Surgical Treatment for Voice Disorders
In some cases, surgery is the best option for treating a voice, swallowing, or airway-related condition. At NYU Langone’s Voice Center, our surgeons are experts at providing care that treats the underlying condition while also preserving your vocal quality.
In-Office Laryngeal Laser Procedures
We are pioneers in performing in-office laryngeal laser procedures, offering a minimally invasive option for a variety of vocal cord conditions. We conduct these procedures in a comfortable office setting, avoiding the need for general anesthesia and the associated risks and recovery time.
In-office laryngeal laser procedures involve using a laser beam to treat lesions or abnormalities on the vocal cords. The procedure begins with the administration of a local anesthetic to numb the throat and vocal cords. A flexible laryngoscope, a thin tube with a light and camera, is inserted through the nose to visualize the vocal cords. The laser fiber is then passed through the laryngoscope to precisely target and treat the affected area. The entire process is guided by a video screen, allowing the physician to accurately control the laser and minimize damage to surrounding tissues.
We perform in-office laryngeal laser procedures for a range of conditions affecting the vocal cords, including:
- benign growths, or vocal cord polyps, that can cause hoarseness and voice changes
- wart-like lesions caused by the human papillomavirus (HPV), known as recurrent respiratory papillomatosis (RRP)
- precancerous changes to the surface of the vocal cords called leukoplakia and dysplasia
- vascular lesions that can cause bleeding and voice changes
- inflammatory lesions, known as granulomas, that can result from irritation or injury
Postoperative Care and Instructions
After an in-office laryngeal laser procedure, people can typically resume normal activities within a short period. However, specific postoperative care instructions are essential to ensure optimal recovery.
We usually ask patients to avoid using their voice aggressively for a few days, but they can start light talking right after the procedure.
While there are no specific limits on what you eat after the procedure, don’t eat or drink anything for two hours, since your throat will still be numb. Schedule a follow-up appointment with your physician to monitor your healing and address any concerns. This appointment is typically set for four to six weeks after the procedure.
Vocal Cord Surgery
Lesions that develop on the vocal cords, also called vocal folds—including noncancerous growths and scarring—may cause hoarseness, pain, or fatigue when speaking. A lesion may develop after an isolated incident that places too much strain on the vocal cords or because of repeated patterns of voice use that cause injury over time.
Most vocal cord lesions are not cancerous. But if left untreated, a benign vocal cord lesion may affect the function of the vocal cords and change the way a patient’s voice sounds.
Based on the office assessments, we may recommend phonomicrosurgery, a type of vocal cord surgery to remove lesions endoscopically with the goal of fully restoring a patient’s voice to its usual sound and quality. During the hour-long operation, when patients are under general anesthesia, surgeons use a microscope, a laryngoscope, and targeted lasers and surgical tools to identify and surgically remove vocal cord lesions with maximum precision.
Postoperative Care and Instructions
After surgery to remove vocal cord lesions, it’s common to experience discomfort, such as a sore throat, for several days. Patients may be advised to rest their voice initially and then gradually begin speaking or singing again until their voice is completely restored.
If a vocal cord lesion is determined to be cancerous, experts from our Voice Center can coordinate a patient’s care with specialists at the Head and Neck Center at Perlmutter 鶹Ƶapp Center, for diagnosis, treatment, and recovery.
Treatment for vocal cord cancer can vary based on the patient and the size of the lesion. If treated early when lesions are smaller, treatment for vocal cord cancer can offer a high cure rate with few side effects and a quick recovery.
Laryngoplasty
Laryngoplasty is a surgical procedure designed to improve vocal function by permanently altering the shape of the larynx, or voice box. This procedure is particularly beneficial for people experiencing voice changes due to aging or unilateral vocal fold paralysis.
With age, the vocal cords can become thinner and lose their structural integrity, leading to improper vibration. You may experience symptoms such as hoarseness, vocal fatigue, pain, or tightness in the throat when speaking and breathing. You may also inhale or food or liquid into your lungs. Laryngoplasty can help by rebuilding the vocal cords to restore their normal function.
