Dysphonia, Dysphagia, and the Dys- Between

A Terrifying Observation

At the end of a flexible nasoendoscopy, a procedure in which a small camera was passed through my left nostril, the right one having proved less pliant, there were a few conclusions, though none of particular concern.

The procedure examined my throat and voice box for a simple reason: since I commenced four weeks of radiotherapy for prostate cancer in September 2024, I had lost my natural voice. It had been reduced to a hoarseness, carrying a semblance of weariness and tiredness that might suggest I was gravely ill.

In general, I am fine. The voice that comes and goes does not reflect that impression, and yet a consultant on another stream of the multidisciplinary team that handles my clinical issues and healthcare outcomes has been on my case since January 2025.

Questioning the Cause

While I had surmised that the change in my voice was a long-term side effect of the radiotherapy, she disputed this. Even if I, as a man, were kicked in the testicles, with the usual prospect of momentarily losing my voice, and I had indeed been through the equivalent by way of radiotherapy, the effect should not last as long as it has in my case.

I even dared to question how she, as a female, would know about this uniquely male anatomy.

Then, at my biannual consultation just over a week ago, the consultant took the initiative on the matters I had been reticent to pursue, and scheduled sessions with other specialists in the very fields she had been seeking answers in. My hospital visit yesterday was to see an ENT (Ear, Nose, and Throat) specialist, or should I say an otolaryngologist.

Into the Consulting Room

Before meeting the consultant, I filled in three pages of tick boxes, affirmatives or negatives, to provide a general overview of what needed assessing. I was then called into a consulting room to sit in an abridged version of a dentist's chair.

On what was my third hospital visit in eight days, I could be forgiven for feeling some trepidation, whilst remaining hopeful that nothing untoward would be found.

Understanding Dysphonia

The condition under review is called dysphonia, a medical term for any voice disorder that makes your voice sound hoarse, raspy, breathy, or strained. This is in addition to sexual dysfunction, an obvious side effect of the radiotherapy, and dysphagia, another condition that may have been exacerbated by radiotherapy but has existed for longer, for which I had an oesophagogastroduodenoscopy in May.

In layman's terms, my vocal cords were considered quite thin, not closing properly when I talk, and carrying a slight tremor. It was watching the video playback, while we discussed the prognosis, that left me a little terrified. The movement of my vocal cords looked like the wings of a bat about to take off from a perch. You mean that was happening inside me?

The Prognosis

A contributory factor to my snoring was that my palate is unusually low, though nothing was attributed to that condition beyond the raspiness in my voice, which is probably caused by acid reflux that does not occur all that often.

We agreed there was little else to do, unless I initiated a follow-up because my voice had noticeably worsened, or unless I wanted the filler injection known as vocal fold injection augmentation, not an endearing prospect from what I have read about it.

Exploring the Prefix Dys-

Meanwhile, the original consultant has already scheduled an appointment to discuss the results, and I am learning more about the prefix dys-, which might refer to any of the following kinds of situations.

Bad / Ill: working in a harmful or poor way.

• Dysfunction: impaired or unhealthy functioning (e.g. family dysfunction)
• Dyspepsia: bad digestion
• Dystopia: a bad or undesirable society
• Dysphoria: a state of unease or dissatisfaction

Difficult / Painful: causing trouble or hurt to do.

• Dyslexia: difficulty reading
• Dysphagia: difficulty swallowing
• Dyspnoea: difficulty breathing
• Dysmenorrhoea: painful menstruation

Abnormal / Impaired: moving away from the normal state or standard.

• Dysplasia: abnormal development of cells or tissue
• Dyskinesia: abnormal or impaired movement
• Dysarthria: impaired speech articulation
• Dysgraphia: impaired writing ability

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I've Never Liked Liquorice

A Restless Anticipation

I had a good enough night's rest, setting my wake-up alarm for 7:00 AM in anticipation of my oesophagogastroduodenoscopy procedure. In the end, the main thing that weighed on my mind was whether this apparently simple but unpleasant procedure could lead to complications.

I did not prepare myself for adverse outcomes, instead steeling myself with the inclination that everything would turn out right. I had already expiated my deepest concerns in the blog "Tubing Down the Gullet", which I wrote yesterday.

Setting Off to Hospital

After chatting to Brian, whose words of comfort and support meant a lot to me, I called an Uber to take me to the hospital, and sent a message to my neighbour about what was going on.

Arriving at the endoscopy unit, I was registered by the desk clerk at the reception. I had hardly settled into a comfortable seat before the coordinator of the unit invited me in for a preprocedural assessment, checking my details, gaining my consent, and explaining what the procedure would entail.

Briefed Before the Bed

It would last 7 minutes. You could add "long" or "short" as a qualifier of time; the personnel opted for "short", which was to minimise the conceptual understanding the patient might have of enduring such a long and uncomfortable intrusive activity.

The most important piece of advice was to keep breathing: in through the nose and out through the mouth. I ended up breathing entirely through my mouth, as my nose was slightly blocked when we started.

After that engagement, I was led to another waiting room to wait for the consultant who would conduct the endoscopy.

Meeting the Consultant

The consultant arrived: pleasant, amiable, and professional, doing his best to keep me at ease. After introductions, we walked to the examination room, well-lit and neat, with nurses giving off a warm aura of encouraging mien that could disarm every sense of anxiety.

