Treatment of Vocal Fold Scarring
What are the treatment options for vocal fold scarring?
Currently, no treatment can eliminate formed scars or reverse scar
formation. Rather, interventions are aimed at preventing continued
scarring and/or improving voice.
Prevention Is the Best Treatment
The best treatment for vocal fold scarring is, of course, prevention.
- Healthy and appropriate voice use can effectively prevent vocal fold scar.
- Excessive scarring from surgical treatment can be prevented by:
- Using careful and precise laryngeal and phonomicrosurgical techniques (For more information, see Prevention and Phonomicrosurgery.)
- Ensuring full patient compliance with voice rest after surgery
- Treating other associated medical conditions, such as laryngopharyngeal reflux, aggressively especially during surgical recovery
- Minimizing use of the CO2 lasers
- Appropriately managing breathing tubes when a breathing tube is necessary
 Key Information
Ongoing Research Important to Addressing Key Questions on Vocal Fold Scarring
Presently,
no definitive treatment modalities for scarring exist. Different
surgeons prefer different treatment options. Ongoing research is
focused on:
- How scarring is produced specifically in the vocal folds
- How best to improve voice function, if not remove scar
- How best to prevent vocal fold scarring
Research Specific to Vocal Folds Necessary
An understanding of vocal fold scarring should not simply be deduced
from findings regarding scarring elsewhere on the body, since scarring
in the vocal folds affects voice function.
Non-Surgical Treatment Options for Vocal Fold Scarring
- Other medical problems: The first line of
intervention for vocal fold scarring should be to treat any associated
medical problems that could be compounding the voice disorder
associated with vocal fold scarring. The two most common such problems
are allergic conditions and laryngopharyngeal reflux disease.
- Allergies:
Allergies of the sinus and nasal regions can often have a detrimental
effect on voice quality and worsen voice symptoms associated with vocal
fold scarring. This problem can be successfully treated with a variety
of options such as medication, allergy shots, and avoidance of specific
allergens.
- Voice therapy: Voice therapy is another
important preliminary (and sometimes the only) step in the treatment of
patients with vocal fold scarring. Voice therapy will not directly
change the nature of the vocal fold scar; however, it will assist the
patient in compensating for the voice problems. The body can develop
poor singing/speaking adaptive behaviors when scar tissue forms on the
vocal folds. High quality voice therapy will address these issues and
teach alternative techniques to maximize voice efficiency and quality.
Voice therapy is especially helpful for patients with symptoms of vocal
fatigue and instability of the voice. Often, voice therapy is extremely
helpful, but will not directly affect the actual quality of the voice. (For more information, see Voice Therapy.)
- Singing voice therapy:
Singing voice therapy is another technique often employed in the early
stages of treating patients with vocal fold scarring. Singing voice
therapy involves using a variety of singing exercises to optimize both
spoken voice and singing voice production in the face of some
underlying vocal pathology such as vocal fold scarring.
Surgical Options for the Treatment of Vocal Fold Scarring
Multiple options exist for the surgical treatment of vocal fold
scarring. The selection of a surgical option depends upon the severity
of the voice problem and the patient's specific symptoms and voice
demands.
- Removal of associated lesions: Patients with
vocal fold scarring often have associated lesions, such as cysts or
polyps. These lesions should be removed via phonomicrosurgical
techniques. (For more information, see Phonomicrosurgery.)
- Augmentation of vocal fold closure:
When vocal fold scarring causes poor or no vocal fold closure during
voice production, the voice is often extremely weak and breathy. A
successful surgical approach to this problem is called vocal fold
augmentation. The procedure is aimed at increasing the size or bulk of
the vocal folds to improve vocal cord closure by medializing or pushing
each vocal fold toward each other (the midline). This enables the vocal
folds to close and subsequently vibrate better, despite still having
scar tissue within the lamina propria. This type of surgical
augmentation of the vocal folds can be done either with fat injection
(lipoinjection) of the vocal folds or with bilateral thyroplasty.
- Dealing with the scar:
Surgical options for the direct problem of scar tissue within the
all-important lamina propria of the vocal fold are currently not proven
and remain under intense study. (For more information, see Frontiers.)
Treatment of vocal fold scarring is one of the most difficult areas
of vocal fold surgery and should be performed by surgeons with
significant expertise and experience in this area.
Currently, what can patients reasonably expect from vocal fold scar treatment?
- The success of treatment depends on the initial
severity of the vocal fold scar, the nature of the patient's voice
demands, and the patient's response to a particular treatment technique.
- There
is no one single treatment option that works for all patients with
vocal fold scars. Thus, preventing vocal fold scarring and attempting
all non-surgical treatment options prior to surgery are crucial.
- For
severe vocal fold scarring, substantive improvement can be attained
through treatment, but generally there will not be a complete return to
function, especially with regard to singing. It is not known if one
surgery treatment is superior to another.
- For minor vocal
fold scarring, non-surgical treatments (medications, voice therapy, and
singing voice therapy) will often allow the patient to resume all or
almost all vocal function.
- Vocal fold augmentation can also result in noticeable voice improvement.
Key Information
Opting Not to Treat Vocal Fold Scarring
- According to current best practices, when the cause or causes of vocal fold scarring are eliminated, no further voice problems will occur if an individual chooses not to have treatment for vocal fold scar.
- However,
if the cause of the vocal fold scar is not eliminated, as when vocally
abusive activities such screaming, yelling, or singing in unhealthy
fashion continue, then further vocal fold scar or other voice problems
will most likely develop, resulting in a further decline in vocal
function.
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