Laryngoplasty is also a highly effective treatment for unilateral vocal fold paralysis. This occurs when one of the vocal cords is unable to move, often due to nerve damage, and can cause significant voice impairment, including hoarseness, breathy voice, and difficulty swallowing.
Laryngoplasty has shown high success rates in improving vocal quality and reducing symptoms. Patients often experience significant improvements in voice strength, clarity, and endurance. The procedure helps improve overall quality of life, since weakness of the voice and inability to communicate can lead to social isolation.
During laryngoplasty, the surgeon makes a small incision in the neck to access the larynx. An implant made of surgical-grade plastic or Gore-Tex is then placed next to the vocal cords. This implant moves the weak or paralyzed vocal cord closer to the functioning vocal cord or builds up the bulk of the vocal cords. This allows them to touch and vibrate together, which is necessary to create sound. The procedure can be performed under local anesthesia with light sedation, allowing the surgeon to adjust the implant based on real-time feedback from the patient's voice.
Postoperative Care and Instructions
After laryngoplasty, patients are given specific postoperative care instructions to ensure optimal recovery. You do not need to rest your voice after the procedure. It will be raspy for about three weeks following the procedure due to swelling. Drinking plenty of fluids is crucial to keep your vocal cords hydrated and promote healing. There are no dietary restrictions following this procedure. You should schedule a follow-up appointment with your physician to monitor healing and address any concerns. This appointment is typically set for two to three weeks after the procedure
Vocal Cord Injection
Vocal cord injection therapy may be recommended if you have a weak or breathy voice and hoarseness that’s caused by vocal cord paralysis or a thinning (atrophy) of the vocal cords, but no evidence of a vocal cord lesion.
Injecting a short-term filler, such as Restylane, which contains hyaluronic acid, enhances the vocal cords by pushing them together to enhance voice sound and quality. Vocal cord injection can be an office-based procedure with local anesthesia or in the operating room with general anesthesia. Surgeons inject the filler through the mouth or through the skin of the neck.
Vocal cord injection therapy may involve a stepwise approach. If the temporary filler improves symptoms, for example, our doctors may recommend using fat as a vocal cord injection filler or performing laryngoplasty for more permanent results.
Zenker’s Diverticulectomy and Cricopharyngeal Myotomy
Zenker’s diverticulectomy and cricopharyngeal myotomy are closely related procedures that address swallowing difficulties caused by abnormalities in the lower throat and the cricopharyngeal muscle. At the NYU Langone Voice Center, we specialize in these advanced surgical techniques and are considered a high-volume center for treatment of these conditions.
Zenker’s Diverticulum
Zenker’s diverticulum is an anatomical abnormality where a pouch forms alongside the esophagus. This pouch can fill with food or liquid, which may then be regurgitated into the throat, leading to swallowing difficulties, aspiration, and chronic cough. Symptoms often include a sensation of food sticking in the throat, regurgitation of undigested food, and bad breath.
Treatment for Zenker’s diverticulum mostly involves surgical intervention to release the cricopharyngeal muscle, a semi-circular muscle at the top of the esophagus that controls the passage of food and liquid between the throat and the stomach. Depending on the size of the diverticulum, it may be prudent to also remove the pouch.
There are two main surgical approaches:
- Open surgery is the traditional approach. Your surgeon makes an incision in your neck to access and remove the diverticulum. The cricopharyngeal muscle is also cut to prevent recurrence.
- Endoscopic surgery is a minimally invasive technique using an endoscope inserted through the mouth to visualize and treat the diverticulum. The surgeon uses specialized instruments, including a laser, to cut the cricopharyngeal muscle. Endoscopic surgery typically results in shorter recovery times and less postoperative discomfort.
Depending on the complexity of the condition, surgery for Zenker’s diverticulum may require an overnight to several days’ hospital stay. Postoperative care includes dietary modifications and swallowing therapy to ensure a smooth recovery and prevent complications.
