Voice disorders occur when voice quality, pitch, and loudness differ or are inappropriate for an individual. Approximately one out of 13 adults in the United States will experience a voice disorder annually but few (less than 10% seek medical treatment.)
Estimated 17.9 million adults reported a voice problem in 2014 study.
- Infectious laryngitis was the most common 685,000 cases
- GI reflux was mentioned in 308,000 cases
Voice problem lasted 56.2 days on average in this survey.
Young adults aged 24-34 with voice disorders was estimated at 6%.
Adults aged 60 and above with voice disorders was estimated 4.8% to 29.1%.
Among adults aged 19-60 the most frequent diagnosis included functional dysphonia (20%), acid laryngitis (12.5%), and vocal polyps (12%).
Adults over the age of 60 who were examined by medical professionals, voice disorders were most commonly presbyphonia (changes associated with aging voice), reflux inflammation, functional dysphonia, vocal fold paralysis and Reinke’s edema. Rienke’s space is the non-muscle part of the vocal cords. This is commonly called the vocal fold and swelling here prohibits the cords from vibrating normally.
Laryngeal cancer was commonly in the age group of 75-79.
Children- voice disorders more prevalent in males than in females
Adults- voice disorders more prevalent in females than males
- Females had no specific causes and the diagnosis was dysphonia
- Males has diagnosis of chronic laryngitis most commonly
- Males had higher cancer rates than females
- Teachers were 3 times more likely than the general population to have voice disorders
- Voice disorders among singers was estimated to be close to 50%
- Manufacturing industry employees were 1.4 times more likely than the general population
- Service industry workers were 2.6 times more likely than the general population to develop laryngeal growths
Voice Disorders Classification
Organic- these disorders arise from alterations in the laryngeal, respiratory or vocal mechanisms
- Neurogenic- disorders with the peripheral nervous system or the central nervous system that affect the vocal cord function
- Structural- disorders that result from structural changes of the vocal cords
Functional- Voice disorders with intact vocal cords but inefficient use of the mechanism
- Vocal fatigue
Normal voice production depends on muscle power and airflow supplied by;
- Respiratory System
- Laryngeal Muscles
- Coordination of the pharyngeal, oral cavity and nasal cavity
Disruption to any one of these systems can cause voice abnormalities
These disruptions are further classified as organic, functional or psychogenic
- Vocal cord abnormalities such as nodules or polyps
- Inflammatory disorders such as arthritis or laryngitis
- Trauma such as post intubation or chemical exposure
- Nerve paralysis
- Multiple Sclerosis
- Chronic stress
- Conversion reactions
- Trauma such as screaming or yelling
- Vocal cord fatigue
Clinical Practice Guidelines for the treatment of hoarseness
American Academy of Otolaryngology guidelines
- History and physical exam including recent surgery, masses of neck, respiratory distress, tobacco use, vocation as in a professional vocalist
- Identify dysphonia in a patient with altered quality of voice, pitch, loudness and vocal effort
- Diagnostic laryngoscopy
- Surgical options for suspected malignancy, symptomatic vocal cord lesions or glottic insufficiency
- Botulinum toxin injections for spasmodic dysphonia
Academy recommends against
- Routine antibiotics
- CT or MRI prior to direst visualization by laryngoscopy
- No anti-reflux meds prior to direct visualization of larynx
- No routine use of steroids prior to laryngoscopy
A sulcus vocalis is a scar of the vocal cord fold. It is different from scarring elsewhere in the body as it prevents or inhibits the vocal cords from vibrating normally. The vocal fold sulcus /scar is a disruption to the Reinke’s layer which impairs free motion of the underlying mucosa of the cords.
The scar formation can occur from;
- Vocal cord lesions present for a long period of time
- Prior surgery
- Hemorrhaging in the area
- Repeated trauma
Methods for treating vocal atrophy with sulcus vocalis
- Fat injection laryngoplasty
- Hyaluronic acid laryngoplasty
- Steroid injection
- Platelet Rich Plasma laryngoplasty
Platelet Rich Plasma is an autologous blood derived concentrate rich in growth factors and cytokines which will activate the body’s regenerative capabilities. When used in sulcus vocalis, studies have shown great improvement in the scar and the promotion of tissue remodeling in the vocal cord leading to improvement of the voice.
