The surgical procedure of Thyroplasty is done to place an implant in the larynx or the voice box along with the vocal cord. In this, the position of the vocal cord is changed in order to make them stronger. The purpose of the implant is to allow the paralyzed vocal cord to arrive at the mid line. The aim of the surgery is to eliminate the problems arising from the weakening of the vocal cords such as choking or coughing while swallowing and it also corrects the voice disorders.
Different Types of Thyroplasty
Type 1 Thyroplasty: The surgical procedure is performed by placing the vocal cords near to each other in order to reduce the outcomes of the abductor spasms.
Type 2 Thyroplasty: The surgical procedure is performed by spreading the vocal cords apart by a shin. This helps in separating the vocal cords by not allowing them to come in contact during the spasms.
The surgery takes place under local anesthesia together with intravenous sedation that is applied to the patient.
In the crease of the neck, an incision is made.
The fiber optic Laryngoscope is done in order to view the vocal cords and topical anesthesia is given in the nose.
The surgeon may ask to speak while performing the surgery in order to know the improvement in the voice when the adjustments are carried out on the vocal cords.
The swelling can be reduced by using steroids and many times swelling makes it hard to measure the correct estimates regarding the size of both the placements and implants.
The surgeon then closes the incision by covering with a dressing.
Before Thyroplasty (vocal fold surgery)
Vocal cords are thoroughly examined.
Voice tests are performed.
To examine the vocal fold pliability and the vocal fold closure, Laryngeal Stroboscope is performed.
The aerodynamic requirements of the patients are tested according to the patient's airway.
The type of the Thyroplasty is selected by examining the requirements of the patient.
Vocal Cord Paralysis
The process of vocal cord (vocal fold) paralysis is a condition that occurs when the voice is affected due to a disorder. This condition occurs when either one or both the vocal folds (vocal cords) do not open or close properly. The vocal fold paralysis can be categorized into two types-
Bilateral Vocal Cord: In this, both the vocal cords are involved that gets stuck in halfway between the paramedic positions and does not move in any way.
Unilateral Vocal Fold Paralysis: In this, a single side is paralyzed in between the closed and open and these paralyzed folds do not vibrate with another fold. There could be either abnormal vibration or no vibration. The patients suffering from this will be not capable of speaking properly and clearly. This type of vocal cord paralysis is the most common.
Symptoms for Vocal Cord Paralysis
Facing difficulty in breathing
Hoarse or breathy voice
Choking or coughing while eating
Problem in speaking loudly
Problem in projecting the voice loudly
The problem of Pneumonia as both the food and the liquid are moving into the lungs
Vocal Cord Paralysis Causes
The paralysis is caused by tumors, stroke, disease and head and neck injuries. There are branches of the vagus nerve which runs from the brainstem into the voice box (larynx), thereby controlling the movement of the vocal cords. Any damage or injury to the vagus nerve is the most important cause of the vocal cord paralysis.
Diagnosis code for vocal cord paralysis
To diagnose the problem many tests are done-
The Laryngeal EMG is done to see the functioning of the muscles and for this the electrodes are placed inside the voice box.
Neck CT scans
To study the vocal folds (vocal cords), an endoscope is inserted either through the mouth or the nose.
To watch the movement of the vocal folds, stroboscope is used.
To watch the process of liquid and food that begins in the mouth and goes down to reach the esophagus along with x-ray methods, modified barium swallow procedure is performed.
Treatments for Vocal Cord Paralysis
The problem of bilateral vocal fold can be treated medically and needs a tracheotomy so as to enable the person to breathe and eat safely. The aim is to sustain an airway to breathe by placing tracheotomy (through the neck). For opening the airway, the surgical procedures of Arytenoidectomy and Cordotomy can also be performed.
The Unilateral vocal cord paralysis condition can be treated with the help of speech therapy and by medical process. The different procedures are-
To enlarge the paralyzed vocal fold, injections are used. The different injection materials are selected depending upon the long term effect.
The surgical procedure of Thyroplasty can also be performed.
The surgical process of Arytenoid can be performed along with Thyroplasty.
The speech language pathologist will conduct a speech therapy of the patient. This is one of the significant parts of the treatment and the patient may require only this treatment. The treatment includes stress reduction surgeries, vocal techniques and also the elimination of the behaviors that can spoil the voice.
Vocal Cord Disorder
The most frequent vocal disorders include –
Vocal Cord Nodules: This disorder is small and hard that is caused by the abuse of the vocal. They usually arise in pairs having a single nodule at every vocal cord at the place where there is a greater irritation.
Laryngitis: This disorder is a result of infection or inflammation that causes the swelling of the vocal cords. A person can lose his or her voice if there is a severe inflammation.
Vocal Cord Polyps: A Polyp is a soft and small growth that appears to lie on a vocal cord. Continuing exposure to irritants like cigarette smoke or chemical fumes and vocal abuse can lead to vocal cord polyps.
Contact Ulcers: The disorder is not so common and these are the sores and erosions located on the vocal cord. The main cause of this disorder is that when the person uses extra force before starting to speak. The ulcers can largely affect the public speakers.