Surgical therapy for vocal dysfunction.

In general, misuse and abuse of the voice in the form of using the voice too loudly and too long and affecting a fundamental frequency that is too low produce chronic changes in the lamina propria while inhalation of irritants produces changes in the epithelium of the true vocal cords. Voice therapy plays an essential role in the preoperative and postoperative management of the patient. The use of the operative microscope under general anesthesia has permitted the regular preservation of the external elastic lamina, which is necessary for the restoration of the voice to its full dynamic and frequency ranges. Resection of the left recurrent laryngeal nerve is of great value in the treatment of spastic dysphonia. In the paralyzed larynx, injection of Teflon paste is of proven value in restoring the voice in permanent unilateral recurrent laryngeal nerve paralysis. Reinnervation procedures for unilateral and bilateral recurrent laryngeal nerve and superior laryngeal nerve paralysis must at this time be considered developmental.