People with a paralyzed vocal cord often have a breathy, weak voice; in addition, they may aspirate – have food or liquid go into the lungs. Vocal Fold medialization surgery can help to close the voice box, provide a stronger, more natural voice, and help prevent aspiration. This can be accomplished by an injection of material into the vocal folds to help push them together. This injection is either performed in the office under topical anesthesia, or in the operating room. Another procedure requires a small incision over the Adam’s apple and the placement of a small implant to push the paralyzed vocal fold toward the midline. Both are short surgeries, easily tolerated, and often with a great result.
A laryngoscopy is an examination of the pharynx (back of the throat), larynx (voice box) and vocal cords. The procedure can be performed directly or indirectly.
An indirect laryngoscopy uses two mirrors and a light source. One mirror is held towards the back of the patient’s throat, while the doctor wears the other mirror. Light is reflected from the doctor’s mirror into the throat so he or she can evaluate any throat conditions that may be present.
A direct laryngoscopy involves a fiber-optic scope that can be flexible or rigid. The scope allows the doctor to see deeper into the throat than is possible with an indirect evaluation. Flexible scopes are mostly used in examinations. Rigid scopes are used for surgery, tissue sampling, removing obstructions, and laser procedures, and require general anesthesia.
Tonsillectomy is one of the most common throat operations, tonsillectomy surgically removes the tonsils, masses of lymph tissue in the back of the throat that work with the adenoids and immune system early in life to defend the body against invading bacteria and viruses. Occasionally the tonsils become infected or abscessed, and, if these conditions continue, enlarged, causing breathing and swallowing problems such as snoring, disturbed sleep, chronic mouth breathing (possibly resulting in deformations of the face and mouth), ear infections and hearing loss. Signs that you or your child may have tonsillitis (infected tonsils) include:
- Tonsils that are enlarged, redder than usual, or have a white or yellow coating
- Swelling that causes a slight voice change
- Sore throat
- Difficult or painful swallowing
- Swollen lymph nodes (glands) in the neck
- Bad breath
The first stage of treatment for chronic tonsil inflammation is a course of antibiotics or steroids; if this fails to resolve the problem, the tonsils may be removed. Removal is usually recommended for patients with three or more infections of the tonsils each year and patients with sleep-disordered breathing, and may also be recommended for patients with tumors or difficulty breathing.
Tonsillectomy requires local or general anesthesia depending on the technique and the patient’s age and preferences. Patients are released a few hours or the morning after surgery.
Surgery may be performed with a scalpel (“cold knife dissection”) under general anesthesia with minimal post-operative bleeding; by electrocautery, minimizing bleeding but increasing the risk for tissue damage by heat; with a harmonic scalpel, which offers precision cutting through ultrasonic vibrations; with a carbon dioxide laser (laser tonsil ablation, or LTA) that vaporizes tonsil tissue in 15-20 minutes with minimal pain; with a microdebrider, a shaving/suctioning device that removes the part of the tonsil blocking the airway; by monopolar radiofrequency ablation (somnoplasty), where thermal energy causes scarring that shrinks enlarged tonsils; or by bipolar radiofrequency ablation (coblation), where an ionized saline layer is created to remove the enlarged portions of the tonsil without heat energy.
Post-surgical complications may include pain in the throat or ears, swallowing problems, halitosis, infection, vomiting, fever and, rarely, bleeding.