Vocal Cord Surgery: Procedure, Recovery & What to Expect

What Is Vocal Cord Surgery?

Vocal cord surgery, also called phonosurgery or microlaryngoscopy, is a minimally invasive procedure performed through the mouth to diagnose and treat conditions affecting the vocal cords. The surgeon uses a laryngoscope to visualize the vocal cords and operates using microsurgical instruments or laser technology.

The vocal cords (also called vocal folds) are two bands of muscle tissue located in the larynx (voice box) at the top of your windpipe. When air passes through the vocal cords, they vibrate to produce sound. Any abnormalities affecting the vocal cords can impact your voice quality, causing hoarseness, voice weakness, or difficulty speaking.

Vocal cord surgery encompasses several different procedures, all aimed at restoring normal vocal cord function and voice quality. The specific technique used depends on the underlying condition being treated. Modern vocal cord surgery is highly refined, using operating microscopes and precision instruments to preserve as much healthy tissue as possible while removing or correcting the problem.

This type of surgery falls under the specialty of laryngology, a subspecialty of otolaryngology (ear, nose, and throat medicine). Laryngologists undergo additional fellowship training specifically focused on voice disorders and laryngeal surgery, making them uniquely qualified to perform these delicate procedures.

Common Reasons for Vocal Cord Surgery

There are several conditions that may require surgical intervention on the vocal cords. Understanding why surgery might be recommended can help you prepare for the procedure and set appropriate expectations for recovery.

• Vocal cord nodules: Benign growths caused by voice overuse or misuse, common in singers, teachers, and others who use their voice extensively
• Vocal cord polyps: Fluid-filled lesions that develop on one vocal cord, often due to a single traumatic event like shouting
• Vocal cord cysts: Fluid-filled sacs that form within the vocal cord tissue
• Vocal cord paralysis: Weakness or complete immobility of one or both vocal cords due to nerve damage
• Laryngeal papillomatosis: Benign wart-like growths caused by human papillomavirus (HPV)
• Reinke's edema: Swelling of the vocal cords, often associated with smoking and voice overuse
• Suspicious lesions: Abnormal tissue that needs to be biopsied to rule out cancer
• Vocal cord scarring: Stiffness from previous injury, surgery, or radiation therapy

Your doctor may also recommend surgery to obtain a tissue sample (biopsy) for examination under a microscope. This is particularly important when there is concern about precancerous or cancerous changes in the larynx.

How Do You Prepare for Vocal Cord Surgery?

Preparation for vocal cord surgery includes stopping smoking several weeks beforehand, fasting before the procedure if general anesthesia will be used, having your voice recorded for comparison, and possibly seeing a dentist if you have dental problems. Your doctor will provide specific instructions based on your situation.

Proper preparation for vocal cord surgery is essential for achieving the best possible outcome. Your healthcare team will provide detailed instructions tailored to your specific situation, but there are several general preparation steps that most patients will need to follow.

The weeks and days leading up to your surgery are an important time to optimize your health and ensure you're in the best condition for the procedure. Taking these preparation steps seriously can significantly impact your recovery and long-term results.

Stop Smoking Before Surgery

If you smoke, you should stop several weeks before your surgery. Smoking irritates the vocal cords and airways, increases the risk of surgical complications, and can significantly impair healing. The chemicals in tobacco smoke cause inflammation and swelling of the vocal cord tissue, making surgery more difficult and recovery slower.

After surgery, it is strongly recommended that you do not resume smoking, as this can cause the underlying problems to return and may even worsen your condition. Smoking is a leading cause of many vocal cord disorders, including Reinke's edema and laryngeal cancer. Quitting permanently is one of the most important things you can do for your voice health.

If you need help quitting, speak with your doctor about smoking cessation programs, nicotine replacement therapy, or medications that can help you quit. Many hospitals offer resources to help patients quit smoking before surgery.

Fasting Requirements

If you will be receiving general anesthesia, you will need to fast before the operation. This typically means not eating or drinking anything for several hours before your scheduled surgery time. Fasting is necessary to prevent aspiration (inhaling stomach contents into the lungs) during anesthesia.

