Vocal Cord Surgery for Hoarseness

What are vocal cords?

Vocal cords, or vocal folds, are paired structures located on the lateral walls of the larynx, responsible for sound production. Voice is created by the vibration of the vocal cords due to the air current during exhalation. Pathological conditions of the vocal cords or the nerves that control them can lead to difficulties in sound production or voice abnormalities (hoarseness, loss of voice). When dysfunction or pathology cannot be treated conservatively, vocal cord surgery is indicated.

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What is vocal cord surgery?

Vocal cord surgery is a surgical procedure aimed at restoring optimal vocal function.

Surgical approaches include:

Phonosurgery: Removal of lesions or pathological formations on the vocal cords using microsurgical techniques and, if necessary, laser (e.g., polyp surgery).
Injection laryngoplasty: Injection of the patient’s own fat tissue or hyaluronic acid preparations into the vocal cord. This is done in cases of unilateral (one-sided) paralysis or atrophy of the vocal cords to bring the non-functional vocal cord closer to the other, thus improving glottis closure—the opening between the vocal cords.
Thyroplasty: Implantation of implants (medical silicone, hydroxyapatite, Gore-Tex implant) into the vocal cord through an external neck incision. This is applied in severe cases of incomplete glottis closure (> 3 mm).

When is vocal cord surgery needed?

Indications for vocal cord surgery include:

Pathological formations on the vocal cords (polyps, nodules, cysts, granulomas, Reinke’s edema, tumors, etc.)
Glottal insufficiency—imperfect closure of the vocal cords during voice production, which can cause hoarseness and difficulty swallowing, and in some cases, infections due to frequent aspiration (inhalation of foreign substances or particles).

The most common causes of glottal insufficiency are unilateral paralysis and paresis of the vocal cords—complete or partial immobility of the vocal cord.

(Bilateral vocal cord paralysis is a potentially life-threatening condition where the airway is compromised and is treated urgently.)

The two most common symptoms indicating vocal cord pathology are hoarseness and loss of voice. Two groups of patients at increased risk of such issues are:

Voice professionals such as teachers, caregivers, singers, actors
People exposing their vocal cords to harmful environmental influences (tobacco smoke).

In the case of vocal cord paralysis, the following symptoms may also occur:

Chronic cough
Difficulty swallowing
Frequent need to “clear the throat”
Shortness of breath while speaking

Vocal cord pathology can also be caused by laryngopharyngeal reflux—regurgitation of stomach contents through the esophagus to the pharynx and larynx. Besides hoarseness and loss of voice, symptoms can include voice fatigue, a sensation of a lump, increased mucus production in the throat, throat burning, and a bitter taste in the mouth.

Vocal cord surgery is indicated by a specialist otorhinolaryngologist during an ENT examination. For recurring voice/vocal cord problems, detailed diagnostics, including stroboscopy—a method to analyze vocal cord vibrations—is performed, and the type of treatment is decided:

Conservative, which includes speech therapy exercises or
surgical.

Procedure overview

Surgical procedures vary depending on vocal cord pathology.

In the presence of pathological lesions (e.g., polyp surgery) on the vocal cords, phonosurgery is performed, removing them under general anesthesia. The patient is in a supine position with the head in hyperextension (tilted back). A laryngoscope is inserted into the mouth to visualize the vocal cords, and necessary endoscopic instruments are introduced through it for excision of the formation. A laser is used for excision or ablation if needed.

Injection laryngoplasty, treating vocal cord paralysis, can be performed under local anesthesia injected percutaneously just below the vocal cords. A fiber-optic endoscope is inserted through the nose to visualize the vocal cords, and then a special needle is used to inject the substance into the paralyzed vocal cord percutaneously.

Thyroplasty can also be performed under local anesthesia, involving a small neck incision through which an implant is placed into the paralyzed vocal cord.

Preparation for vocal cord surgery

Before a procedure under general anesthesia, follow standard preoperative steps including:

Blood tests, EKG, and a consultation with the anesthesiologist
No food or drink 8 hours before the procedure.

Avoid taking medications that affect blood clotting (Andol, Aspirin) and nonsteroidal anti-inflammatory painkillers (Brufen, Voltaren, Ketonal, etc.) 2 weeks before the procedure.

Recovery from vocal cord surgery

Patients recover quickly after vocal cord surgery and usually go home the same or the next day. Voice rest depends on the type and extent of the procedure.

For faster recovery, it’s recommended to drink enough fluids to moisten the throat and reduce discomfort. Eat soft foods for the first few days to reduce irritation of the operated area.

If diagnosed with acid reflux, take prescribed medications and avoid foods that cause exacerbation.

Avoid alcohol and cigarettes for a week

and strenuous physical activity and straining for two weeks after the procedure.

Speech therapy for speech rehabilitation and optimizing vocal function may be indicated as needed.