変声障害に対する外科的治療の適応

Abstract

In general, the primary therapy for mutational voice disorder is voice therapy since the disorder is believed to be mainly functional. However, we sometimes see organic changes such as slight vocal cord atrophy in some patients with mutational voice disorder who have mainly voice breaks as well as high pitch and hoarseness. We assume that asynchronous growth of the laryngeal cartilage and vocal cords might cause imbalance of tension of the vocal cords that results in atrophic appearance of vocal cord and prolonged mutational voice. When organic changes such as atrophy or tension imbalance of the vocal cords exist, voice therapy may not be effective and surgical treatment may yield better results.We performed thyroplasty type III with lateral compression in three patients with mutational voice disorder with organic change. If the imbalance of the vocal cord tension causes mutational voice disorder associated with vocal cord atrophy, thyroplasty type III conbined with lateral compression may correct both the imbalance of the vocal cord tension and the glottal gap caused by vocal cord atrophy.The effect of the operation was rapid and dramatic. In all three patients the voice pitch became much lower immediately after the procedure, and breathiness and voice breaks were reduced or disappeared. None of the patients required voice therapy after the operation. In conclusion, thyroplasty type III is quite effective for mutational voice disorder with unilateral vocal cord atrophy.