intermittent hoarseness

Dear Dr. Thomas

Thanks for your video's and website, they are both very informative.

I am 38 yr old male living in London, UK. My voice has progressively become a problem over the last 6 years. It is now quite bad in that it feels weak, raspy and breathy and it is having a huge impact on my life personally and professionaly. I have seen 2 ENT's over the last 6 years. The first diagnosis was reflux and the second was spasmodic dysphonia, neither medication nor botox injections resolved the voice problem. I am still searching for an accurate diagnosis.

What baffles me most of all is the intermittent nature of the problem. My voice seems to be good on some days (usually early on in the week and weekends and really bad on Thursdays and Fridays. Also, my voice returns to normal (within roughly 24 hours) when I am out of the UK on holiday / travelling. There is very little difference in my diet when I am in the UK or away. This makes me wonder whether the problem is mechanical, environmental or psychosomatic or something else entirely.

I am asthmatic, I try to use my inhalers as little as possible and gargle after each use.

My question are: Which voice conditions present as having intermittent symptoms? Could vocal cord paresis or other mechanical issues be intermittent? Would a 24hr pH test be beneficial?

Thanks again

Regards