Voice therapy usually is sufficient to improve glottic insufficiency for most patients; however, some people may need more invasive help to close a particularly large gap in the vocal folds or because of the failure of voice therapy to provide adequate improvement to meet the needs of the patient.
Explore This IssueMarch 2008
The fourth and final step in the voice lift therapy process, according to Dr. Sataloff’s schema, is surgery. There are several approaches to surgery, but the basic principle of all of them is to bring the vocal folds closer together, so that when people exert minimal effort, instead of having a gap and flabby partial closure, they have good, firm, redundant closure for a little effort, said Dr. Sataloff.
Two main surgical approaches are used to bring the vocal folds together: injection laryngoplasty or thyroplasty. The most common first approach used is injection therapy, in which filler such as collagen, fat, or hydroxyapatite is injected into the larynx to bulk up the vocal folds. Thyroplasty is often used to correct large vocal fold gaps, and consists of an implant placed through a small incision in the neck to compress the laryngeal tissues. According to Dr. Sataloff, it takes a great deal of skill and experience to determine when to use which approach.
If someone has vocal folds that are almost completely closed and just a little gap and flabbiness and a lack of resistance, then often injecting a little filler to bulk up the vocal folds is the ideal methodology, he said. Although, he said, a disadvantage of this approach is the frequent need to repeat the procedure several times to obtain permanent closure, he also emphasized the need at times to intentionally use only temporary fillers.
If you’re not sure how a filler will work or if the patient is not certain he or she wants it done, there are temporary substances that we can inject that are gone in anywhere from five weeks to six months, depending on what we choose to inject, he said, adding that temporary fillers are also good for patients with temporary vocal fold paralysis who cannot wait for their voice to recover on its own, such as radio announcers.
Thyroplasty, or external implants, he observed, is often reserved for people with large vocal fold gaps, although this approach too has complications, including shifting implants and, more rarely, infection or rejection.
©2008 The Triological Society