- Platelet Rich Plasma for Vocal Fold Scar: A Preliminary Report of Concept J Voice 2021 Jan 12;50892-1997(21)00012-6 PMID 33446439
Introduction- The purpose of this study was to review the technical aspects of collecting PRP and injecting it into the vocal fold
Case- Vocal fold scar was identified and 4 monthly injections of PRP which was temporarily halted due to Covid-19. The patient received 1 injection of PRP. Subjective improvement was noted at 1 month and independent analysis of voice showed improvement at 4 months.
Conclusion- This report was part of a trial investigating the use of PRP to treat vocal cord atrophy and scar. This study will help to validate the safety and efficacy of PRP injections
- Short Term Voice Improvement after Repeated Office Based PRP Injection in Patients with Vocal Fold Scar, Sulcus, and Atrophy J Voice 2021 Mar 18;50892-1997(21)00081-3 PMID 33745803
Introduction- Improving the voice of patients with vocal atrophy, scar and sulcus vocalis remains challenging. Office based injections of PRP may serve as a source of improved wound healing.
Methods- 32 office- based injections of PRP were performed in 14 patients with scar, sulcus and vocal atrophy. Follow up was 15 months. 11 of the 14 patients thought the intervention was worthwhile enough to repeat. The other 3 thought the improvement was transient
Conclusion- Office PRP injection into the fold of patients with scar, sulcus and atrophy is a biologic worth considering
- Laryngeal Applications of Platelet Rich Plasma and Platelet Poor Plasma: A Systemic Review J Voice 2021 Aug 9;50892-1997(21)00232-0. PMID 34384663
Background- PRP and PPP are regenerative therapies that offer the potential for improving disorders of the larynx. The laryngeal applications of these substances have been examined in both animals and humans. The goal of this review was to examine the various applications and evaluate the outcomes and complications.
Results- 7 studies were included based on selection criteria. The animal studies found elevated levels of growth factors, organized collagen deposition, decreased granulation tissue, increased vascularization and increased cartilage proliferation in the PRP treated laryngeal tissues.
Conclusion- PRP might have the potential to be used safely in the laryngeal area and at least temporarily influence wound healing and vocal function.
- Autologous Fat Plus Platelet Rich Plasma versus Autologous Fat Alone on Sulcus Vocalis J Clin Med 2022 Feb; 11(3): 725 dol: 10.3390/jcm11030725
Purpose- Sulcus vocalis is a frequent cause of glottic insufficiency that leads to incomplete vocal cord closure during phonation. Treatment with fillers such as fat or hyaluronic acid in the vocal cords is widely used but the duration of effects is variable. Platelet Rich Plasma can enhance the survival of autologous fat in fat grafting and also is used to treat sulcus vocalis. This study aimed to compare the effectiveness of autologous fat versus fat plus PRP to treat sulcus vocalis in 34 patients.
Conclusion- The use of PRP plus fat is associated with faster healing and shorter recovery time than fat alone. PRP promotes angiogenesis and adipogenesis, inhibits apoptosis and regulates collagen production resulting in improved fat distribution and survival. The combination resulted in a longer duration of filling of the tissue defect and increased volume and softening of the tissue. The mixture also prevented fibrosis in the post -surgical tissue.
Overall, we thought fat plus PRP is a promising method for treating sulcus vocalis.
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA approved and designed for safety and effectiveness. They are cost effective and easy to use, providing consistency of concentrated product when obtained from the same source.
Additionally, Juventix offers a patent pending LED- Activator to activate the platelets and begin the regenerative process. The activation, a critical step in the release of cytokines and growth factors, is accomplished with light and not with the addition of other chemicals such as Calcium Chloride or Thrombin.
Juventix also supplies a Bio-Incubator that transforms the Platelet Rich Plasma to an Injectable Platelet Rich Fibrin or PRF. The PRF, commonly referred to as the “second Generation of platelet products” has a broader range of clinical applications and provides outstanding outcomes.
Juventix Regenerative Medical features a Platelet Rich Plasma Kit combined with a non-crossed linked Hyaluronic Acid that could be used in cases of sulcus vocalis providing the advantages of both PRP and HA.
RESTORE, REVIVE, REGENERATE – JUVENTIX REGENERATIVE MEDICAL
Dr. Robert McGrath