Your surgical team will provide specific instructions about when to stop eating and drinking. Follow these instructions exactly, as failing to fast properly may result in your surgery being postponed for safety reasons.

Avoid Certain Medications

Some pain medications and blood thinners may need to be stopped before surgery. These medications can increase the risk of bleeding during and after the procedure. Common medications that may need to be discontinued include:

• Aspirin and aspirin-containing products
• Ibuprofen (Advil, Motrin) and other NSAIDs
• Blood thinners such as warfarin, rivaroxaban, or apixaban
• Certain herbal supplements that affect bleeding

Always inform your doctor about all medications, supplements, and herbal products you are taking. Never stop any prescribed medication without first consulting with your doctor, as some medications should not be discontinued abruptly.

Voice Recording

Before surgery, your voice may be recorded. This recording serves as a baseline that allows your healthcare team to objectively compare your voice before and after the procedure. The recording is typically done by a speech-language pathologist (also called a speech therapist) or by other healthcare staff.

The recording session usually involves reading standardized passages, sustaining vowel sounds, and speaking in conversation. This documentation helps track your progress and can be valuable for planning any post-operative voice therapy you may need.

Dental Evaluation

While the risk of dental injury during vocal cord surgery is very low, if you have pre-existing dental problems, you may need to see a dentist before surgery. This is because the instruments used during the procedure are placed through your mouth and can potentially put pressure on your teeth.

If you have loose teeth, dental crowns, bridges, or other dental work, your dentist may recommend treatment to reduce the risk of damage during surgery. A dental guard or protective device may be used during the procedure to protect your teeth.

How Is Vocal Cord Surgery Performed?

During vocal cord surgery, you lie on your back while the surgeon inserts a laryngoscope (viewing tube) through your mouth to visualize the vocal cords. Using microsurgical instruments or laser, the surgeon performs the necessary procedure. The operation typically takes about 30 minutes and can be done under local or general anesthesia.

Understanding what happens during vocal cord surgery can help reduce anxiety and allow you to better prepare for the experience. The procedure is well-established and performed routinely by laryngologists and otolaryngologists around the world.

Modern vocal cord surgery is a testament to the advances in medical technology and surgical technique. The use of operating microscopes, specialized instruments, and in some cases laser technology allows surgeons to work with remarkable precision on the delicate structures of the vocal cords.

Anesthesia Options

Vocal cord surgery can be performed under local anesthesia or general anesthesia. The choice depends on several factors, including the type of procedure being performed, your overall health, and your surgeon's preference. Your doctor will discuss the best option for your specific situation.

With local anesthesia, you remain awake but your throat is numbed so you don't feel pain. This approach may be preferred for certain diagnostic procedures or minor interventions. With general anesthesia, you are completely asleep during the surgery. This is more common for more extensive procedures and allows the surgeon to work without any patient movement.

The Surgical Procedure

During the surgery, you will lie on your back on the operating table. A special instrument called a laryngoscope is used to keep your mouth open and hold down your tongue, providing a clear pathway to your larynx. The laryngoscope is a rigid tube that allows the surgeon to see and access your vocal cords.

The surgeon then inserts instruments through the laryngoscope to examine and operate on your vocal cords. An operating microscope or endoscope provides magnification, allowing the surgeon to see the fine details of the vocal cord tissue. This magnification is essential for precise surgery while preserving healthy tissue.

Depending on the condition being treated, the surgeon may use various microsurgical instruments or a laser to remove lesions, take biopsies, inject materials, or perform other procedures. The specific technique depends on your diagnosis:

• Excision: Removing nodules, polyps, cysts, or other growths
• Biopsy: Taking a small tissue sample for laboratory analysis
• Injection: Adding bulk to a paralyzed vocal cord to improve voice
• Laser treatment: Vaporizing abnormal tissue or treating blood vessel abnormalities
• Medialization: Moving a paralyzed vocal cord to the midline

The surgery typically takes approximately 30 minutes, though this can vary depending on the complexity of the procedure. Because the surgery is performed through your mouth, there are no external incisions, which means no visible scars and generally faster healing.

