Vocal Fold Scar:
Abnormal scar tissue in the vibrating layer of the vocal fold that causes voice problems
Vibrating component of the vocal folds that covers the vocal fold muscle or body; the lamina propria is composed of three layers: superficial, intermediate, and deep lamina propria
Wave-like motion of the vibrating layer of the vocal fold as seen upon slow motion-like viewing through stroboscopy
Laryngoscopy with synchronized strobe light that provides a slow motion-like view of vocal fold vibration (mucosal wave); stroboscopy is the key tool used to analyze vocal fold vibration
What are the treatment options for vocal fold scarring?
Currently, no treatment can eliminate formed scars or reverse scar formation. Rather, interventions are aimed at preventing continued scarring and/or improving voice.
Prevention Is the Best Treatment
The best treatment for vocal fold scarring is, of course, prevention.
Healthy and appropriate voice use can effectively prevent vocal fold scar.
Excessive scarring from surgical treatment can be prevented by:
- Using careful and precise laryngeal and phonomicrosurgical techniques (For more information, see Prevention and Phonomicrosurgery.)
- Ensuring full patient compliance with voice rest after surgery
- Treating other associated medical conditions, such as laryngopharyngeal reflux, aggressively especially during surgical recovery
- Minimizing use of the CO2 lasers
- Appropriately managing breathing tubes when a breathing tube is necessary
Ongoing Research Important to Addressing Key Questions on Vocal Fold Scarring
Presently, no definitive treatment modalities for scarring exist. Different surgeons prefer different treatment options. Ongoing research is focused on:
- How scarring is produced specifically in the vocal folds
- How best to improve voice function, if not remove scar
- How best to prevent vocal fold scarring
- Research Specific to Vocal Folds Necessary
An understanding of vocal fold scarring should not simply be deduced from findings regarding scarring elsewhere on the body, since scarring in the vocal folds affects voice function.
Non-Surgical Treatment Options for Vocal Fold Scarring
Other medical problems: The first line of intervention for vocal fold scarring should be to treat any associated medical problems that could be compounding the voice disorder associated with vocal fold scarring. The two most common such problems are allergic conditions and laryngopharyngeal reflux disease.
Allergies: Allergies of the sinus and nasal regions can often have a detrimental effect on voice quality and worsen voice symptoms associated with vocal fold scarring. This problem can be successfully treated with a variety of options such as medication, allergy shots, and avoidance of specific allergens.
Voice therapy: Voice therapy is another important preliminary (and sometimes the only) step in the treatment of patients with vocal fold scarring. Voice therapy will not directly change the nature of the vocal fold scar; however, it will assist the patient in compensating for the voice problems. The body can develop poor singing/speaking adaptive behaviors when scar tissue forms on the vocal folds. High quality voice therapy will address these issues and teach alternative techniques to maximize voice efficiency and quality. Voice therapy is especially helpful for patients with symptoms of vocal fatigue and instability of the voice. Often, voice therapy is extremely helpful, but will not directly affect the actual quality of the voice. (For more information, seeVoice Therapy.)
Singing voice therapy: Singing voice therapy is another technique often employed in the early stages of treating patients with vocal fold scarring. Singing voice therapy involves using a variety of singing exercises to optimize both spoken voice and singing voice production in the face of some underlying vocal pathology such as vocal fold scarring.
Surgical Options for the Treatment of Vocal Fold Scarring
Multiple options exist for the surgical treatment of vocal fold scarring. The selection of a surgical option depends upon the severity of the voice problem and the patient’s specific symptoms and voice demands.
- Removal of associated lesions: Patients with vocal fold scarring often have associated lesions, such as cysts or polyps. These lesions should be removed via phonomicrosurgical techniques. (For more information, see Phonomicrosurgery.)
- Augmentation of vocal fold closure: When vocal fold scarring causes poor or no vocal fold closure during voice production, the voice is often extremely weak and breathy. A successful surgical approach to this problem is called vocal fold augmentation. The procedure is aimed at increasing the size or bulk of the vocal folds to improve vocal cord closure by medializing or pushing each vocal fold toward each other (the midline). This enables the vocal folds to close and subsequently vibrate better, despite still having scar tissue within the lamina propria. This type of surgical augmentation of the vocal folds can be done either with fat injection (lipoinjection) of the vocal folds or with bilateral thyroplasty.
- Dealing with the scar: Surgical options for the direct problem of scar tissue within the all-important lamina propria of the vocal fold are currently not proven and remain under intense study. (For more information, see Frontiers.)
Treatment of vocal fold scarring is one of the most difficult areas of vocal fold surgery and should be performed by surgeons with significant expertise and experience in this area.
Currently, what can patients reasonably expect from vocal fold scar treatment?
- The success of treatment depends on the initial severity of the vocal fold scar, the nature of the patient’s voice demands, and the patient’s response to a particular treatment technique.
- There is no one single treatment option that works for all patients with vocal fold scars. Thus, preventing vocal fold scarring and attempting all non-surgical treatment options prior to surgery are crucial.
- For severe vocal fold scarring, substantive improvement can be attained through treatment, but generally there will not be a complete return to function, especially with regard to singing. It is not known if one surgery treatment is superior to another.
- For minor vocal fold scarring, non-surgical treatments (medications, voice therapy, and singing voice therapy) will often allow the patient to resume all or almost all vocal function.
- Vocal fold augmentation can also result in noticeable voice improvement.
Opting Not to Treat Vocal Fold Scarring
According to current best practices, when the cause or causes of vocal fold scarring are eliminated, no further voice problems will occur if an individual chooses not to have treatment for vocal fold scar.
However, if the cause of the vocal fold scar is not eliminated, as when vocally abusive activities such screaming, yelling, or singing in unhealthy fashion continue, then further vocal fold scar or other voice problems will most likely develop, resulting in a further decline in vocal function.
Patient education material presented here does not substitute for medical consultation or examination, nor is this material intended to provide advice on the medical treatment appropriate to any specific circumstances.
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