Voice Surgery for Vocal Fold Paralysis

 

You may have noticed some changes with the quality of your voice, from its former strength, to a now hoarse and breathy quality.  You may also notice that your ability to deliver quite a long speech before had now been limited to a few words before you feel like you are running out of breath. This condition is happen gradually or abruptly, but usually, the symptoms are very noticeable for one to take it for granted.

WHAT IS VOCAL FOLD PARALYSIS?

Vocal fold paralysis or what is also commonly known as vocal fold paralysis, is a voice disorder that occurs when one or both of the vocal folds don't open or close properly. While the incidence of single vocal fold paralysis is quite common, paralysis of both vocal folds can be life threatening.

If we go back to the anatomy of voice production, the vocal folds are the two elastic bands of muscle tissue located in the larynx (voice box) directly above the trachea (windpipe). When we breathe, our vocal folds remain apart and when we swallow, they are supposed to close tightly. When we speak or produce sound, air from our lungs causes our vocal folds to vibrate between open and closed positions.

Imagine if you have vocal fold paralysis, with one side affected, swallowing may be a bit difficult as the vocal folds will not be able to close fully, now if you have bilateral vocal fold paralysis, then it will not only be difficult but also dangerous in the sense that food or liquids could accidentally enter the trachea and lungs, which can cause serious health problems such as aspiration pneumonia or airway obstruction.

WHAT CAUSES VOCAL FOLD PARALYSIS?

The condition often results from nerve injury which can be caused by several factors such as viral infection, trauma due to surgery or accidents involving the neck, tumor on the neck or chest, intubation for surgery, and on some cases, idiopathic.

WHAT ARE THE SYMPTOMS OF VOCAL FOLD PARALYSIS?

Symptoms of vocal fold paralysis vary according to the severity of the nerve damage but the most common symptoms are vocal fatigue, effortful speech, breathy voice, inability to cough or clear throat, reduced vocal range (more evident for singers), and in more severe cases, frequent aspiration.

WHAT ARE THE TREATMENTS FOR VOCAL FOLD PARALYSIS?

At Yoskarn Clinic, Prof. Kunachak, our head surgeon, performs 3 types of procedures to remedy vocal fold paralysis. Being one of the most coveted ENT surgeons in Thailand, Prof. Kunachak has innovated techniques for the medialization of the paralyzed vocal fold.

The first one is the placement of an implant to bring the vocal fold closer together. This surgical procedure involves putting in a silicone or goretex implant to move the paralyzed vocal fold towards the midline position. The second technique, which we mostly recommend for patients, is the injection for fillers along the paralyzed vocal fold. Basically, the two techniques only have one goal, to bring the paralyzed vocal fold near the center to restore physiology of the vocal folds.

The third technique that Prof. Kunachak uses is the incorporation of stem cell to augment the vocal fold. Stem Cell as we all know, is a versatile type of cell that has the potential to differentiate to another type of cell therefore the potential to naturally augment the vocal fold as well.

WHAT IS THE RECOVERY PERIOD FOR EACH PROCEDURE?

Since the other 2 techniques (filler injection and stem cell therapy) are both minimal invasive in nature, these two procedures are the ones we highly recommend patients to consider. Voice rest will still be recommended for at least a week after surgery (speak only when necessary) but since there will be no incision for the fillers (only a small incision for the stem cell therapy if your own fat will be used), healing time will be faster.

For those opting for the implant, an incision will be made along the neck and suture removal will be done 7 days after surgery. After the procedure, patients are recommended to have voice rest for at least two weeks.

The use of the implant has been popular before since it is the most direct treatment for vocal fold paralysis, but, with the availability of the endoscopic machine to guide our modern surgeons, and with the same efficient result, more and more surgeons are choosing the less aggressive approach.