Facts About Yeast And The Voice
Yeast are microscopic fungi. Candida is a type of yeast. There are at least twenty species of Candida which can cause infections in humans, but Candida Albicans is the most common. Candidiasis, which is also often referred to as thrush, is a fungal infection caused by this specific yeast.
Candidiasis affecting the oral cavity, pharynx or larynx can be particularly problematic for professional voice users such as actors, singers and public speakers. It is a frequently made diagnosis by laryngologists.
We must remember that yeast is common in the environment. Most of us have yeast in our mouths. If cultures were done looking for yeast on the majority of the population, they may show up as positive for at least a small amount of the organisms.
Historically, yeast infections of the mouth or throat have been rare in people with normal immune systems. Patients with immune suppression due to chemotherapy or certain disease states were more likely to develop yeast infections. Diabetics are also more likely to have this problem. With the increased use of broad spectrum antibiotics as well as use of steroids or steroid inhalers, we are seeing greater numbers of patients develop yeast infections. If two or three of these medications are used together, there is a much greater likelihood of developing candidiasis.
These infections, which occur when there is unrestrained growth of the fungus, can be tricky to diagnose. Symptoms include a sore throat, scratchiness, bad taste in the mouth, difficulty swallowing, throat clearing, laryngitis or other voice changes. It should be noted that these symptoms can also occur from a multitude of other problems.
A full work up is necessary to confirm or rule out whether yeast is present or more important, whether it is really the partial or full cause of the problem. Yeast can sometimes be diagnosed by examination. White patches on the mucosa, a coating on the tongue or white patch like lesions on the vocal cords make the diagnosis probable. Cultures can be done, but because yeast often grows slowly, a culture specifically looking for it may take up to two weeks until results are available.
Yeast that affects only the mucosa of the mouth and throat can be treated with a topical rinse or lozenges. If there is true laryngeal candidiasis, an oral medication such as fluconazole or ketoconazole must be used. If the infection goes untreated, it can worsen or spread.
The appearance can often mimic leukoplakia or cancer, leading to possibilities of misdiagnosis. If there is no visible response to treatment, a biopsy must be recommended.
In the practice of laryngology, yeast has become a very frequently made diagnosis. Patients are often put on multiple courses or antifungals and placed on stringent diets. Although I agree that yeast can and is a problem in many patients, I do think there is an issue with over diagnosis or over emphasis of its primary role in throat and voice problems. As always, I recommend an exhaustive search for the root of a problem.
If something is labeled as simply due to yeast, many other etiologies could be missed. As laryngologists, we owe it to our patients to consider any and all contributing factors in making a proper diagnosis and formulating an appropriate treatment.