There are several circumstances in which a person's voice may become weak and breathy. Probably the commonest of these is a paralysis of one or other vocal cord (vocal fold). Vocal cord paralysis can happen as a result of various processes: for example surgery on the neck or due to a cancer invading one of the nerves to the larynx. Beyond vocal cord paralysis, another potential reason for vocal weakness is ageing of the voice, in which the muscles lose tone and strength.
If the vocal cords do not close effectively, the voice sounds quiet and breathy; a procedure to make the vocal cords come together more efficiently can help to remove much of the weakness and breathiness. The quickest and easiest way to do this is by injecting filler material into the vocal cord – this is called medialisation of the vocal cord. This has become known as the voice-lift procedure – however, although this implies that it is a "cosmetic" procedure, this is really not the case – it is a procedure to give back strength to the voice. It can also help with functions of swallowing and coughing.
This procedure can be performed under general or local anaesthetic – in many patients, an injection under local anaesthetic is the better option.
The filler material is used to plump up the vocal cord and achieve better closure of the cords, giving a stronger voice. The positioning of the needle is achieved by monitoring its position using an endoscope in the nose.
Mr Costello runs regular workshops (in association with Merz) for ENT surgeons wishing to learn the technique of vocal cord medialisation injection in the clinic. Please email email@example.com for more information.
Left: Paralysed left vocal cord resulting in weak breathy voice
Middle: Needle being advanced towards the paralysed vocal cord to inject the filler
Right: Trans-cricothyroid injection diagram – With thanks to Merz Pharma