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fluctuation in voice/speech problems

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Kristina1

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I was hoping others with voice and speech changes could chime in here. I have a nasal tone to my voice all the time now, but sometimes it is much worse than other times. I also have trouble enunciating, and my speech can come out mumbled or slurred, but this too is better or worse at different times throughout the day or on different days. There is a threshold where my voice/speech never get "better" than that threshold, but as to how bad they get, there is definitely fluctuation.

I think part of it is that when I have more energy I can try really hard to enunciate with some success, but when I have less energy I just can't and it comes out much worse.

I also discovered this strange thing, months and months ago before ALS was on my radar, which is that when my voice is slurry and I am struggling to enunciate sounds, if I pinch my nostrils closed I can make the sounds come out a little more clearly. Does anyone else experience this?
 

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I definitely have fluctuations in terms of enunciation and fluency--can't quite figure out if it's related to energy level or other factors. It can vary from day to day and within a day, No nasal issues I'm conscious of. A glass of wine makes it worse.

Ed
 

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The hypernasal sound is due to the weakening of muscles in the face. The sound of your voice is due to the structures the air moves through as you speak. Those structures are changing and just like you get a change in voice tone when you have a cold, as the structures weaken it changes the tone of you voice. Pinching the nostril will be tightening some of the facial structures.

On the other hand I could cup my hand beside my nose, covering part of a cheek and put pressure on it and sound very similar to Chris in the early days of his speech issues. We were thinking there was a structural issue of some kind back then.

You are quite right that it can kind of seem to come and go. It doesn't get better, you are so right there, but is worse at times, usually when tired or stressed. At first my Chris would only slur for a few hours a day, this was well before we thought anything serious was wrong.
 

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Ed when Chris first started slurring it was always after a couple of sips of beer. He was never a 'drinker', usually a single beer was all he would have, and he would feel his mouth change within a first mouthfuls.
 

Kristina1

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interesting that you mention worse when stressed. I often test my speech out-loud to myself before making a phone call to make sure it is good enough that they will understand me. But often it will sound ok when I test, but then when I am actually on the phone trying to communicate just seconds later it is horrible! Now I am wondering if maybe that happens from the stress of performance anxiety- already being nervous about how well I will be understood.
 

Jlynn

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My brother Mikes voice fluctuates as well. His voice is more slurred when he's tired. He is no longer comfortable talking on the phone as he thinks he might not be understood.
 

DaChief

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Ed when Chris first started slurring it was always after a couple of sips of beer. He was never a 'drinker', usually a single beer was all he would have, and he would feel his mouth change within a first mouthfuls.
Mine started the same way. Only happened when I was drinking for a few months, then started at other times as well. That started a year and a half ago. Now it is all the time. It does get worse when I get tired though.

Bruce
 

faithandlove

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I sound raspy, like I have a cold. My caregiver has noticed that I have a difficult time with enunciation. I know how to pronounce the words, but it takes me a few seconds to get some of them out of my mouth correctly. I think it happens more when I am stressed and/or tired too. In my profession, I was a public speaker many times, and had planned to speak before Nevada Legislators this year to advocate for the Death with Dignity law. I can no longer plan to do this with my voice. I'm working on Plan B, and have an appointment with my Speech Therapist this month. I'm, also, extremely tired, and I believe it is because I have been hit with a lot of losses last week and this week. ALS -Always Losing Something

Hugs,
Deb
 

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faith do get checked over because raspy makes me wonder if it's breathing issues more than bulbar.

There are 2 issues PALS can have with voice. As the breathing declines the voice can become quieter, raspy etc

As the tongue and facial/throat muscles decline it becomes hypernasal and slurs.

DaChief, for Chris, slurring after a few sips of beer only happened for a couple of months too, then he started slurring at work. He ran his own cafe so he talked non-stop and it was very difficult as people were immediately asking him what was wrong. He also had emotional lability so he would go into fits of laughter and have to walk out the back.

His staff approached me very concerned about his bizarre behaviours and he started telling stories of slurring, spraying water everywhere when trying to drink and the laughter. I had never heard of ALS and was totally baffled as was he.

But this thread is about fluctuations - and in these very early months his slurring would be worse at times. But the big thing is that over just a few months it became steadily worse. It did not fluctuate in a way of saying it would get better for a while. It would simply be worse at different times of the day or under pressure or when really tired. As he progressed it became pretty much the same all day.

I think it's worth noting however that when there are a certain number of ancillary muscles helping ones that are failing this is always true. On a cold morning Chris's hands would be stiff and far worse than a few hours later as the day warmed up a bit. That's while his hands were functioning in most ways but were weak. So I think it's a similar thing.
 

kellykago

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Yes, I too have fluctuations. When I am well rested, by speech is much better. When I am tired or have talked alot, it becomes more difficult to enunciate. When it's cold, I have a harder time and get alot of chattering chin. I also have a nasal quality to my voice. I've had a cold and it makes it worse. I also have a hard time blowing my nose. It comes out of back of my throat.....
 

Firefighter58

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Hello everyone, I have had all of the symptoms talked about above and now I can not speak at all. I rely on a type to speak Ipad that works really well.
Al
 

Artist

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I too have had voice changes and some difficulty with enunciation. Try singing cuz sometimes that improves my speech for some unknown reason. I also practice whistling especially when I see birds. Also practice saying a - e- I - o - u and exaggerate the sounds and you facial muscles while saying the vowels!signed "artist"
 

tripete

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"As the breathing declines the voice can become quieter, raspy etc

As the tongue and facial/throat muscles decline it becomes hypernasal and slurs."

I have both of what Tillie has described. For two years now it has been primarily do to repository issues, weak voice and raspy especially when tired or stressed. Recently it has been "fat tongue" and slurring/blending of words.

Another factor is using the wrong words and words not coming to you. This more cognitive but still effects speech.
 

Smith2026

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My dad jyst had a swallow test done by the speech pathologist and she thought all was ok, and didn't recommend he have the swallow test that involved an X-ray. He has the raspy voice and his volume has gotten quieter since last spring. It is really, really noticeable when he is tired. The feed back on this thread is suggesting that it is more of a breathing issue rather than a swallowing on, and to get a breathing test done. What is actually measured in a breathing test, is it like a asthma breathing test that uses a peak flow meter or something more technical? We have a neurologist/rehab doctor on April 7th, should I be asking for this test?
 

Kristina1

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Smith, the breathing test they did with me, which as I understand it is the standard for ALS, was called the Pulmonary Function Test (PFT). My voice also gets hoarse and raspy now (which is new, and was not happening when I first wrote this thread). In my case I feel it is more like my voice is too tired/strained, like when a normal person is starting to loose their voice after having been shouting all day. Only for me it happens after having just been trying to speak normally for 20 minutes.
 
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