Vocal Cord Medialiaztion: “The Voice Lift”
In the modern age of communication, the voice is critical in projecting image and personality and establishing credibility. Until very recently, voice has not received enough attention from the medical profession or from the general public. In fact, most people (doctors and the general public) do not realize anything can be done to improve a voice that is unsatisfactory or even one that is adequate but not optimal. Singers, actors, and public speakers have sought out “voice lessons” for centuries. However, recently techniques for voice improvement have expanded and improved; and they have become practical for a great many more people.
Vocal weakness, breathiness, instability, impaired quality, and other characteristics commonly associated with aging can interfere with social and professional success. For most people, these vocal characteristics, which lead people to perceive a voice (and its owner) as “old” or “infirm”, can be improved or eliminated by a vocal habilitation or restoration program supervised a laryngologist. Doing so is important not only for singers and other voice professionals (teachers, radio announcers, politicians, clergy, salespeople, receptionists, etc.) but also really for almost everyone. This is especially true for older persons. It is ironic but true that, as we grow older, our voices get softer and weaker at the same time our spouses and friends start losing their hearing. This makes professional communication and social interaction difficult, especially in noisy surroundings such as cars and restaurants.
When one has to work too hard to communicate, it is often related to vocal deficiencies. Therefore, it is not surprising that, when exercises and medications alone do not provide sufficient improvement, many patients elect voice surgery in an attempt to strengthen their vocal quality and endurance to improve their quality of life (so called “voice lift surgery”). Several different procedures can be used to strengthen weak or injured voices. The selection of the operation depends on the individual’s vocal condition as determined by a voice team evaluation, physical examination including strobovideolaryngoscopy, and consideration of what the person wants. Care must be taken to ensure that the patient expectations are realistic.
In most cases, surgery is directed toward bringing the vocal folds closer together so that they close more firmly. This is done by injecting a material through the mouth or neck into the tissues adjacent to the vocal folds, to “bulk up” the vocal tissues and bring the vocal folds closer together. This is called injection laryngoplasty and is performed usually using fat, collagen, or other materials. It is sometimes performed in the operating room under general or local anesthesia and, in selected patients, in the office with only local anesthesia. Alternatively, the problem can be corrected by performing a thyroplasty. This operation involves making a small incision in the neck. The skeleton of the larynx is entered, and the laryngeal tissues are slightly compressed using Gore-Tex, silastic implants, or other materials. All of these procedures usually are performed on an outpatient basis. Recovery usually takes days to weeks. Rarely, the voice can be made worse. The most likely complications are that voice improvement is not quite sufficient or that it does not last over time. When these problems occur, they can be corrected by “fine tuning” through additional injections or surgical adjustment of the implant. However, usually satisfactory results are achieved the first time.
Voice rehabilitation through medical intervention and therapy/exercise training is appropriate for anyone unhappy with his or her vocal quality. It is suitable for almost anyone who does not have major, serious medical problems such as end-stage heart disease and is not on blood thinner medication that cannot be stopped safely for surgery, so long as that person has realistic vocal goals and expectations. As physicians and the general public become more aware of the options available, people will not only look young for their age, but sound so as well.
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