Laryngeal and Voice Surgery

Phonosurgery

Not every vocal fold lesion needs surgery, and for some the first-line treatment is voice therapy. When surgery is the right step, the aim is the least tissue disturbance that solves the problem. The layered structure of the vocal fold is unforgiving: taking too much, or working in the wrong plane, trades one voice problem for another. We plan each case around preserving the vibrating layer, and we are candid when the honest recommendation is to treat conservatively first, or to accept a lesion that does not need removing.

Where a procedure can be done awake in the clinic instead of the theatre, we consider that route first. Voice surgery describes the operations that do need the exposure and control of the operating room.

Who this is for

Phonosurgery is considered for benign lesions of the vocal folds that cause persistent voice change and have not resolved with therapy: nodules, polyps, cysts, Reinke's oedema, papilloma, and scar or sulcus in selected cases. It is also used to take biopsies of suspicious lesions. Referring physicians send patients with a hoarse voice that has not settled, or a lesion seen on examination that needs tissue diagnosis. Where a lesion proves to be premalignant or malignant, care follows a different pathway, described on Laryngeal Precancer and Cancer.

The decision to operate follows a full assessment with stroboscopy, and, for many benign lesions, a trial of voice therapy first.

What the procedure involves

Microlaryngeal surgery is performed under general anaesthesia. The surgeon reaches the vocal folds through the mouth, with no external incision, using a microscope and fine instruments or a laser. The lesion is removed or corrected with attention to the surrounding layers. The operation itself is usually short. Because there is no external wound, the visible recovery is quick, but the voice needs time and rest to settle.

Evidence and experience

Microlaryngeal phonosurgery is a long-established set of techniques with a broad literature. At this institute it sits alongside a large office-based practice, and the choice between the two settings is made case by case rather than by default.

What to expect afterwards

Most patients are advised a period of voice rest after surgery, followed by voice therapy to consolidate the result. The voice often sounds worse before it improves, as swelling settles over days to weeks. For benign lesions the outlook is generally good, though some conditions, such as papilloma, can recur and need repeat treatment, and scar-related problems improve less predictably than discrete lesions. We give each patient a specific expected timeline and are clear about which conditions carry a risk of recurrence.