Voice Therapy Management of Vocal Fold Scarring and Sulcus Vocalis

Abstract

Vocal fold scarring and sulcus vocalis remain major therapeutic challenges in voice therapy. The loss of the superior lamina propria results in a change to the pliability of the vocal folds, along with changes in the glottal configuration and glottal closure and a reduced to absent mucosal wave motion. This results in dysphonia of varying severity, including breathiness, roughness, loss of pitch range, and flexibility. The dysphonia caused by vocal fold scarring and sulcus vocalis is often severe and difficult to treat, and no suitable voice therapy has been established, let alone validated in a prospective study. We performed voice therapy for patients with mild to moderate vocal fold scarring and sulcus vocalis and functional problems, such as an alternative hyperfunc-tional voice or vocal misuse. The concept of voice therapy in our clinic involved the following: minimizing vocal effort, optimizing the vocal quality, and developing vocal flexibility. As a result, the vocal function has signifi-cantly improved with regard to various vocal parameters in aerodynamic assessments, acoustic analyses, stro-boscopic examinations, and self-evaluations. Ten of 13 patients completed treatment for vocalization through voice therapy, without the need for additional treatments. Three of the 13 patients showed an improvement in their vocal function on inspection, although they were not satisfied with their professional voices. These results indicate that voice therapy has potential utility for improving the vocal function in patients with mild to moderate vocal fold scarring and sulcus vocalis.