Treatment of Voice Disorders

From Khalid Ghufoor FRCS

The vast majority of people who suffer a change in voice or hoarseness will have a self limiting short lasting problem usually related to a viral infection. Occasionally the voice can remain poor due to other factors such as bacterial infections leading to pain on speaking, fever and feeling unwell. Fortunately such symptoms respond well to antibiotic, voice rest and steam inhalations.

Chronic voice disorder has many causes, the most commonest is related to voice misuse, leading to vocal nodules.

Vocal nodules

Vocal nodules, swelling the middle part of the vocal cords (folds)

The treatment of this problem involves a careful assessment to identify factors that are leading to vocal strain such as raising the voice, shouting, cough or throat clearing and counseling against such harmful behaviour. Accurate evaluation of the larynx by endoscopic view during voice use with a specialised stroboscopic light enables a highly magnified and slowed down view of the vocal fold lining. Polyps tumours and nodules can be distinguished as a result of this videolaryngostroboscopic technique. Simple vocal nodules respond well to speech therapy techniques which relax the vocal tract and prevent misuse.

Less common causes for voice change include laryngeal cancer which is amenable to treatment by standard radiotherapy techniques or by laser surgery which has been shown in many studies to have excellent cure rates 1,2.

Laryngeal cancer

Laryngeal cancer, (left image) swelling of the right vocal cord, which was successfully cured by laser surgery (right image)

1: Management of early glottis cancer : Cummings Otolaryngology: head and neck surgery (book) 2010 page101-104
CW Cummings, PW Flint, T Phelps, WM Abuzeid

2: Higher laryngeal preservation rate after CO2 laser surgery compared with radiotherapy in T1a glottic laryngeal carcinoma
Head & Neck Volume 31, Issue 6, pages 759–764, June 2009
M L. Schrijvers, E L. van Riel, J A. Langendijk, F G. Dikkers, E Schuuring, J E. van der Wal, B.F. A. M. van der Laan .

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Treatment of children with sleep-disordered breathing

From Martin Bailey FRCS

Sleep-disordered breathing affects approximately 12% of children, and consists of an abnormal breathing pattern during sleep which may include snoring, mouth breathing, and pauses in breathing. It is most commonly caused by large tonsils and adenoids.

Obstructive Tonsils

Very large, obstructive tonsils meeting in the midline

In mild cases it characteristically consists of snoring and a disturbed sleep pattern at night, with mouth-breathing and sometimes hyperactivity during the day.

In severe cases the child may struggle to breathe while asleep, and even momentarily stop breathing (‘obstructive sleep apnoea’). Such severe obstruction is potentially serious because it puts a strain on the heart and the lungs, and may affect growth and development. Even one obstructive episode per hour is significant in children, and the resulting sleep fragmentation can over time result in intellectual impairment with a reduced IQ1.

Treatment is removal of the tonsils and adenoids, and usually this is dramatically curative. However, an Australian review2 has indicated that in Australia and New Zealand only 1 in 7 of children who would benefit from this surgery are actually being treated, and the figures may well be worse for children missing out on treatment in the UK.

1. Behavior, cognition, and quality of life after adenotonsillectomy for paediatric sleep-disordered breathing: summary of the literature; Garetz SL; Otolaryngol Head Neck Surg 138(1): S19-S26 (January 2008)

2. A joint Position Paper of the Paediatrics and Child Health Division of the Royal Australasian College of Physicians and the Australian Society of Otolaryngology, Head and Neck Surgery, 2008 Sydney

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The Medel Bonebridge Bone Conduction Implant System

From Robert Quiney FRCS

The Medel Bonebridge fully buried hearing implant, for conductive hearing loss which is not suitable for other surgical treatment.

Medel Bonbridge Hearing Implant

Hearing Implant in various colours


The auditory processor is hidden under the hair, and is easily removed for hair washing and swimming. There is no need to remove hair follicles at the time of surgery, and as there is no scar around the ear the hair can be worn up or tied back.

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