She took my bag, cane, coat and hat, and had me sit on the bed. I was asked for the third time if I had any allergies. I always respond with "jealousy", something I learnt from the song "Footsteps Following Me" by Frances Nero, which contains the line, "I am allergic to jealousy". It is quite an icebreaker, I think. [Footsteps Following Me (Lyrics) / (YouTube)]

As I was not going to be sedated, I had this foul-tasting numbing spray squirted down my throat and larynx before I lay down on my left side on the bed. A mouth guard was inserted to stop me from biting on the camera tubing.

The Endoscope Goes Down

The endoscope, which I had seen earlier, looked like a generously thick length of liquorice, just a little over 1 cm in diameter from my estimation. It was introduced into my mouth and wound its way into my throat, where I had to swallow to give it access, and then I began to gurgle. My head was held still as I was advised to keep breathing.

I was breathing, but my gag reflex was triggered so many times that I was retching violently, somewhat scared I might aspirate any fluids. The nurse used a suction tube to draw out the fluid, and there were moments I was comfortable just breathing through my mouth before I was retching again, with my body and legs reacting wildly to the inconvenience.

The camera travelled down to the deepest reaches of my duodenum within two minutes, and for thorough examination, the endoscopist had the camera look back on itself, which is called retroflexion. With air being blown in to allow for a better view, all of it was coming back up in the gurgling and retching.

Biopsies and Relief

Towards the end, I was asked if biopsies could be taken. I'd rather suffer this once than have it done again, so I signalled my consent, and a thin red line was channelled into the camera stem for that purpose.

Imagine the relief when the endoscope was finally extracted, only for me to find that despite all the preparation, my top was soiled to the back of my left shoulder. I tried to dry up before being taken to recovery, where I awaited the preliminary findings of the procedure.

Another set of blood pressure, blood oxygen, and temperature measurements was taken, showing my blood pressure had fallen some 20 points between when I arrived and soon after the procedure.

The Findings

The findings indicated a hiatus hernia, suggesting my stomach had moved slightly above the diaphragm. This is apparently common and could be age-related. Further along, there was an incomplete Schatzki ring not causing any significant narrowing. This is a circle of tissue in the lower oesophagus that might make it difficult to swallow food.

These findings might not fully explain the food impaction and choking events, but they might indicate something to be aware of. The nurse in the recovery ward suggested I give more time to chewing and mastication before swallowing.

The histopathology of the biopsies is expected in anything from 6 weeks, scribbled in over the printed two weeks. I also had to wait an hour after the application of the numbing spray before ingesting anything.

Heading Home

Then I was discharged and walked back home to take a long bed rest. While I feel alright, the invasion of my innards was quite a shock to my system, bringing on exhaustion and tiredness.

I could have written this blog in the hospital, but it has taken hours afterwards, using AI to explain all the medical terms that are inscrutable to the layman, and trying to understand everything that happened: the findings, and the possible issues that might result. The premise is that there is nothing to worry about, just knowledge that explains some historical issues.

A Parting Thought

One final thing: I was their first customer, and it looked like 3 others had cancelled their appointments. I was never once addressed as a patient. Was I the bigger fool for attending what others were not ready to endure? I have no answer to that question.

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Tubing Down the Gullet

The Weight of Anticipation

Anxiety is a weight. It sits on your chest and bears down regardless of whether you are lying down, sitting, or standing. Anxiety also signals that the issues of life, though measurable in the brain, are situated in the chest cavity where your heart and lungs reside.

For instance, when you feel confident, you are likely to beat your chest rather than slap your head. Slapping your head, it turns out, is an act of self-deprecation in recognition of one's silliness or foolishness. Anticipation can create anxiety, and nothing quite causes that feeling of foreboding like the hours just before a long-scheduled medical procedure.

Lessons from a Previous Encounter

With hindsight, two years ago, after a multiparametric MRI scan, the consultant sprang a biopsy of my prostate gland on me without first reviewing the results or explaining the reasons. Even so, I was quite well prepared for the encounter.

I asked questions, demanded answers, and only acquiesced to the procedure once I was convinced of the need. The importance of reading up on your medical situation is paramount.

A Portmanteau of Procedures

Tomorrow, I am going for an Oesophagogastroduodenoscopy. I could have sworn that is not a word, but welcome to the world of medical terms that suggest a portmanteau of activities. The word reminds me of German, where portmanteau words are joined up with the letter "S". I would suppose, with medical terms, it is the letter "O", much like when I had that inguinoscrotal abscess last month.

In summary: I am having an endoscopy that will reach down through my oesophagus, past the gastrointestinal junction, to the first and shortest section of my small intestine. I have not deigned to measure that in miles, but it feels like a long way down to places never before visited, rather like the first landing on the moon.

Why This Procedure Is Necessary

This is pursuant to an investigation that presaged my visit to A&E after a choking incident which impacted my ability to swallow anything, including fluids, for hours. I was eventually discharged about five hours into my hospital attendance, after managing a sandwich and a drink. Taken alongside a history of choking events going back decades, and three such incidents since that discharge, this procedure is necessary.

Herewith, the cause of my anxiety: without a chaperone, I can only elect for the most basic palliative, which would be a numbing spray to the back of the throat, rather than a sedative.

Finding Peace

I believe I shall be fine. I suppose it is just part of human nature to be slightly concerned at that kind of invasive activity, and it is not helped by a mind full of others recounting their own endoscopic odyssey.

Shalom! Peace to my mind, peace to my soul, peace to my thoughts, peace through it all.

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