I wake up one morning a few weeks ago with a sore throat and a sharp, stabbing sort of a pain when I speak. As it turns out I also have a posterior chink – but don’t know it at the time. Or what on earth it is.
Sore throats tend to be bacterial or viral in origin and are usually best left to sort themselves out, with the minimum of medical intervention. But it’s been like this for over a week and I’m concerned that it might be a side effect from the collagen injection. So I go to my GP. He’s away and I see another doctor. He diagnoses laryngitis and prescribes a course of antibiotics, with the rider – “come back if it doesn’t clear in a week”.
The timing is unfortunate. I also have my first appointment with a speech therapist, for what Mr ENT describes as “the full package”. She is unable to determine if what she is hearing is due to the reason I was sent to her in the first place – vocal palsy resulting from cancer surgery – or laryngitis. We agree to leave it for a couple of weeks with the proviso that I will spend the intervening time blowing through a straw in a glass of water 10 times a day¹.
A week later and there’s no improvement. I see my GP this time. “It looks very angry down there; very red.” He diagnoses pharyngitis. This is just a fancy word for sore throat. I explain my concern about the injection. There’s a letter from Mr ENT to my GP on the computer screen. It describes how the third procedure showed much improvement in the closing of the vocal cords, apart from a ‘posterior chink’. A what?
I mull over this new addition to my medical lexicon. The mind boggles. Could it be as simple as a ‘gap at the back’? My GP is no expert on posterior chinks, so I leave it in case our musings take us down some totally inappropriate byway.
Apart from the substitution of a couple of letters, there’s a lot of difference between pharyngitis and laryngitis. My GP can see my pharynx – it’s the back of the throat – but cannot see into my larynx. But what he can see is ‘very angry and very red’. Given the length of time this has lasted he prescribes a wide spectrum antibiotic. “Things will be very loose”. He waits to see if I understand. I nod. I know all about very loose. You don’t live with an ileostomy bag without becoming an expert on very loose.
I recount all this to Annie when I get home. Her look (honed over many years of teaching) suggests that milking posterior chink for a few cheap laughs would not be appreciated. But I need to find out what it means. To my utter surprise Googling this phrase immediately takes me to a series of academic medical papers describing what I had surmised at the outset – a gap at the back of my larynx when my vocal cords are closed.
I find it very easy to become distracted when I’m Googling – a bit like being in a library. I’m wandering along the shelves looking for a particular book and my eye is drawn to another. And as soon as I’ve put that one down, up pops another and I end up miles from where I began.
During this particular search I come across ‘general vocal disorders and reflux’. It appears that stomach acid can cause real damage to the larynx. Further more – laryngo-pharyngeal reflux is common in 10% of the general population, but occurs in 46% of professional voice users. Why? Do professional voice users have a different diet or a different digestive system from the rest of us? I think back to some of the singers I’ve seen playing in pubs. Nerves, beer and smoke were never far away. Perhaps they do.
I return to my posterior chink – or as I discover, more correctly – posterior glottal chink (PGC). I eventually find what I’ve been looking for; a picture. And there it is – a small dark triangle at the back of the throat when the vocal cords are closed. Much like a pair of jeans that won’t quite do up. But what it all actually means is quite complex. I read through endless medical papers until I begin to lose the will to live. My inability to pin this down comes from the fact that the cause of PGC is so varied – perhaps trauma, as in damage to the vagus nerve (probably what happened in my case) or disease or a naturally occurring feature of a particular voice. It is also a subset of a general condition known as Vocal Cord Disorder.
As an aside, I also learn that the accepted spelling is ‘vocal cord’. Not ‘vocal chord’ as some think (and have pointed out to me – you know who you are). The original definition had nothing to do with music.
Most papers are concerned with treatment rather than effect. I find one example – complete with graphic details on video – of a thyroplasty. This is something I once considered; the insertion of a lump of plastic through the side of the neck to push the paralysed vocal cord towards its more mobile neighbour. Then I considered it a bit more. No.
It seems that the most common means of addressing VCD is speech therapy – hence ‘the full package’. The therapist explains that my voice has undergone two separate sets of trauma; the first from the damage caused by surgery and radiotherapy. The second results from me trying to accommodate this damage over the past 18 months by the way I’ve been speaking. I have much to learn. And it appears, much to unlearn.
The key to speaking (or singing) efficiently – i.e. without strain – is ensuring that there’s a clear column of air from the diaphragm to the voice box. That means paying attention to my posture, to my breathing and rehabilitating the muscles that form the voice box. It’s the latter that I find hard – how to exercise a muscle that you can’t see or feel? Yet people do – it’s something that professional voice users must do all the time.
The therapist was very surprised to hear that I’d not been offered respiratory physiotherapy following lung surgery. Given that I was riding an exercise bike just three days after the operation, perhaps they assumed I didn’t need it. So I’m stuck with blowing bubbles. I hum while blowing for ten repetitions, ten times a day. The exercise is designed to relax and strengthen the muscles of the larynx. After about a year I can expect to get the same effect without the straw.
There is absolutely no way of making this interesting. Although Annie does try, bless her. She is currently using the no-nag motivational technique, opting instead to leave glasses of water with straws at various locations around the house. This does not go unnoticed; following a couple of recent visits, Emma asks for an explanation. She is relieved – she had assumed that we’d both finally lost the plot – she thought we couldn’t remember where we’d left our drinks. Little does she know.