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telefon

Berlin Center
+49 30 315 076 55

Mail

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info@wohlt.com

telefon

Vienna Center
+43 1 513 05 27

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+49 160 948 703 37

GER

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Italiano
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русский
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telefon
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  • Dr. Wohlt
    • Curriculum Vitae
    • Press & Media
    • Philosophy
  • Organization
    • Appointments
    • Berlin Center
    • Vienna Center
    • Invoicing for Services
    • International Patients
  • Voice Disorders
    • Voice Disorders – General Information
    • Vocal Cord Paralysis
    • Vocal Cord Nodules
    • Vocal Cord Polyps
    • Reinke’s Edema
    • Vocal Cord Cyst
    • Laryngeal Papillomatosis
    • Vocal Cord Granuloma – Contact Granuloma
    • Vocal Cord Leukoplakia | Laryngeal Cancer
    • Aging Voice – Vocal Cord Atrophy
    • Functional Dysphonia
    • Psychogenic Dysphonia
  • Voice Surgery
    • Voice Surgery – General Information
    • Vocal Cord Paralysis Surgery
    • Vocal Cord Nodules Surgery
    • Vocal Cord Polyp Surgery
    • Reinke’s Edema Surgery
    • Vocal Cord Cyst Surgery
    • Laryngeal Papillomatosis Surgery
    • Vocal Cord Leukoplakia Surgery
    • Vocal Fold Augmentation After Cancer Surgery
    • Anti-Aging Voice Surgery
  • Voice Therapy
    • Voice Therapy – Speaking Voice
    • Voice Therapy – Singing Voice
    • Vocal Rehabilitation After Vocal Cord Surgery
  • Singers’ Page
    • Vocal Arts Medicine
    • Voice Surgery for Professional Singers
    • Vocal Rehabilitation for Professional Singers
    • Vocal Cord Surgery for Singers

Voice Surgery for Vocal Cord Paralysis

When is voice surgery for vocal cord paralysis indicated?

In patients with unilateral vocal cord paralysis, the paralyzed vocal cord is immobile, making it impossible for the vocal folds to close completely during voice production. This condition is frequently associated with significant hoarseness, shortness of breath and difficulty swallowing.

If no sufficient voice improvement is noted after a period of six months (with or without voice therapy), it can be assumed

that the manifest paralysis will no longer resolve by itself.

That is the time when the option of a surgical intervention should be considered in order to achieve complete or markedly improved closure of the vocal folds during voice production. Such an intervention not only has a beneficial effect on voice quality, but also on air consumption and on any swallowing difficulties.

Vocal cord paralysis before surgery

Vocal cord paralysis before surgery

Vocal cord paralysis after surgery

Vocal cord paralysis after surgery

Voice recording: Vocal cord paralysis before surgery

Voice recording: Vocal cord paralysis after surgery

Dr. Wohlt’s Operative Method

The operative method used by Dr. Wohlt involves augmentation of the paralyzed vocal cord with autologous fat tissue.

Vocal fold augmentation is a decades-long established procedure. Yet, over the course of time, there have been advancements in materials used for augmentation.

In earlier times, these interventions were carried out with paraffin, later with Teflon paste. Since then, the range of modern materials available has broadened.

Those deserving special mention include:

  • Hyaluronic acid
  • Calcium hydroxylapatite
  • Silicone compounds

What all these substances have in common is that they consist of artificial materials that can trigger allergic reactions or even be rejected by the body as a result of inflammatory processes. Moreover, some polymer plastics can exhibit unpredictable hardening phenomena after injection into the tissue.

For the reasons mentioned above, Dr. Wohlt exclusively uses autologous fat tissue for augmentation of the paralyzed vocal fold. The advantage of using autologous fat tissue is that it cannot trigger any allergic reactions as compared to artificial products because it constitutes endogenous tissue from the patient's own body.

Neither are rejection reactions to be expected for the same reason. The primary advantage, however, lies in the soft, supple texture of the fat tissue itself. By its nature, this type of tissue is especially suited for augmenting vocal folds.

As an alternative to fat augmentation, the surgical method of thyroplasty is an option. By this procedure, through an external access, the larynx is opened and a small silicone block or Gore-Tex strip is implanted in it. This pushes the paralyzed vocal fold towards the middle. However, the implant is not able to upholster the paralyzed vocal fold.

Moreover, the intervention can be accomplished within approx. 45 minutes on an outpatient basis. It is also not necessary to make an external incision, as would be necessary with thyroplasty.