What the Surgeon Sees

Through the laryngoscope and operating microscope, the surgeon has a detailed view of your vocal cords and surrounding structures. The vocal cords appear as two white, pearly bands of tissue that come together when you speak and separate when you breathe. Any abnormalities such as nodules, polyps, or areas of concern can be clearly visualized and addressed.

What Happens After Vocal Cord Surgery?

Most patients feel well after vocal cord surgery and go home the same day. Post-operative care includes eating soft, cool foods initially, taking over-the-counter pain relievers for throat soreness, and following voice rest instructions carefully. Temporary hoarseness is common and can last from days to months before improving.

The recovery period after vocal cord surgery is a crucial time for healing. Following your doctor's instructions carefully during this period will help ensure the best possible outcome for your voice.

Your body's healing response begins immediately after surgery. The vocal cords are remarkably resilient, but they need time and proper care to heal correctly. The steps you take during recovery can significantly impact your long-term voice quality.

Immediate Post-Operative Period

After the surgery, you will be taken to a recovery area where medical staff will monitor you as the anesthesia wears off. If you had general anesthesia, you may feel groggy, drowsy, or slightly nauseous initially. These effects typically resolve within a few hours.

Most patients feel well enough to go home later the same day. However, you should not drive yourself home after receiving anesthesia. Make sure to arrange for someone to pick you up and stay with you for at least the first night after surgery.

Managing Discomfort

It is normal to experience some throat soreness and neck discomfort for several days after surgery. This is typically mild and can be managed with over-the-counter pain relievers containing paracetamol (acetaminophen). Avoid aspirin and ibuprofen unless your doctor specifically approves them, as these can increase bleeding risk.

Eating soft, cool foods can also help minimize discomfort in the first few days. Avoid hot, spicy, or acidic foods that might irritate your throat. Good choices include:

• Smoothies and milkshakes
• Yogurt and pudding
• Soft scrambled eggs
• Mashed potatoes
• Applesauce
• Soup (served lukewarm, not hot)

Voice Rest: The Most Important Part of Recovery

Voice rest is one of the most critical aspects of recovery after vocal cord surgery. This does not mean complete silence – rather, it means using your voice gently and sparingly. Your doctor will provide specific guidelines about how long and how strictly you need to rest your voice.

During voice rest, you should:

• Speak softly and gently when you need to communicate
• Avoid whispering – contrary to popular belief, whispering actually puts more strain on your vocal cords than soft speech
• Avoid shouting or yelling
• Avoid throat clearing and coughing when possible – sip water instead if you feel the need to clear your throat
• Avoid heavy lifting – this strains the vocal cords as you hold your breath and bear down

The duration of voice rest varies depending on the type of surgery performed. It may range from a few days to several weeks. Follow your surgeon's specific instructions, as adhering to voice rest recommendations is essential for proper healing.

If you have a job that requires extensive voice use, you may need to take time off work during your voice rest period. Your doctor can provide documentation if needed for your employer.

Hoarseness After Surgery

It is very common to be hoarse after vocal cord surgery. This is a normal part of the healing process and should not cause alarm. The hoarseness occurs because the vocal cords have been manipulated during surgery and need time to heal and return to their normal function.

The duration of post-operative hoarseness varies widely. For some patients, voice quality returns to normal within a few days. For others, hoarseness may persist for several weeks or even months. In most cases, the voice gradually improves over time as the surgical site heals.

If your hoarseness does not improve as expected or worsens significantly, contact your doctor. While some persistent hoarseness is normal, your healthcare team should be aware of your progress.

When Will I Get My Results?

If tissue samples (biopsies) were taken during surgery, they are sent to a laboratory for microscopic examination. Results typically take several days to a week. Your doctor will contact you with the results or schedule a follow-up appointment to discuss the findings.

If your surgeon removed tissue or took biopsies during the procedure, these samples are sent to a pathology laboratory for analysis. A pathologist (a doctor who specializes in examining tissue samples) will examine the tissue under a microscope to determine exactly what type of cells are present.

The timing of results can vary. Ask your doctor what to expect regarding when and how you will receive your results. Some practices call patients with results, while others prefer to discuss findings in person at a follow-up appointment.

