Vocal Cord Surgery

The human voice is a remarkable instrument, capable of expressing emotions, conveying ideas, and connecting people across cultures and generations. It is an essential tool for communication, enabling us to share our thoughts, feelings, and experiences with the world. However, there are instances when our vocal cords may become damaged or impaired, affecting our ability to speak or sing. In such cases, vocal cord surgery offers a glimmer of hope, a chance to reclaim the power of our voice. 

Importance of Vocal Cord Surgery

Vocal cord surgery is a medical procedure aimed at improving or restoring the function of the vocal cords. The vocal cords, also known as vocal folds, are two small muscles in the larynx that vibrate to produce sound during speech or singing. When the vocal cords are damaged or impaired, it can affect a person's ability to speak, sing, or even breathe properly.

Vocal cord surgery plays a crucial role in treating various conditions that affect the vocal cords. The goal of the surgery is to correct any abnormalities or repair damaged vocal cords, ultimately improving the voice quality and overall functioning of the voice box. The specific type of surgery recommended will depend on the underlying condition and the severity of the vocal cord problem.

Common Conditions Requiring Vocal Cord Surgery

There are several common conditions that may require vocal cord surgery. These conditions can range from benign growths to more serious abnormalities affecting the vocal cords. Some of the most common conditions requiring vocal cord surgery include:

1. Vocal Cord Polyps: Polyps are noncancerous growths that can develop on the vocal cords due to vocal strain, chronic laryngitis, or vocal cord abuse. Surgery may be necessary to remove the polyp and restore normal vocal cord function.
2. Vocal Cord Nodules: Nodules are small, callous-like growths that form on the vocal cords due to vocal overuse or misuse. In severe cases, surgical intervention may be required to remove the nodules and improve voice quality.
3. Vocal Cord Paralysis: Vocal cord paralysis occurs when one or both vocal cords are unable to move properly. Surgical procedures such as vocal cord injection or medialization may be performed to restore movement and improve voice function.
4. Vocal Cord Cancer: In some cases, vocal cord cancer may require surgical removal of the affected tissue or the entire vocal cord. This is typically done in combination with other treatments such as radiation or chemotherapy.
5. Vocal Cord Hemorrhage: A vocal cord hemorrhage is a rupture in the blood vessels of the vocal cord, often caused by excessive vocal strain. Surgery may be necessary to repair the damaged blood vessels and prevent further complications.
6. Laryngeal Papilloma: A condition characterized by wart-like growths on the vocal cords caused by Human Papillomavirus (HPV).

It's important to note that not all vocal cord conditions require surgery. In some cases, nonsurgical treatments such as voice therapy or medication may be sufficient to improve vocal cord function. If you suspect you have a vocal cord problem, it's best to consult with a medical professional who specializes in voice disorders. They can evaluate your condition and recommend the most appropriate treatment options, including vocal cord surgery if necessary.

Types of Vocal Cord Surgery

If you are considering vocal cord surgery, it is important to understand the different types of procedures available. Here are three common types of vocal cord surgery:

Phonosurgery

Phonosurgery is a broad term that encompasses a range of surgical procedures aimed at improving voice quality and function. This type of surgery is often used to treat vocal cord nodules, polyps, cysts, and other benign vocal cord lesions. Some common procedures performed during phonosurgery include:

• Vocal cord microflap surgery: This procedure involves removing and reshaping a small portion of the vocal cord tissue to improve vocal fold closure and reduce voice strain.
• Vocal cord injection: In some cases, vocal cord injections can be used to correct vocal cord weakness or improve vocal cord closure. This involves injecting substances, such as collagen or fat, into the vocal cords to improve their function.

Microlaryngeal Surgery

Microlaryngeal surgery is a minimally invasive procedure that uses specialized surgical instruments to treat various vocal cord conditions. This type of surgery is often performed under general anesthesia and involves using a microscope to visualize and access the vocal cords. Some common microlaryngeal procedures include:

• Vocal cord polyp or nodule removal: During microlaryngeal surgery, the surgeon can remove vocal cord polyps or nodules using laser technology or other surgical instruments.
• Vocal cord scar tissue removal: This procedure is performed to remove excess scar tissue that may be interfering with vocal cord function.

Injection Laryngoplasty

Injection laryngoplasty is a procedure that involves injecting a substance, such as hyaluronic acid or calcium hydroxyapatite, into the vocal cords to improve vocal cord closure. This can be used to treat vocal cord paralysis or weakness and improve voice quality.

It is essential to consult with an experienced laryngologist who specializes in voice disorders to determine the most appropriate treatment plan for your specific condition.

