Philadelphia Ear, Nose and Throat Associates: PENTA

Voice Changes

Can surgery change the pitch of a voice?

Surgery of the laryngeal skeleton can also be used to modify vocal pitch.  Although such operations are done infrequently, they are valuable in certain circumstances.  By closing the space between the cricoid and thyroid cartilages (an extreme version of cricothyroid muscle function), the vocal folds can be lengthened and tensed, and the voice raised.  By cutting out vertical sections of the thyroid cartilage, the vocal folds can be shortened and their tension decreased, lowering pitch.  While these techniques are not sufficiently predictable for elective use in singers or other professional voice users, they are valuable in treating selected voice abnormalities and in altering vocal pitch in patients who have undergone transsexual surgery.

What can be done about a voice that is worse after surgery?

Too often, the laryngologist is confronted with a desperate patient whose voice has been "ruined" by vocal fold surgery, recurrent or superior laryngeal nerve paralysis, trauma, or some other tragedy.  Occasionally, the cause is as simple as a recently dislocated arytenoid that can be reduced.  However, if the problem is an adynamic segment, decreased bulk of one vocal fold after "stripping," bowing caused by superior laryngeal nerve paralysis, or some other serious complication in a mobile vocal fold, great conservatism should be exercised.  Voice therapy is nearly always helpful in optimizing compensatory strategies and minimizing fatigue, but it usually will not restore normalcy of the patient's voice.  None of the available surgical procedures for these conditions is consistently effective.  If surgery is considered at all, the procedure and prognosis should be explained to the patient realistically and pessimistically.  It must be understood that the chances of returning the voice to excellent quality are slim, and that it may be made worse.  Zyderm Collagen [Xomed] injection and fat injection are currently the most common approaches in these difficult cases.  However, a great deal more research will be needed to determine the efficacy of the treatments currently available for vocal fold scarring and to establish the treatment of choice.