Phonosurgery
What is Phonosurgery?
Phonosurgery is a specialised surgical procedure that focuses on improving the quality of the voice, such as clarity, volume, or tone, by altering the structures of the voice box or larynx. This type of voice box surgery is valuable for individuals who have voice disorders resulting from various causes, such as vocal cord nodules, polyps, paralysis, scarring, or other abnormalities affecting the vocal folds. It is minimally invasive and uses techniques such as microlaryngeal surgery, which involves using a microscope to remove lesions or masses. Medialisation thyroplasty is another procedure that can reposition the vocal cords to improve sound production. Our experienced ENT surgeon, an expert in laryngology, will recommend selected surgical technique(s) according to your condition.
These procedures are often performed under general anaesthesia and by a skilled surgeon, allowing patients to recover quickly enough to go home the same day.
How do Vocal Cords Work?
The vocal cords, or vocal folds, are two bands of elastic muscle tissue located in the larynx (voice box). They play a crucial role in producing sound and regulating airflow during speech and breathing. When we speak, air from the lungs passes through the closed vocal cords, causing them to vibrate. These vibrations generate sound waves, which are further modified by the throat, mouth, and nasal cavities to form speech. The tension, length, and position determine the voice’s pitch and volume. For instance, tightening the cords produces higher-pitched sounds, while looser cords create lower tones. Proper functioning of the vocal cords ensures clear and consistent voice production. Any disruption, such as swelling or lesions, can impair their ability to vibrate effectively and thus lead to voice disorders.
What Affects our Vocal Cords
Vocal cord nodules, polyps, and cysts are common conditions that can significantly affect vocal cord function. Nodules are small, callous-like growths typically caused by prolonged voice overuse. They often develop symmetrically on both vocal cords. Polyps are soft, fluid-filled growths often resulting from acute vocal strain or irritation, either from shouting or exposure to irritants. Cysts are encapsulated masses that can obstruct vocal cord vibration, leading to a hoarse or breathy voice. Each of these conditions affects voice clarity and strength, causing challenges in everyday communication.
Lifestyle habits such as excessive drinking and smoking can dehydrate the vocal cords and increase the risk of laryngitis or even throat cancer. As such, it is important for patients to maintain good vocal hygiene, stay hydrated and avoid irritants to preserve their vocal health.
Who can Perform Phonosurgery?
Phonosurgery is a surgical procedure that requires the expertise of an experienced Ear, Nose, and Throat (ENT) surgeon. Dr Ker Liang is a skilled throat specialist in Singapore who is well-versed in Laryngological conditions related to the throat, voice, and swallowing. Dr Ker Liang is able to perform phonosurgery and restore vocal function of her patients.
What to Expect
Before the Sugery
The preparation for phonosurgery begins with a detailed consultation with your ENT specialist. During this consultation, your ENT specialist will evaluate your current symptoms, review your complete medical history, and perform a comprehensive examination of your vocal cords using imaging techniques such as laryngoscopy or stroboscopy. These tools enable your ENT specialist to identify the specific cause of the voice disorder and guide you through the surgical plan.
You may be advised to avoid smoking and limit alcohol consumption in the weeks leading up to the surgery. This is because smoking and alcohol intake may negatively impact healing. You may also need to pause taking certain medications, particularly blood thinners, to reduce the risk of bleeding. You will receive clear fasting instructions, typically at least 6-8 hours before the procedure begins under general anaesthesia. A pre-surgical discussion with your ENT specialist ensures you are fully informed and confident about the upcoming surgery.
During the Surgery
Phonosurgery is typically done under general anaesthesia and takes approximately 30-60 minutes, depending on the complexity of the condition. The procedure is minimally invasive; it only involves access through the mouth without external incisions. Microlaryngeal surgery is used for conditions like vocal nodules or polyps. This technique uses specialised surgical tools and a high-powered microscope to accurately remove the excess growths without damaging surrounding tissues. In cases requiring structural adjustments, medialisation thyroplasty may be performed to reposition or stabilise the vocal cords to enhance voice quality and function.
After the Surgery
Recovery after phonosurgery is straightforward but requires careful adherence to post-operative care. Most patients can go home on the same day but are advised to rest their voice for several days to allow the vocal cords to heal. This may involve complete voice rest or limited speech, as the ENT specialist recommends. After the surgery, patients may experience mild throat discomfort, swelling, or hoarseness. These symptoms are normal and can be managed with prescribed medications and adequate hydration. Patients are also advised to avoid whispering, smoking, and consuming very hot or cold beverages during the initial recovery phase. Follow-up appointments are essential to assess healing and vocal function. Your ENT specialist might also recommend speech therapy, as it helps to restore strength and clarity in your vocal quality gradually. Optimal voice restoration and recovery are usually achieved within a few weeks to a few months.
