Two types of surgery commonly used to treat voice problems are laryngeal microsurgery and vocal fold medialisation.

Laryngeal microsurgery

Laryngeal microsurgery is usually performed to remove a lesion in the voice box which is causing hoarseness. Prior to surgery, the ENT specialist and speech therapist will assess your voice problem. If there are alternatives to surgery, they will discuss them with you. You may even have undergone these treatments already.

If surgery is required, you will be admitted to hospital. The admitting doctor and nurse will do some final checks, and pre-operative tests such as blood tests, an ECG (heart recording) and a chest x-ray may be performed.

An anaesthetic doctor will be present during the surgery to give you general anaesthesia. A short metal tube called an operating laryngoscope will be passed through the mouth to reach your voice box. The surgeon will operate through the laryngoscope using special instruments, usually with the aid of a microscope.

"There is a small risk of injury to the teeth and lips during the passage of the operating laryngoscope. Due care is taken to avoid such injury and a special guard is used to protect the teeth," say doctors from the Department of Otolaryngology (Ear, Nose & Throat)​, at Singapore General Hospital (SGH), a member of the SingHealth​ group.

Typically, the surgery is very safe and you may even be discharged on the same day. Your throat may feel slightly sore and your tongue may also feel a little numb. You will be given instructions on how to look after your voice following surgery.

Vocal fold medialisation

Vocal fold medialisation is usually performed to improve the voice when a vocal fold is paralysed. The cause of paralysis may require investigation and will be discussed with you before embarking on treatment. Vocal fold medialisation is typically performed under local anaesthesia in the operating theatre. Sedation is given so patients feel comfortable during the procedure. A skin incision is made, and a window is created in the voice box to insert an implant to make the voice stronger.

You may be asked to use your voice during the procedure to test the position of the implant. A small neck drain may be inserted to allow drainage of excess blood. This drain will be removed the next day before you go home.

As an alternative to this surgery, your doctor may recommend injection laryngoplasty. This involves injecting a filler material into the vocal fold instead of using an implant, to make the voice stronger. The injection can be carried out in the outpatient clinic (usually a temporary material is injected) or under a short general anaesthetic (if a permanent material is used).

The choice of procedure to treat vocal paralysis may depend on a number of conditions such as the cause of paralysis and your overall medical condition. Sometimes the condition may not even require surgery. If you have vocal paralysis, your surgeon will discuss the options with you and help you make the best choice.

Ref: T12