Cricopharyngeal Myotomy
Cricopharyngeal myotomy is a surgical procedure designed to improve swallowing by cutting the cricopharyngeal muscle. This muscle normally opens to allow food and liquid to pass into the esophagus and closes to prevent reflux. When the cricopharyngeal muscle malfunctions, it may not open fully or may open or close at the wrong times, causing difficulty swallowing or a sensation of a lump in the throat.
Cricopharyngeal muscle dysfunction can develop gradually over many years. If you consistently have difficulty swallowing, a feeling of food getting stuck, or aspiration, you may need prompt treatment to avoid complications like malnutrition and dehydration.
Our surgeons perform cricopharyngeal myotomy using two main approaches:
- An open surgical approach involves making a small incision in the neck to access and cut the cricopharyngeal muscle. This approach provides direct access to the muscle and is effective for severe cases.
- An endoscopic approach is a minimally invasive technique. An endoscope inserted through the mouth allows your surgeon to visualize and cut the cricopharyngeal muscle using specialized laser technology. The endoscopic approach typically results in shorter recovery times and less postoperative pain.
People undergoing cricopharyngeal myotomy may need to stay overnight in the hospital. Patients may also need to follow a soft or liquid diet for a few days to allow the surgical site to heal.
Tracheal and Laryngeal Surgery for Airway Stenosis
Airway stenosis, a narrowing of the trachea or larynx, is a common condition in people who have been intubated with an endotracheal tube for extended periods. This narrowing results from scar tissue that develops due to trauma from the breathing tube, which can significantly impede breathing and reduce quality of life. At the NYU Langone Voice Center, we offer advanced surgical treatments to address airway stenosis, allowing you to breathe more easily and improving your overall wellbeing.
Endoscopic Treatments for Managing Airway Stenosis
Endoscopic treatments are minimally invasive procedures used to manage airway stenosis. These techniques can vary, but most are performed in the operating room under general anesthesia. Recent advances include office-based procedures under local anesthesia that are available at the NYU Langone Voice Center.
Below is a list of commonly performed endoscopic procedures for airway stenosis:
- A tiny balloon is inserted into the narrowed area of the airway and then inflated to stretch and widen the stenotic segment. This procedure, called balloon dilation, can provide immediate relief and improve airflow.
- Laser surgery allows your doctor to precisely remove scar tissue and open the airway. This technique is effective for treating both tracheal and laryngeal stenosis and can be performed in an outpatient setting.
- In some cases, a small tube called a stent may be placed in the airway to keep it open and prevent further narrowing.
- Laryngotracheal reconstruction is a surgical procedure designed to widen the airway, allowing for improved breathing by placing a graft made from cartilage or a flap of tissue into the narrowed section of the trachea or larynx. This procedure is particularly beneficial for patients with severe or recurrent stenosis that does not respond to endoscopic treatments.
- Tracheal resection is a more extensive surgical procedure used to treat severe tracheal stenosis. During this procedure, the surgeon removes the narrowed segment of the trachea and then sutures the remaining healthy ends together. This technique effectively eliminates the stenotic area and restores normal airway function. Tracheal resection is often performed in cases where other treatments have failed or when the stenosis is particularly severe.
Benefits for Patients with Chronic Tracheostomies
People with chronic tracheostomies, who rely on a tracheostomy tube for breathing, can significantly benefit from airway surgery. Surgical interventions such as endoscopic dilation, laryngotracheal reconstruction, and tracheal resection can often make it possible for these patients to be decannulated, meaning they can have their tracheostomy tube removed and breathe on their own again. This can greatly enhance their quality of life, reduce the risk of infections, and improve their ability to speak and swallow.
Other Treatments for Voice and Swallowing Conditions
The team at NYU Langone’s Voice Center performs a wide range of advanced and minimally invasive surgical techniques that can help preserve voice sound and quality, and relieve swallowing and airway symptoms.
Still, many conditions that affect the voice, breathing, or swallowing don’t require surgery. Vocal cord lesions, for example, may improve with voice therapy alone, which involves learning and practicing targeted exercises to strengthen and coordinate vocal cord muscles and other parts of the vocal system.
For more information about surgical care provided by the Voice Center, please call 646-754-1207 or email VoiceCenter@NYULangone.org.