The Benefits of Phonosurgery
Phonosurgery offers transformative benefits for individuals with voice disorders.
- Improved Voice Quality: Patients can speak more confidently and without strain. This procedure can be useful, especially for professionals whose careers depend heavily on the usage of their voice.
- Enhanced Well-Being: Many patients report feeling more confident and socially engaged after the procedure as the psychological stress associated with voice disorders is reduced.
- Reduces Risks of Complications: Phonosurgery can help prevent further damage to the vocal cords by removing lesions or correcting structural issues. This reduces the risk of complications such as chronic laryngitis or permanent voice loss.
When combined with post-operative care and speech therapy, the results of phonosurgery are long-lasting.
What is the Sucess Rate of Phonosurgery?
Phonosurgery has a high success rate, with 85% to 95% of patients experiencing significant improvements in voice quality and function. The outcomes depend on factors such as the underlying condition and adherence to post-operative care. Patients can achieve their desired results under the care of an experienced throat specialist in Singapore, Dr Ker Liang. Success can be further enhanced with speech therapy, which ensures long-term vocal health and performance.
What are the Potential Risks and Complications of Phonosurgery?
While phonosurgery is generally safe and minimally invasive, it carries potential risks and complications. Common risks include temporary hoarseness, throat discomfort, and mild swelling. However, these symptoms can typically resolve within a few days. Some patients may experience slight voice fatigue during the recovery period.
On several occasions, rare complications such as infection, excessive scarring or changes in vocal quality may occur in patients. To manage these complications, patients may require additional treatment. Overcorrection during the procedure can also lead to vocal fold stiffness or impaired vibration, thus affecting sound production. In rare cases, airway obstruction or persistent dysphonia (difficulty speaking) may also take place after the surgery.
To minimise potential risks and complications, it is important to have a thorough consultation before the surgery and follow post-operative instructions provided by your ENT specialist. Regular follow-up visits and going to speech therapy may enhance recovery and long-term outcomes. Maintaining vocal hygiene by avoiding smoking and receiving enough hydration on a daily basis is also crucial to preserve surgical results.
Enhance Vocal Quality and Schedule a Consultation with our ENT Specialist in Singapore
If you are experiencing voice-related issues that affect your daily life, schedule a consultation with Dr Ker Liang. With her expertise in laryngology (a branch of medicine that focuses on the voice box), she can provide an accurate diagnosis and tailored treatment to help you regain your voice.
Frequently Asked Questions
Will my voice change after surgery?
Phonosurgery aims to improve vocal quality while preserving the natural tone of your voice. Temporary changes like mild hoarseness are typical during recovery but can resolve within a few weeks.
Do I need speech therapy after phonosurgery?
Yes, speech therapy is often recommended to maximise the benefits of surgery. It helps patients strengthen their vocal cords, improve clarity, and adopt techniques that reduce strain and prevent future issues from occurring.
Can I drink hot or cold beverages after phonosurgery?
During the initial recovery period, avoiding very hot or cold drinks is advised as they can irritate the healing tissues. Room-temperature or slightly warm fluids are generally more comfortable and promote healing.
Medical Teaching
Assistant Professor Ker Liang has a passion for teaching and is an Assistant Professor with NUS Yong Loo Lin School of Medicine (YLLSOM). As the NUS-NUH Otolaryngology Department Undergraduate Medical Director, Dr Ker Liang supervises the training of medical students from YLLSOM, NUS. She is actively involved
in the training of postgraduate junior doctors and residents in the Head and Neck Surgery department. She was conferred with an Undergraduate Teaching Award by the National University Health System in 2016 for her outstanding efforts as an Otolaryngology educator.
Medical Teaching
Assistant Professor Ker Liang has a passion for teaching and is an Assistant Professor with NUS Yong Loo Lin School of Medicine (YLLSOM). As the NUS-NUH Otolaryngology Department Undergraduate Medical Director, Dr Ker Liang supervises the training of medical students from YLLSOM, NUS. She is actively involved
in the training of postgraduate junior doctors and residents in the Head and Neck Surgery department. She was conferred with an Undergraduate Teaching Award by the National University Health System in 2016 for her outstanding efforts as an Otolaryngology educator.
