Image is of a man with a big speech bubble

Speech problems and MS

 When progressive multiple sclerosis began affecting his voice, Ian Cook got to the bottom of it

I often feel progressive multiple sclerosis (MS) is a bit like an octopus. It has many arms and each one attacks the body in different places, and in different ways. To mix my metaphors a bit, progressive MS is a slippery fish.

To give a recent example, it is well known that MS can affect your voice. One of the many MS voice problems is hoarseness – with your voice sounding raspy or strained. This has been my particular problem for the past year.

The beginning

It all started early in 2022. Initially I thought I might have a pollen allergy. There are different sorts of pollen allergies and there is a season for each. Spring allergy season (tree pollen) starts in March. Then, as summer arrives, pollens from grass appear. Summer allergies are in full swing by July. But it’s not over then, far from it. Starting in late summer and throughout autumn, various weeds especially ragweed are the big seasonal allergy offenders. Then, as winter arrives, you shut all your windows and indoor allergy triggers like dust mites kick in.

Throughout 2022 my hoarseness remained at more or less the same level. It clearly wasn’t caused by a specific allergen, but things weren’t improving, and I was starting to avoid places where I needed to raise my voice or speak clearly. Speaking for long periods was impossible. It wasn’t until 2023 that I began to ask myself whether my voice problems might be related to my advancing MS, so I asked my neurologist at our annual meeting. He said it was certainly worth investigating.

MS and speech

According to the US magazine MS Focus, as many as 40 per cent of people with MS face speech difficulties at some time and there are many different ways MS can cause these. MS can affect parts of your brain that control the muscles involved in speech. When these muscles are affected, the speech problem is called dysarthria. MS can also cause problems with memory and thinking, so-called cognitive communication difficulties. Finally, MS can affect messages in the brain that control your voice box. This can change the sound of your voice, something known as dysphonia.

Hearing me speak, the neurologist suggested I see an ENT (ear nose and throat) specialist. A month or so later I was back in the hospital. This time in its ENT department. There, after a brief chat, the specialist pulled out a thin tube, called a nasendoscope, and asked me if it was alright to stick it up my nose so he could see what was going on in and around my vocal cords.

The specialist had a large screen so that he could see my larynx or voice box as the nasendoscope was inserted. Helpfully he turned the screen around so that I could also see what he was doing. The first thing I saw was a white mist, which I was told was a huge amount of mucous blocking the view. I was asked to swallow and clear my throat and, as if by magic, the mist of mucous cleared and I could see everything clearly.

The good news was that I could then see my vocal cords, or vocal folds to give the correct medical term. These two flaps of smooth muscle vibrate to produce the sound of your voice. They were moving as I spoke to the specialist and everything seemed normal. There were no nasties, as he put it.

The solution

However, when we zoomed in on the edges of the vocal folds there was a ‘cuff’ which was a darker colour than the rest of the vocal fold. “That is old hardened mucous,” the specialist said. He explained there was so much mucous that initially looking at the vocal folds had been almost impossible, with the screen misted over by its profusion. This encrusted mucous on the edges of my vocal flaps was giving my voice its raspy sound. As I left, the consultant wrote down the name of a natural sea water-based nasal spray, Sterimar, which I could buy over the counter for about £5 and which would go down into my voice box and wash away the mucous, keeping the whole area clean and decongested.

A few days later a letter arrived from the ENT doctor confirming that the examination of my mouth, throat and neck was entirely normal. That was the good news. However, he also wrote, “Flexible nasendoscopy (camera test) showed copious amounts of secretions sitting in the top part of the voice box or supraglottis.” Reassuringly he said the vocal cords were entirely healthy and moving normally.

“It is likely that your voice changes are related to the supraglottic secretions which is probably secondary to a mild problem in swallowing related to your multiple sclerosis. I have advised that if you do want some treatment for this you can trial a saline nasal wash to try and wash away the secretions,” he advised.

It is true I do have mild swallowing problems. For years the process has become increasingly difficult and slow as MS advances so it’s possible that over the past year this may have caused saliva to dribble down ‘the wrong way’ into my larynx which in turn has led to a build-up of mucous or, in medical terms,  ‘copious amounts of secretions’ the ENT doctor had noticed.

Fortunately, I have been using Sterimar for the past month and am happy to say the congestion has greatly improved. My voice is improving daily, and I will continue using the spray until things are entirely back to normal. It is rare in progressive MS that you can talk about a problem being easily identified and solved but I would say that I am as close as I can get to this happy place and I, for one, will settle for that.

Ian Cook is a journalist and MSer who writes regularly in New Pathways magazine. To find out more, and to subscribe to the magazine, click here.