When I entered residency training in Otorhinolaryngology-Head and Neck Surgery, all I wanted is to become a good ENT surgeon. Through the years of training and seeing many patients with different diseases, voice cases interested me the most. I even became a voice patient once which added more to my eagerness to know more about this subspecialty. Our hospital does not have a very good foundation in voice subspecialty and in order for me to acquire knowledge and skills in the field that I want, I need to look for a competent hospital that can provide me with these.
The first time I've been to Seoul, I told myself that I would definitely be back. I love everything in Seoul, the people, rich culture and tradition, the places, and also the food. The second time that I came to Seoul was an invitation to observe in one of their biggest hospitals. Then I thought, why not look for a hospital in Seoul that offers a training in the field that I've always wanted. I have searched and found that there is one prestigious center that specializes in voice, the Yeson Voice Center. Yes, I found a hospital but I don't know how to get in and where to start. Maybe I am just so fortunate and this is really the path that I should take for Yeson Voice Center just so happened to be looking for an ENT specialist from the Philippines to be their trainee. Without a doubt, I immediately applied for the position.
The training program is in cooperation with Korea Health Development Institute. They aim to give overseas medical doctors an opportunity to gain extensive medical knowledge and skills, while broadening their understanding about Korea and the country’s medical services.
A doctor's education never ends. We need to pursue on continuing education to stay up to date and learn new advancements in our chosen specialty field. A center that gives unparalleled opportunity to obtain broad knowledge and high skill is Yeson Voice Center. The center is spearheaded by notable group of gentlemen with the best knowledge in the field of Voice. The Director of the center is Dr. Kim Hyung Tae, Chairman of Board of Directors is Dr. Yoon Hee Ro, Associate Director is Dr. Lee Ji Wook, and and Associate of the hospital is Dr. Kim Hyun Soo. The faculty is committed to excellence in research, teaching, patient care and advancement in the art and science of voice. The training provides variety of clinical opportunities including assessment and treatment. Exposure to have additional experience with major areas of specialized assessment strategies and medical and surgical intervention. In my three months of training in Yeson Voice Center I look forward to acquiring as much knowledge and skills with the help of Dr. Kim Hyung Tae who directly supervises my training.
There are diverse patients seen in Yeson Voice Center and specialists are well trained to best evaluate and diagnose these cases. They have Vocal Fold Paralysis; Dysphonia secondary to Vocal Cord nodule, Vocal Cord Polyp, Vocal Cord Cyst, Granulomatous Laryngitis, Reinke's Edema, Sulcus Vocalis, Laryngeal Papilloma, Laryngeal Cancer, and Laryngopharyngeal Reflux ; Spasmodic Dysphonia; and Functional Dysphonia. The faculty are also highly specialized to perform different procedures using state of the art equipments. Percutaneous Injection Laryngoplasty, Microlaryngeal Surgery, PDL Laryngeal Surgery, Voice Feminization Surgery and Botox Injection are done in the center, and I get to observe all of these procedures. I am given the chance to see different cases and learn the techniques on how they are surgically managed. A higher learning and more specialized skills that I can practice in the future. Techniques that I can share to my fellow Filipino ENT, residents in training, and patients.
In order to arrive at a correct diagnosis and plan of management, a meticulous examination are always done. The center is equipped with the largest diagnostic facilities for voice examination. They have equipments for computerized voice analysis, aerodynamic examination, digital laryngeal stroboscopes and nasopharyngoscopes of Kay Elemtrics. They have also introduced high speed vocal cord color filming equipment and phonokinetic evaluation for the first time in Asia.In the afternoon, I get to observe in the examinations done at the Artceum for the clinical evaluation for voice: Psychoacoustic Evaluation, Phonatory Aerodynamic Test, Speech and Voice Acoustic Study, Voice Range Profile, Rhinolaryngeal Stroboscopy, Nasometer II, Screening Language Evaluation, Phonatory Pattern Screening Test, and Multichannel Phonokinetic Evaluation System. Their facilities are very much advanced which I will encourage our hospital to have in order to reestablish our voice laboratory.
