Opening the Airway…Speaking and Breathing Easier with Laser Cordotomy

Paralysis of your vocal cords affects more than your ability to speak; it also restricts your breathing and turns any physical activity into a struggle for air. When vocal cords or folds are immobile due to trauma, disease, arthritis or other causes, they become “fixed” in position less than one-eighth of an inch apart, a space too small for easy breathing.

A new laser procedure that expands the airway is now offered by otolaryngologists (physicians specializing in the treatment of ear, nose, and throat disorders) in Cleveland Clinic Voice Center. This procedure, known as laser cordotomy, can significantly improve your ability to breathe while maintaining vocal quality, and is available at only a handful of medical centers nationwide.

How We Speak

The voice box, or larynx, is made up of cartilage joined by ligaments, muscles, and two flaps of tissue called vocal cords or folds. Normally, the vocal cords, which lie over the top of the windpipe or trachea, move together to allow speech. The vocal cords separate to allow air to pass in and out of the trachea for breathing. Muscles surrounding the larynx control the opening and closing, length and tension of the vocal cords. As the column of air passes through the larynx, the tensed vocal cords vibrate. These vibrations produce sounds that are then shaped into words by the mouth and tongue.

Causes of Vocal Cord Problems

Vocal cord paralysis or impairment can result from radiation therapy, injury during surgical procedures, neurological disorders, arthritis of the joints between the cartilages of the larynx, or from problems present at birth. Paralysis of both vocal cords, for example, is a rare but major complication of thyroid surgery.

Traditional or Conventional Treatment

Traditional surgical techniques used to treat vocal cord paralysis have some serious consequences. One technique focuses on removing some of the cartilage of the larynx to open up the airway. Because of early postoperative swelling, this procedure also requires a tracheotomy, a temporary opening in the windpipe. A tracheostomy allows you to breathe and retain a serviceable voice, but it creates other problems, including the risk of infection. Another traditional treatment option, surgically pinning aside one vocal cord to create an expanded airway, results in improved breathing but leads to a breathy (weak) voice.

An Improved Technique

Laser cordotomy offers appropriate patients an alternative to these traditional surgical techniques. This innovative procedure permits breathing without a tracheostomy and without removal of cartilage. Just as important, it also allows you to maintain a good quality voice by preserving the most significant vocal fold relationships.

What to Expect

All laser cordotomy patients undergo a preoperative assessment to evaluate breathing and vocal cord activity. This assessment includes measurements of sound, air flow and force, as well as your own impression of your vocal quality and breathing ability.

Working together with other Voice Center specialists, the speech and language pathologist examines the airway and documents its size by videotaping the vocal cords before and after the procedure. Prior to treatment, vocal quality varies, depending on the nature and severity of the problem. Vocal quality, pitch and loudness are also reassessed after the procedure.

With the patient under general anesthesia, the surgeon uses a focused laser beam to make an incision in one vocal cord. The cord then stretches along the cut edge, opening the airway. Unlike traditional surgical techniques, the laser-separated edges heal quickly with very little scar formation to impair voice quality.

Patients undergoing laser cordotomy at Cleveland Clinic can expect to be hospitalized for 23 hours. General anesthesia is used during the procedure and antibiotics and steroids are prescribed during the three-month healing process. Very few people may require two laser cordotomies to achieve the best possible result.

Benefits of Laser Cordotomy

Although laser cordotomy may not be the answer for everyone with vocal cord paralysis, it offers benefits for many people.

Laser cordotomy:
  • improves breathing
  • maintains good vocal quality
  • preserves the cartilage of the larynx and the ability to swallow
  • eliminates the need for a tracheostomy

If you have been treated for bilateral vocal cord paralysis with a tracheostomy, you may now be eligible for laser cordotomy and closure of your tracheostomy.

This information is for educational purposes only and should not be relied upon as medical advice. It has not been designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient.

Reviewed by a Cleveland Clinic medical professional.

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