Microscopic Laryngeal Surgery

Hoarseness or a change in the sound of your voice is a common symptom. Most often it is related to swelling from a cold or voice overuse. This type of hoarseness frequently will spontaneously resolve within 3 weeks. Sometimes, voice changes can be the first symptom of something more serious like a vocal fold weakness, vocal fold mass, or even throat cancer. If you have hoarseness lasting longer than 3 weeks, it is recommended that you be evaluated by an ENT physician who can examine your larynx.

The physicians at Bellingham ENT use state of the art equipment to diagnose and treat voice disorders. The work up for complaints of hoarseness starts with a comprehensive head and neck history and physical examination. This typically includes examination of the larynx with a rigid or flexible fiberoptic laryngoscope. Often, it is also necessary to examine the vocal fold function with laryngeal video stroboscopy. This allows video documentation of slow motion images of the vocal folds as they vibrate. Although, this sounds like a scary test, most patients are pleasantly relieved at how simple and pain-free the test really is. The vocal folds will be examined for inflammation, weakness, and lesions including nodules, polyps, cysts, trauma, scarring, hemorrhage, and cancer. Most voice complaints can be successfully treated with lifestyle/voice use modification, vocal hygiene, voice rest, and vocal exercises. Often, the care team will include your physician, a speech language pathologist, and sometimes a voice coach.

Occasionally, voice disorders require an in office procedure such as a vocal fold injection with BOTOX or a vocal fold filler. Sometimes, surgery is necessary. This may include removal of a vocal fold lesion like a cyst, polyp, or nodule, biopsy of a suspicious lesion, removal of a non-cancerous growth such as a papilloma (wart), removal of edema caused by smoking, or excision of a pre-cancer or cancer. Surgery on the vocal folds most often is performed with microlaryngeal direct laryngoscopy under general anesthesia. Patients are completely asleep, and a metal tube is used to hold the tongue to the side so the vocal folds can be examined with a microscope. Microscopic instruments are then used to operate on the vocal folds. Sometimes a CO2 laser is used to cut or ablate tissue during surgery. Most laryngeal surgery is performed as an outpatient at Peace Health St. Joseph Medical Center, which is one of the top hospitals in Washington State. After limited voice rest, patients usually return to work after 1 week and have gradual improvement of their voice over several weeks to months.

Dr. Andrew Verneuil is one of the few fellowship trained laryngologist in the state, and the only one practicing north of Seattle. He is affiliated with the University of Washington as clinical faculty, and he lectures for the Speech Language Pathology department at Western Washington University. He is trained in office based procedures and microsurgery techniques for treatment of voice disorders.


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