My husband has been diagnosed with the Epstein-Barr virus. He is a singer and has not been able to talk normally for about two months now. His doctor said his voice box was inflamed but really did not seem too concerned. Will his voice return to normal? If so, how long does this usually take? Is this common in EBV? My daughter and I were diagnosed with EBV about two years ago, but we never lost our voices like he has.

B.J.

Infection with Epstein-Barr virus (EBV) is commonly called infectious mononucleosis, or mono. It has been called "the kissing disease," since the virus is passed in saliva and may be spread to other people through intimate oral contact. Mono used to be called "glandular fever," owing to the common symptoms of fever and enlarged lymph nodes.

Infections tend to cause different symptoms in different patients, and mono is no exception. Many patients are never diagnosed. A woman with very mild symptoms (fever, sore throat, enlarged lymph nodes in the neck) might assume she has a cold or flu and may not seek medical attention. Another woman might see her doctor, only to be told, "It's just a cold." If EBV is not considered (and tested for), the diagnosis will not be made. Thus, it is likely that only the most severe cases of mono are detected.

Some patients come to the doctor with severe redness and swelling of the throat; the tonsils may swell to enormous size, even to the point of suffocation. Some patients develop enlargement of the liver and spleen. The spleen may swell to the point of rupture; this is a rare but lethal complication of mono. Patients with enlarged spleens due to mono must show caution with intense physical activity (such as contact sports) for this reason. The heart, lung and kidneys are usually spared. Pneumonia and meningitis may occur but are uncommon complications.

There is an unfortunate belief among doctors and patients that recovery from mono will take months. This belief stems from the fact that a few patients do have prolonged recoveries, remaining fatigued and depressed for several months. Despite this, the majority of patients recover within three to four weeks.

What about your husband's voice? I suspect that his doctor is correct; your husband may have residual edema (swelling) of the vocal cord mucosa. This could be readily detected by simple inspection: An ear, nose and throat doctor (ENT) could examine your husband's vocal cords and see whether they are swollen. This could be done using a small mirror, but many ENTs prefer using a fiberoptic telescope, since this allows for a lengthier and more detailed examination.

If his vocal cords are swollen, then he should take conservative measures to restore the health of his larynx. These measures, along with "tincture of time," should lead to an improvement in his voice. I would not recommend a do-it-yourself approach, however; too much is at stake. He should certainly work with an ENT and a speech therapist to optimize his chances for a good recovery.