By Stephanie Ciccarelli
July 3, 2009
When a voice becomes weak, breathy or struggles to perform, there may be something more serious going on with the vocal folds than meets the eye.
I asked a number of questions of Dr. H. Steven Sims, Director of the Chicago Institute For Voice Care, about thyroplasty, a procedure that helps fatten up the vocal folds for people who may be experiencing symptoms mentioned above. Patients who opt to have this procedure done do so because their vocal folds are not vibrating as closely together as they should be.
In this short interview, you'll learn what causes the vocal folds to act this way, what the symptoms are, how a stressed voice may sound, and what a thyroplasty consists of.
Before we get into the interview, I wanted to share more about why I wrote this article. I received an email from a friend, Bob Green, a professional voice talent, who is about to undergo a thyroplasty. Bob said it was fine with him that I shared his recordings, the first of which was made with a "normal" voice and the second read was recorded two weeks later with a "stressed" voice. He thought it might be interesting for those who are curious or those who are experiencing similar afflictions.
Listen carefully to the first read when his vocal folds were stronger as compared to the second read where his vocal folds are dramatically weaker and stressed. Note the robust and resonant sound in the first read as contrasted with the second read, demonstrating how his voice has changed.
After Bob has had the procedure, he will check in again and share more about his experience and also how he is doing post-surgery.
Now that you have some context for how a potential candidate for thyroplasty might sound, we'll go on with the interview.
VOX: Welcome back and thank you for joining us! What exactly happens to the vocal folds to make them become less robust? What are the symptoms of this?
DR. SIMS: Several things can happen. The nerve (called the recurrent laryngel nerve) that tell most of the vocal muscles to move also helps stimulate them to grow and develop. Benign tumors, thyroid lumps, and even an aneurysm in the aorta can compress the nerve and make the muscles weaker. Also, they naturally become less robust as a person ages. There are some viruses that attack nerves and make them weaker too. So, there are lots of different ways through which a person can wind up with weak vocal muscles.
VOX: Can this be prevented?
DR. SIMS: Some of the causes (like having a surgeon injure the nerve during an operation) are preventable. Things like aging are not.
VOX: How would one know that they may be at risk and need to have a procedure done such as Thyroplasty?
DR. SIMS: For most of medicine, history or the background story is the key.
If your voice changed after a bad cold (and I mean didn't really ever get back to normal) you may have contracted a virus that weakened the nerve. If your voice changed after thyroid surgery, lung surgery, heart valve surgery and surgery to put a plate on the spine where they got to the spinal column from the front, then the nerve my have been injured during the surgery. Hopefully, your surgeon let you know this was a possible complication from the beginning.
Pretty much any ear nose and throat specialist can look at the vocal folds and see if they move. However, voice specialists have some unique tools to pick up more subtle findings. Perhaps not everyone needs to see a voice doctor, but if you find you can't project your voice and/or it seems to give out really quickly, then maybe a thyroplasty or some sort of vocal fold augmentation could have potential benefit.
VOX: I've heard thyroplasty referred to as "Fatty Injection Thyroplasty." What happens during a thryoplasty procedure?
DR. SIMS: Thyroplasty is also called a "voice lift". I think people sometimes use this terminology because we use liposuction to harvest fat before injecting it into the vocal folds.
There are also several synthetic substances that we use (Cymetra, Radiesse, Juvaderm). The problem with them all is duration, fat and the synthetics substances all get degraded by the body over months (9-12 or so) and have to be repeated. There are products that have been shown to last longer: Teflon--produces granulomas and isn't use much anymore; Bioplastique--no FDA approval, widely used in Europe but unavailable here; and Artefill, which was available in the US until the company went bankrupt.
VOX: That's all very interesting, Steve. Thank you for sharing your expertise and for enlightening us more about thyroplasty.
Thank you to Dr. Sims for his time and expertise, and also a very warm thank you to Bob Green for sharing his story with us and voice samples.
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