An effective solution for hoarseness caused by vocal cord paralysis and condition after vocal cordectomy surgery
We are often not aware of the role and importance of our vocal cords for voice and speech. We start to worry about their health only when we notice the first problems. Sometimes these problems are solved with a few lozenges and hot tea, such as temporary hoarseness after going to a concert.
However, sometimes hoarseness, cracking of the voice or difficulty speaking can take a long time. Such chronic occurrence can be a sign of the development of disorders on your vocal cords; Polyps, nodules, tumors, cysts, edema and paralysis of the vocal cords are just some of the diagnoses that cause these symptoms.
Sometimes excess tissue needs to be removed (polyps), and sometimes it is necessary to add new fat tissue so that the vocal cords can produce sound properly (vocal cord paralysis).
Surgery to enlarge the vocal cords with adipose tissue is one of the common procedures in the field of laryngology, and its effectiveness enables the proper functioning of the vocal cords despite their paralysis or a thinned vocal cord that does not adhere well to the other vocal cord.
The vocal cords produce sound on the same principle as instruments; vibrations change the airflow and sound is produced.
Exhaled air travels from the lungs, reaches the trachea, and when talking or singing, the vocal cords connect and thus “push” the air through a smaller space. In addition to merging, the vocal cords begin to vibrate in sync, thus creating sound wavese.
The more the vocal cords are connected, the more they will vibrate and a higher frequency sound (squeaky voice) will be produced. Likewise, if the vocal cords are slightly further apart from each other, the vibrations will be weaker and the sound will be deeper and more penetrating.
When the vocal cords are completely apart, no sound can be produced. This is what happens under normal conditions when we are silent.
Vocal cord paralysis is related to the inability to move the vocal cords due to damage to the nerves that are responsible for innervating the muscles that move the vocal cords. The causes of this disorder can be injuries caused during surgical procedures, such as thyroid surgery, surgery, cyst, lymph node biopsy, vagal nerve schwannoma, cervical spine surgery or upper respiratory tract surgery.
In addition to surgical procedures, this disease can also be caused by tumors that press on the nerve and neurotropic viruses. However, in most cases, the cause of vocal cord paralysis remains unknown.
Paralysis of the vocal cords can be unilateral and bilateral. Unilateral paralysis is manifested by the movement of only one vocal cord when speaking. It can be recognized by poorer speech quality and chronic hoarseness.
Cervical spine surgeries, thyroid surgery, Lyme disease and viral neuronitis are responsible for unilateral paralysis of the vocal cords.
Bilateral paralysis is considered a much more dangerous disorder. In addition to preventing the production of sound, completely separated vocal cords can miss the passage of food into the trachea when swallowing.
Bilateral paralysis of the vocal cords most often occurs by surgery for formations in the neck and thyroid gland, as well as trauma caused by tracheal intubation.
Left vocal cord paralysis is more common in the left vocal cords. The left recurrent nerve is longer than the right, and its path from the brainstem to the larynx is at a higher risk of damage.
Although the exact cause is unknown, vocal cord paralysis is more common in women than in men.
At the Lohuis Filipović Polyclinic , we diagnose disorders of the vocal cords through several methods:
Using a flexible endoscope, we observe the area of the nose, pharynx, larynx and the initial part of the esophagus and thus determine the mobility of the vocal cords.
Video documentation of the anatomy of the vocal cords, throat and other surrounding structures gives us an insight into existing disorders.
Using a fiberoptic laryngoscope, the doctor examines your airways. The examination is performed under anesthesia, which makes you more relaxed and prevents the “gag” reflex. With a detailed examination, the doctor gets an insight into the structure of the vocal cords and larynx.
During laryngoscopy, the doctor may take a tissue sample from the vocal cords. This tissue is later analyzed under a microscope to detect abnormalities, such as tumors or cysts.
Augmentation is the name for a procedure in which various types of fillers are injected into the diseased vocal cord. The filler most often consists of adipose tissue, hyaluronic acid or calcium hydroxylapatite.
By injecting fillers, the vocal cords thicken and they can connect more easily when speaking.
It should be noted that vocal cord augmentation with a chemical filler is only a temporary solution. The reason for this is that sometimes the damaged nerve can recover, bringing the work of the vocal cords back to normal.
