are traveling to a country with low immunization rates, the risk is higher. Keep in mind that even in countries with high immunization, there may be communities within those countries where immunization is low. It’s important to research the location and communities you plan to visit to fully understand the risk.

I don’t know my vaccine history. How can I know if I’ve been vaccinated for measles?

You can get a blood test from your doctor to see if you’re immune. You may also be able to check the immunization records of the city where you grew up.

A sneezy, stuffy, runny nose makes it hard to concentrate and get a good night’s sleep. Nasal sprays, which are sprayed directly into the nose, can provide relief for your nasal allergy symptoms by targeting the mechanisms leading to them.

To make an appointment with Anthony G. Del Signore, MD, PharmD, call 212-844-8450

Many prescription and over-the-counter nasal spray options are available that reduce or eliminate nasal allergy symptoms, but each contains different medications that target different symptoms. In this Q&A, Anthony G. Del Signore, MD, PharmD, Director, Rhinology and Endoscopic Skull Base Surgery, Mount Sinai Beth Israel, and Assistant Professor of Otolaryngology, Icahn School of Medicine at Mount Sinai, explains what nasal sprays are available and how to choose the best one for you.

What nasal sprays are available to treat my allergy symptoms?

The following is a guide to some of the most popular nasal spray options. It provides details on how these sprays work, what they treat, and their potential side effects. However, you should consult your physician or otolaryngologist before using them.

Saline Spray or Gel:

These sprays help to lubricate dry nasal passages, and are often recommended for patients with epistaxis, or nosebleeds. However, they may not relieve nasal congestion.

Examples: Simply Saline™, Xlear®, A&H, Ayr®

Saline Irrigations:
These treatments, which mix purified, distilled or boiled tap water with salt and baking soda, help flush mucus from the nasal passages, thins nasal secretions and thus pair well with nasal sprays for relieving congestion.  These are often first line and the backbone of nasal regimens when treating allergies to viral and bacterial infections.

Tips: It is important to regularly clean your irrigation device and to use purified water. Depending on your symptoms, your physician or otolaryngologist may recommend using steroids or antibiotic ointments to achieve the best outcomes.

Examples: Neti Pot, NeilMed®, Ayr

Steroid Sprays

Nasal steroids are typically recommended as a firstline treatment of nasal allergy symptoms. These sprays help decrease inflammation in the nasal passages, which reduces symptoms such as congestion, runny nose, and sneezing.

Tips: To achieve the full benefit of these sprays, you should use them as recommended—once or twice each day for several weeks. The benefit is not immediate and must be used consistently to see adequate relief of symptoms. To minimize the risk of nasal bleeding be sure to aim away from the nasal septum and towards the side of the nose (think of pointing the bottle towards the eye).

Side effects: Although oral steroid use has associated risks, including cataracts, elevated blood sugar levels, mood changes, and disturbances of sleep, these risks are considerably lower when steroids are taken in nasal form. The more common risks include nosebleeds and nasal perforations when improperly used.

Over-the-counter examples: triamcinolone acetonide (Nasacort®), fluticasone propionate (Flonase®), mometasone (Nasonex®)

Prescription spray examples: beclomethasone (Beconase®), ciclesonide (Zetonna®)

Antihistamine Sprays

Much like oral antihistamines, these sprays block the effects of histamine, a chemical in cells responsible for many allergy symptoms, including a runny nose and sneezing.

Tips: To achieve the full benefits of these sprays, it is important to use them once or twice daily. For an additive benefit, be sure to use in conjunction with the nasal steroid spray.

Side effects: Some patients have reported drowsiness when taking these sprays. If you experience drowsiness, consider taking them before bed. Other patients have reported a bitter taste, dry mouth, and dizziness.

Examples: Azelastine (Astelin®, Astepro®), olopatadine (Patanase®)

Steroid and Antihistamine Sprays

This combination spray (azelastine and fluticasone) is only available by prescription. It can provide relief from nasal allergies in cases where using a steroid spray is not fully effective.

Tips: Use consistently to see maximum benefits. Often prescribed up to two times in each nostril once or twice daily. To minimize the risk of nasal bleeding, be sure to aim away from the nasal septum and towards the side of the nose (think of pointing the bottle towards the eye).

Example: The only branded combination spray currently available is Dymista®.

Anticholinergic Sprays

Available only by prescription, these sprays help to block a neurochemical that increases mucus secretions in the nose. They mainly provide relief from nasal drip .

Tips: This spray can be added to other nasal spray regimens to control nasal drip. The spray can be used up to four times a day. Best results seen when a known trigger is identified, i.e., cold weather, eating, consuming hot beverages, and typically can be pre-treated prior to the inciting factor.

Side effects: Some patients have reported dryness, nosebleeds, bitter taste, headaches, and irritation when using these sprays.

Example: The only spray currently available is ipratropium bromide (Atrovent®)

Cromolyn Sodium Sprays

These over-the-counter sprays work by blocking mast cell release, which induce inflammation and lead to nasal congestion, runny nose, and sneezing.

Tips: To achieve the best possible results, you should use them one to two times a day, starting at least several weeks before allergy season begins.

Side effects: Some patients have reported a burning sensation in their nose and a bitter taste in their mouth when using this spray.

Example: There is only one branded cromolyn nasal spray: NasalCrom®.

Decongestant Sprays
These over-the-counter treatments work by reducing swelling of blood vessels in the nose, which helps to relieve nasal swelling and congestion.

Tips: Although decongestants are effective for short-term relief, prolonged use—seven or more days—can result in rebound nasal congestion, also known as rhinitis medicamentosa, with inflammation of the nasal passages. They are also not recommended if you have glaucoma or high blood pressure as they can make these conditions worse.

Side effects: In addition to rebound nasal congestion, some patients have reported dryness, stinging, rapid heartbeat, and higher blood pressure when using these sprays, particularly during prolonged use.

Examples: Oxymetazoline hydrochloride (Afrin®, Sinex™, Dristan®), phenylephrine hydrochloride (Sudafed®)

Remember, nasal sprays can provide effective relief from the allergy symptoms you experience. If you have tried one and it did not work, there are other options you can try. The key is to see an otolaryngologist and discuss your symptoms. Based on that, they will be able to recommend one that does work for you.