Q) What is meant by Phonosurgery?
A) Surgical procedures that restore, maintain or enhance the human voice, are collectively known as Phonosurgery (“phono” refers to voice)
Q) When is this type of surgery indicated?
A) Many conditions that affect the voice box (Larynx) need to be treated surgically. These can be of different types such as benign growth on the vocal cord, paralysis of the vocal cord, abnormal vocal cord muscle movement etc.
Q) Is surgery the only option in such cases?
A) Not always. Many patients with voice problems improve with voice therapy. But when this does not work, or there is a growth which has to be removed, surgery becomes the option.
Q) How is this surgery done?
A) This being a group of surgeries, there are many types and accordingly, different methods.
The most common condition is a benign growth on the vocal cord (cyst or polyp). The procedure to remove this is called microlaryngeal surgery (MLS). This is done endoscopically, under general anaesthesia, whereby a scope is passed per orally, and guided by a microscope or endoscope, precise excision of the growth is done, taking care to cause minimal surgical damage to the all-important medial edge of the vocal cord.
Then, there is a reverse type of condition where there is some deficiency in the vocal cord structure (sulcus or atrophy). This has to be filled up (augmented) using either the patient’s own fat tissue or external material. Here also, the approach is endoscopic, under general anaesthesia.
When there is a paralysed vocal cord causing a weak voice, the corrective procedure entails an external (neck) approach, under local anaesthesia, and placing an implant to push the paralysed cord.
All the above cases are done in the operation theatre. However, there are some cases, whereby some material is injected into the vocal cord to improve its function, which is done in the out-patient department itself.
Q) What are the success rates of these procedures?
A) Again, there cannot be a common answer to all the above types. The first type (removal of a benign growth) usually has the best success rate (nearly 100%). All the others too have very good success rates. A word of caution here is that ultimately, it is one’s subsequent voice usage that also decides the success rate!
Q) Are there any complications?
A) Considering the variety of procedures mentioned, Phonosurgery is generally safe, and without any undue complications, except the minor ones that are usually associated with surgery and anaesthesia. These usually do not have any long-term effect on the patient. Overall, Phonosurgery gives a definite lift – to the patient’s voice, and to the treating laryngologist!
Dr. Unnikrishnan Menon, MS DNB
Clinical Associate Professor – ENT
Amrita Institute of Medical Sciences, Kochi, Kerala