Phonosurgery (Voice Restoration Surgery)
Phonosurgery is a surgical procedure whose intent is to repair, alter, or improve the voice. The various possible procedures involved are relatively new, as the medical profession has only recently turned its attention to improving or repairing the human voice. Speech therapy can be effective in strengthening a weak or damaged voice, but oftentimes only surgery can fix the issues involved.
The term phonosurgery was first used in the 1960s. At Coastal ENT, it includes phonomicrosurgery, which is microsurgery of the vocal folds (cords) performed with an endoscope; and laryngoplastic phonosurgery, open-neck surgery to implant support materials into the vocal folds. Sometimes, laryngeal injections can also be used to provide support to the vocal tissues.
The goal in these procedures is to either remove growths on the vocal cords and surrounding tissues or to provide support to the vocal cords so they can close more firmly.
Modern endoscopic techniques, combined with microscopic magnification, have revolutionized surgery on benign vocal cord lesions without damaging the voice. Formerly, open direct laryngoscopy was performed, accessing the area through the front of the neck. But its lack of the delicate precision necessary often produced scarring on the vocal cords, damaging the voice.
With phonomicrosurgery, microflap surgery is used to remove the polyp or cyst. Microflap surgery is an improvement on conventional surgery, which results in a loss of a certain amount of normal, healthy tissue. In the case of the vocal cords, this loss of tissue damages the patient’s voice. In microflap surgery, a microscopic flap is elevated from the first layer of tissue (called the epithelium) and then the lesion is precisely dissected out. The epithelium is then draped back into position. By utilizing extreme magnification, the surgeons at Coastal ENT are able to take out the growth very precisely, vastly improving the chances of not damaging the vocal performance of the patient.
Laryngoplastic phonosurgery, also called thyroplasty, is a procedure where an implant, often made of Gore-Tex, is placed in the larynx alongside the vocal cord. This implant pushes the vocal cord closer to the middle. Why is this important? Both vocal cords need to touch in the middle in order to have a strong voice. The implant allows a paralyzed or weak vocal cord to reach the midline.
Thyroplasty is performed through a neck incision. The incision is small, one inch, and is needed to access the larynx. Then a small hole is made in the cartilage for the implant. The implant is placed, its position and the function of the vocal cords are checked, and then the patient is closed back up.
Since the procedure is performed with the patient under only local anesthesia, the performance of the patient’s voice can be monitored during the procedure to ensure proper placement of the implant.
Thyroplasty can also be performed to shorten the vocal cords to lower the pitch of the voice. This technique is used to address a developmental disorder known as puberty dysphonia, where a male suffers from a high-pitched, feminine level voice.
Done to address the same problem of weak or paralyzed vocal cords, injections are made into the tissues adjacent to the vocal cords. These injections “bulk up” the vocal tissues and bring the vocal cords closer together. Fat and collagen are the injection materials.
You No Longer Have to Live with Vocal Problems
Issues such as a weak voice, vocal instability, permanent hoarseness, and other vocal quality problems used to be something the patient often simply had to live with. Surgery could do more damage than good. But now, thanks to phonomicrosurgery and laryngoplastic phonosurgery, patients at Coastal Ear, Nose, and Throat can return their voices to their former full-throated glory.