How is voice surgery for vocal cord paralysis performed?

For this procedure, first, a small skin incision is made near the belly button to harvest autologous fat tissue. Afterwards, the wound is closed and the fat is processed according to specific criteria. Next, the fat is injected precisely into the paralyzed vocal fold. During this process, it is particularly important to inject the right amount of fat cells at the optimal sites. Too little or too much fat can result in less satisfactory outcomes, like significant overcorrection.

That said, it should be noted that a certain amount of overcorrection will always make sense; in other words, a little more fat must be injected than would be required for good vocal fold closure.

The reasoning behind this seeming contradiction is that the body absorbs the liquid portions of fat during the first post-interventional weeks. Therefore, a certain amount of reserve autologous fat above and beyond the minimum amount always ought to be injected into the vocal folds.

Right after surgery, the patient can expect to delight in a much more resonant voice of good quality. The results are often highly impressive. The patient does not need to maintain voice rest and may speak right away. He or she will also notice an improvement in their shortness of breath, because they are now able to dose their breathing better. Their swallowing problems will improve noticeably as well.

Vocal fold augmentation (fat augmentation) in a female patient

1 day before surgery

1 day after surgery

4 weeks after surgery

Vocal fold augmentation (fat augmentation) in a male patient

1 day before surgery

1 day after surgery

3 weeks after surgery

What happens during the postoperative phase?

As mentioned above, the patient does not need to maintain voice rest after surgery for vocal cord paralysis using fat augmentation. The only wounds that need to heal are at the injection sites, but these close up relatively fast.

After a brief period, the patient should start postoperative voice therapy aimed at relearning a good phonation pattern to counteract the bad habits acquired by compensating for the paralysis. The longer vocal fold paralysis has been manifest, the longer the voice therapy aftercare phase can be anticipated to last.

As encouragement, unilateral vocal cord paralysis can be treated using Dr. Wohlt's method of vocal fold augmentation, no matter how long the paralysis has lasted. Even patients whose vocal fold paralysis has been present for decades can benefit immensely from this method and have their former voice returned.
A voice of good quality can likewise be given back to even those patients who have suffered from vocal cord paralysis for more than 40 years. It is moving to see the joy expressed by a person who has been afflicted by voicelessness when they can hear the sound of their former voice once again after as long as up to four decades.

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Dr. Wohlt
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Germany

Gerrit Wohlt, M.D.
Board-certified Laryngologist
Board-certified Phoniatrician

Fasanenstraße 70
10719 Berlin

Phone +49 30 315 076 55
Mail info@wohlt.de

Austria

Gerrit Wohlt, M.D.
Board-certified Laryngologist
Board-certified Phoniatrician (Voice and Speech Medicine)

Fichtegasse 2A
1010 Wien

Phone +43 1 513 05 27
Mail info@wohlt.at

Deutsch

© Dr. med Gerrit Wohlt 2023

The medical content of this website is intended for educational purposes only and should not be construed as medical advice or used in place of consulting a qualified medical professional. Specific details may not apply to the individual case and under no circumstances should treatment decisions be based thereupon. Great care was taken in compiling the most accurate information for this website. Notwithstanding these efforts, medicine is a dynamic and living science undergoing constant flux. All warranties, express or implied, with respect to the accuracy, completeness, timeliness or quality of the details provided are therefore disclaimed. The user of this website is hereby made aware of these limitations.

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GERMANY
Gerrit Wohlt, M.D.
Board-certified Laryngologist
Board-certified Phoniatrician

Fasanenstraße 70
10719 Berlin

Phone +49 30 315 076 55
Mail info@wohlt.de

AUSTRIA
Gerrit Wohlt, M.D.
Board-certified Laryngologist
Board-certified Phoniatrician (Voice and Speech Medicine)

Fichtegasse 2A
1010 Wien

Phone +43 1 513 05 27
Mail info@wohlt.at

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The medical content of this website is intended for educational purposes only and should not be construed as medical advice or used in place of consulting a qualified medical professional. Specific details may not apply to the individual case and under no circumstances should treatment decisions be based thereupon. Great care was taken in compiling the most accurate information for this website. Notwithstanding these efforts, medicine is a dynamic and living science undergoing constant flux. All warranties, express or implied, with respect to the accuracy, completeness, timeliness or quality of the details provided are therefore disclaimed. The user of this website is hereby made aware of these limitations.

© Dr. med Gerrit Wohlt 2023