Preparing for Vocal Cord Surgery

Consultation with an Otolaryngologist

If you are considering vocal cord surgery, it is essential to schedule a consultation with an otolaryngologist, also known as an ear, nose, and throat (ENT) specialist. During this consultation, the specialist will evaluate your condition and determine if vocal cord surgery is the right option for you. They will also discuss the procedure, potential risks, and expected outcomes.

Preoperative Evaluations

Before vocal cord surgery, you may need to undergo several preoperative evaluations, which may include:

1. Physical Examination: Your otolaryngologist will perform a thorough physical examination to assess the health of your vocal cords and surrounding structures.
2. Voice Evaluation: A speech-language pathologist may conduct a voice evaluation to assess your voice quality, pitch, volume, and overall vocal function.
3. Laryngoscopy: This procedure involves the use of a flexible scope or a laryngoscope to visualize your vocal cords and assess their movement and any abnormalities.
4. Imaging Tests: In some cases, imaging tests such as an ultrasound, CT scan, or MRI may be required to provide a detailed view of your vocal cords and surrounding structures.

These preoperative evaluations help the medical team personalize the surgical approach and determine the best course of action to address your specific vocal cord concerns.

Vocal Cord Surgery Procedures

Vocal Cord Polyp or Nodule Removal

Vocal cord polyps and nodules are common conditions that can affect the voice, causing hoarseness and other voice-related issues. In some cases, these growths may need to be surgically removed to restore proper vocal cord function. The procedure involves the following steps:

• Preparation: The patient will be given anesthesia to ensure comfort during the procedure.
• Visualization: Using a laryngoscope, the surgeon will examine the vocal cords to locate and assess the polyps or nodules.
• Removal: The surgeon will carefully excise the polyps or nodules, using micro-instruments to minimize tissue damage.
• Closure: Once the growths are removed, any potential bleeding is controlled, and the incision is closed using dissolvable stitches.
• Recovery: After the procedure, the patient will be monitored in a recovery area and given instructions for post-operative care, including voice rest and specific exercises to promote healing.

Vocal Cord Paralysis Treatment

Vocal cord paralysis is a condition that occurs when the nerves controlling the movement of the vocal cords are damaged. Surgical intervention may be necessary to restore proper vocal cord function. The treatment options for vocal cord paralysis may include:

• Vocal Fold Medialization: This procedure involves moving the paralyzed vocal cord towards the middle of the airway to improve vocal cord closure. It is typically done using an implant or injection.
• Vocal Fold Injection: In this procedure, a bulking agent or injectable material is injected into the paralyzed vocal cord. This helps to improve vocal cord closure and restore voice function.
• Vocal Fold Reinnervation: This surgical technique involves restoring nerve function to the paralyzed vocal cord. It may involve transferring nerves from another area of the body or re-routing existing nerves to provide innervation to the vocal cord.
• Rehabilitation: After surgery, rehabilitation therapy may be recommended to strengthen the vocal cords and improve voice quality.

It is essential to consult with a qualified ear, nose, and throat (ENT) specialist or laryngologist to determine the most appropriate surgical approach based on individual circumstances and needs. Vocal cord surgery can help restore normal voice function and improve quality of life for individuals with vocal cord issues.

Potential Risks and Complications

As with any surgical procedure, vocal cord surgery carries certain risks. These may include:



• Voice Changes: Temporary or permanent changes in voice quality, pitch, or volume.
• Bleeding or Infection: Although rare, these complications can occur following surgery.
• Scar Tissue Formation: In some cases, scar tissue may develop on the vocal cords and affect their function.
• Breathing Difficulties: Rarely, there may be temporary breathing difficulties due to swelling.
  

Recovery and Rehabilitation

After vocal cord surgery, it is important to allow your vocal cords to heal properly. Here are some general guidelines:

Voice Rest: Your doctor will likely advise you to rest your voice for a period of time following surgery.

Speech Therapy: Working with a speech-language pathologist can help you regain strength, improve vocal range, and learn proper vocal techniques.

Follow-up Care: Regular follow-up appointments with your surgeon are essential to monitor healing progress and address any concerns.

Conclusion

If you are experiencing voice-related issues that affect your daily life or profession, vocal cord surgery may be a viable treatment option for you. By understanding the basics of vocal cord surgery and working closely with your healthcare team during the recovery process, you can increase the chances of achieving optimal results.

Medical Reviewers

ENT Care Centers | ENT Health Library

Last Review Date: July 2023

Content Reviewers:

• Dr. Jeffrey Nau, MD
• Dr. Joseph J. Creely, MD
• Dr. Bryan Murphy, MD
• Dr. Thomas Higgins, MD, MSPH
• Dr. Elizabeth Burckardt, MD