Deborah Aloba - Singing Teacher

Deborah Aloba - Singing Teacher

Vocal Surgery – Past & Present

Vocal Surgery – Past & Present

In the past surgery was usually the treatment of choice. Voice therapy was often either unsuccessful (because the nodules had become fibrous scars), given post operatively or not given at all. Surgery to remove vocal nodules often had a bad outcome, giving vocal nodules their reputation of being a “career killer”.

Until recently the importance of maintaining the integrity of the gelatinous layer of the Lamina Propria was not fully understood. Surgeons believed removing the swelling and maintaining a straight vocal edge was all that was necessary to restore a clear vocal quality. If the swelling was extensive, the epithelial covering could be “stripped” off the fold. This procedure damaged or destroyed the gelatinous layer so that the epithelial cover became stuck down or “tethered” to the underlying ligament. The mucosal wave could no longer be generated leaving the voice permanently hoarse. Frequently the voice was worse than it had been pre-operatively. If the patient was a singer or professional voice user their career was over.

Nowadays, surgical techniques try, whenever possible, to ensure that the gelatinous layer of the Lamina Propria is preserved. While the vocal folds may be initially a little stiff after surgery, voice therapy and good technique will shake the stiffness loose again and the mucosal wave and clear vocal quality are restored.