Recovery of the nerve is only possible if it is partially damaged or if it is stretched. Nerve recovery lasts from several weeks to several months, and is considered permanent only if the nerve, i.e. The vocal cord does not work for more than a year. However, if it is completely cut, the vocal cord remains paralyzed forever.
In cases of partial nerve damage, augmentation can be repeated several times. However, each subsequent time a smaller amount of filler will be needed due to the gradual return of the vocal cords to normal function.
Once the nerve has recovered and the vocal cords have reached their maximum capacity of action, augmentation can be performed by injecting adipose tissue. Adipose tissue will leave the vocal cords permanently thickened, although it can also partially atrophy (shrink) over time.
After the diagnostic examinations, our team of specialists in neck and head surgery and otorhinolaryngology provides you with guidelines for continuing to treat the detected problems.
In the case of surgery, you will be familiar with all the instructions that you must follow in order for the procedure to go without complications and for the recovery to be as fast as possible.
Since general anesthesia is used for vocal cord surgery, you will need to provide us with certain findings before the procedure, such as an ECG recording, laboratory results or even spirometry findings.
With these findings, we have an insight into your normal vital functions, which will serve us for comparison during vocal cord surgery.
If we notice any deviations due to the action of general anesthesia, such as rapid breathing and heart rate, your findings can alert us to the occurrence of possible complications.
In addition to the attached documentation, before the operation, you will sign a consent in which you will once again be informed in detail about the procedure for applying general anesthesia, the procedure of the operation and the complications that can occur during the procedure.
Before removing a polyp, be sure to adhere to the following guidelines:
If you suffer from blood clotting disorders, be sure to inform us about it so that we can decide on an adequate solution, or completely postpone the procedure.
Also, if any of your loved ones have allergic reactions to anesthesia, or if you have noticed similar problems during previous surgeries, please inform us so that we can adjust the methods of surgery.
Upon arrival at the clinic, you will lie down at the operating table. The anesthesiologist gives you general anesthesia after which you will be in an unconscious state. Due to general anesthesia, the operation will be painless and you will not remember it at all.
During the procedure, the anesthesiologist will observe your vital functions and react if he notices something that could indicate complications.
Once the general anesthesia begins to work, augmentation can begin.
The surgeon passes an operating microscope or fiberendoscope through the upper airway to see the vocal cords clearly.
After locating the vocal cords, the probe is retracted, which has a needle at the tip. The probe is connected to a flexible tube through which hyaluronic acid or adipose tissue will be injected.
In the case of fat injection , it is removed from your abdominal wall, separated from the connective tissue and shredded, i.e. filtered into small segments. The adipose tissue is then injected into the vocal cords with a special applicator.
The needle is placed 5-7mm deep into the vocal cord and then adipose tissue is injected.
Adipose tissue augmentation does not last longer than 30 minutes, and after the procedure you can go home to recover.
After the surgery to enlarge the vocal cords, you were released home the same day. However, following the instructions we have given you can play a big role between proper healing and the occurrence of complications.
After the operation, you can resume your daily activities, with minimal strain. Any kind of strain can irritate the wounds on the vocal cords and encourage the development of complications.
Depending on the severity of the surgery, you should not make any sounds from 7 days after the surgery. In other words, even whispering or talking softly is not allowed.
Your diet must be as light as possible and of poor integrity; Avoid foods that are chewed a lot, as well as swallowing large bites. In the beginning, you will like foods such as yogurt, ice cream or pudding the most.
Likewise, you avoid hot drinks and food. The high temperature of food and drink can cause blood vessels to dilate and open wounds.
After the recovery of the vocal cords, exercises with a speech therapist will follow to get your vocal cords back in shape as quickly as possible.
After augmentation, you may encounter side effects typical of any surgery, such as bleeding, infection, or an allergic reaction to anesthesia.
However, there are several other side effects associated with vocal cord surgery:
At the Lohuis Filipović Polyclinic , we perform procedures on a daily basis that make your voice more beautiful and your vocal cords healthier.
Paralysis of the vocal cords can be a problem that often goes “under the radar” due to symptoms that are associated with problems such as a cold or hoarseness due to too much exertion.
However, if you notice that your speech becomes more difficult over time and that hoarseness has not passed, by making an appointment for an examination, we will have a clear insight into the health of your vocal cords.
So, don’t wait and make an appointment today; Call us at +3851 2444 646 or fill out our online form.
The main goal of LF Polyclinic is to improve the quality of life and health of our clients by providing them with top-notch healthcare services.