Understanding your pathology results is important for your ongoing care. If the results show benign (non-cancerous) tissue, you can typically continue with routine follow-up. If the results indicate precancerous changes or cancer, your doctor will discuss additional treatment options with you.

Tissue Sample Storage

When you have tissue samples taken during medical procedures, a portion of the sample may be stored in what's called a biobank. These stored samples can be valuable for your future medical care, as they provide a reference point if you ever need to have the same tissue examined again. The samples may also be used for medical research to help improve treatments for future patients, though this is typically done with your consent.

What Are the Risks and Complications?

Vocal cord surgery is generally very safe with a low complication rate. Temporary hoarseness is common and expected. Rare complications include infection, bleeding, dental injury, and permanent voice changes. Contact your doctor immediately if you develop fever, severe pain, or difficulty swallowing after surgery.

Like any surgical procedure, vocal cord surgery carries some risks. However, complications are uncommon, and serious complications are rare. Understanding the potential risks can help you make an informed decision about surgery and know what warning signs to watch for during recovery.

The vast majority of patients undergo vocal cord surgery without any significant complications. The surgical techniques used have been refined over many decades, and experienced laryngologists perform these procedures routinely with excellent safety records.

Common Post-Operative Effects

Some effects after surgery are expected and not considered complications:

• Hoarseness: This is normal and expected. It typically improves over time as the vocal cords heal.
• Sore throat: Mild throat discomfort is common for several days after surgery.
• Neck stiffness: Some patients experience temporary neck discomfort from positioning during surgery.

Potential Complications

While uncommon, the following complications can occur:

• Infection: Any surgical procedure carries a risk of infection. Signs include increasing pain, fever, difficulty swallowing, or pus-like drainage.
• Bleeding: Significant bleeding is rare but can occur. Minor blood-tinged saliva immediately after surgery is normal.
• Dental injury: The laryngoscope can potentially damage teeth, though this is very rare. Risk is higher in patients with dental problems, which is why a dental evaluation may be recommended before surgery.
• Permanent voice changes: In rare cases, hoarseness may not fully resolve. This is uncommon but is a risk that patients should be aware of.
• Breathing difficulties: Swelling in the airway after surgery can, in very rare cases, cause breathing problems. This is more likely with extensive procedures.

Will I Need Speech Therapy After Surgery?

Many patients benefit from voice therapy with a speech-language pathologist after vocal cord surgery. Voice therapy helps you learn proper vocal techniques to optimize your voice and prevent future problems. Your doctor will recommend whether voice therapy would be beneficial for your specific situation.

Speech-language pathologists (SLPs) are healthcare professionals who specialize in voice disorders and therapy. Working with an SLP after vocal cord surgery can help you get the most out of your procedure and maintain good vocal health long-term.

Voice therapy may include:

• Vocal hygiene education: Learning habits that protect your voice
• Breathing techniques: Optimizing breath support for speaking
• Resonance exercises: Improving voice quality and projection
• Posture and body alignment: Supporting efficient voice production
• Reducing vocal strain: Learning to speak without tension

Voice therapy is particularly important for patients who developed vocal cord problems due to voice misuse or overuse, such as singers, teachers, or call center workers. Learning proper vocal technique can help prevent problems from recurring.

Being Involved in Your Care

You have the right to be fully informed about your treatment and to participate in decisions about your care. Ask questions, seek second opinions if desired, and make sure you understand the information provided by your healthcare team.

Being an active participant in your healthcare leads to better outcomes. Don't hesitate to ask your doctor to explain anything you don't understand. It's important that you feel comfortable with your treatment plan before proceeding with surgery.

Good questions to ask your doctor include:

• What specific procedure are you recommending, and why?
• What are the alternatives to surgery?
• What results can I realistically expect?
• What are the specific risks in my case?
• How long will my voice rest period be?
• When should I expect my voice to return to normal?
• Will I need voice therapy after surgery?

If you have difficulty understanding the information provided, you have the right to request an interpreter if needed, ask for written materials to review at home, or bring a family member or friend to appointments to help you process the information.