Information for patients
What is Phonosurgery?
The term phonosurgery pertains to any surgical procedure performed with the aim of improving quality of the voice.
Voice is the result of vibration of two delicate structures: The vocal folds (Figure 1).
In order to produce a good voice several conditions have to be met: The neuromuscular system must work properly, so the vocal folds open when we are breathing, and close when we swallow, cough, clear our throat, make an effort (as when lifting weight), or when we speak or sing. In order to produce voice the vocal folds come together and air passes through them generating vibration (Video 1)
There are many individual anatomical factors and health conditions (Figures 2,3,4,5,6) that affect the mechanical properties of the vocal folds causing vibration impairment. Any change on vibration will produce a change in voice quality. Surgical interventions might be necessary to facilitate flawless vibration.
There is a wide range of surgical techniques, and choosing the best option depends on many variables, such as the cause of the problem, the extent of it, the experience and training of the surgeon, the availability of instrumentation and so on.
The one most commonly used is Phonomicrosurgery: A series of delicate, very precise surgeries, performed under general anesthesia with very small instruments or laser beams through a laryngoscope (a metal tube that goes down the throat, up to the level of the vocal folds), with the aid of a microscope.
In other cases it is necessary to modify the position of the cartilages that constitute the framework where the vocal folds are located so those changes facilitate adequate contact between them in order to facilitate easy vibration and voice quality improvement.
Laryngologists also deal with consequences of trauma of the larynx and the vocal folds.
Figure 1
The vocal folds (Ideal configurations) Courtesy of Instituto de Laringología.
Figure 2
Anatomical factors and health conditions. Papillomas of the vocal folds. Courtesy of Instituto de Laringología.
Figure 3
Anatomical factors and health conditions. Congenital web and vocal fold scars. Courtesy of Instituto de Laringología.
Figure 4
Anatomical factors and health conditions. Sub epithelial cyst. Courtesy of Instituto de Laringología.
Figure 5
Anatomical factors and health conditions. Sulvus-Vocalis. Courtesy of Instituto de Laringología.
Figure 6
Anatomical factors and health conditions. Vocal fold carcinoma. Courtesy of Instituto de Laringología.
What kind of specialist performs phonosurgery?
Phonosurgery is a sub specialty of Otolaryngology. The vocal folds are two small, very delicate structures that should only be treated by highly trained specialists, with delicate and fine instruments, in surgical settings where state of the art diagnostic and therapeutic tools are available, in order to ensure that the best possible results are obtained.
What other disciplines are related?
Anesthesiologists: The vocal folds are the valve that protect the airway, and through them anesthesiologists pass tubes to ensure ventilation and oxygenation during any surgical procedure under general anesthesia. In any surgical procedure to treat the vocal folds, the anesthesiologist and the surgeon are basically working together in a very small space, so precise coordination and collaboration are of keen importance.
Voice therapists: Professionals who work on behavioral changes to facilitate voice emission, and also promote life style changes and apply different techniques, proven to be effective to reduce hoarseness and improve voice quality. In many cases voice therapy is the first line of treatment. They also work on rehabilitation and training after surgical procedures on the vocal folds, and in the routine management and training of professional voice users (singers, speakers, preachers, etc).
Voice scientists: Current medical knowledge in the field of phonosurgery and voice rehabilitation is the result of the continuous and innovative lab work in models or in excised larynges, in tissue engineering, physics, aerodynamics and all other related aspects of voice production.
Surgical nurses: Surgeons need the constant assistance of highly trained personnel in the operating room. Surgical nurses are a key element of a machinery that must run perfectly to improve te odds of good results.
Voice teachers and voice coaches: Vocal demands in the modern world, either for speaking or singing voice, are constantly increasing. Proper guidance and implementation of techniques that ensure the best use and adaptation of the voice to the required circumstances are an important part of professional success.
It is clear nowadays that maintaining, improving or recovering a good quality of the voice is a challenging task that demands team work. The International Association of Phonosurgery gathers voice surgeons and scientists of related disciplines, devoted to promote better voice care around the world.