During weekends, I get to see the beauty of Seoul. At first glance, Seoul appears to be a sprawling concrete
mass of high-rise modern buildings interspersed with historical treasures. But
on a closer look, the city can be divided into numerous smaller districts with
their own distinct character.
There are many reasons why I love Seoul. They have a
very rich culture and tradition. The architectural traditions has been
restored and maintained to its finest. A proof of how they value
their history. I have been to some of their palaces and temples and
I can't help but be amazed. There is the famous Gyeongbuk Palace and
Changdeok Palace, also the Bongeunsa Temple and Bulguksa Temple, each with its
own identity and story to share.
You can see people bustling around the busy streets of Seoul
especially its famous places. Seoul is one of greatest places to go
shopping. You can see the diverse fashion sense of Seoulites. They have
big department stores like Lotte, Hyundai and Shinsegae, which are dazzling
emporium selling all kinds of merchandise. But for those who is in a
budget, there are stores all over where you can easily splurge at a reasonable
price. Favorites would be Dongdaemun, Namdaemun, Insadong, and Myeongdong
shopping district. These places are usually crowded and being bumped
around is very common. Shopping can be very much tiring, and anywhere you
can just see food stalls selling different kinds of street food. Grab a
bite and the experience is worthwhile.
I love Korean food. You can try the traditional Korean
dishes or even have international dishes. The dining place can be just a
tent, a stall near the street, small traditional home, or a classy
restaurant. They all serve good tasting cuisines. Must try for me would be samgyeupsal (korean barbeque), ssambap, bulgogi, bibimbap, jigae, and the infamous kimchi of different varieties. They
have a wide range of food to choose depending on your palate. But most of their
food are spicy. Good thing, I like it spicy.
If you're looking for serenity, a walk along the
Cheongyecheon Stream would be a perfect place. It is a 5.8 km remarkably quiet
walk along the stream since it is 15 feet below the street. There are
small waterfalls, fountains, and overhead bridges.Another place that I find amusing and
romantic is the Namison Island.The
tranquil view of the island is captivating. For a little excitement, you can
try to enjoy the rides at Lotte World and for more extreme adventure, Everland
is a must go to attraction. Also, at night, it is great to visit Seoul Tower to have a view of whole of the city of Seoul.
The
Gangnam Style by Korean singer PSY was very popular all over the world at the time of my visit in Seoul. Everyone is talking about it and you can hear it being played everywhere. It's even a dance craze that most are raving
about. To have a better grasp of it, my coordinator arranged a good place
for me to stay in Gangnam while I'm on my training. I can see everyday
how much fun it is at night as most young people go here to party and have
couple of drinks with friends and sometimes party lasts till early
morning. There are even many good restaurants and shops around the area. I stayed at M Chereville Serviced Residence which is few minutes
walk from Gangnam station. One of the busiest subway station I have ever
seen with a huge shopping area just within the station. My room is very
spacious and comfortable. I have a small kitchen and even got my own
laundry machine inside the room. There is also an internet access so I can
always keep in touch with my family. It is a very convenient place for me and I guess anyone who's away from their own homes.
The whole experience would not be possible without the assistance of KHIDI and the staff of Yeson Voice Center. It is truly an honor for me to be trained by Professor Kim Hyung Tae. I admire your dedication and passion to the profession. I hope that someday in the future I can be a good voice specialist like Professor Kim. With great gratitude, I thank all the faculty and staff of Yeson Voice Center and KHIDI for the very warm welcome and making my stay in the Seoul a wonderful experience.
Treatment
of different voice disorders requires special knowledge and expert skills. The doctors in Yeson Voice Center can provide
you the best quality of treatment when it comes to voice diseases.The center is equipped with state of the art
surgical technology that can manage any vocal fold lesion.
PERCUTANEOUS INJECTION LARYNGOPLASTY
Percutaneous
injection laryngoplasty is a new method developed to improve the operating
procedures using electromyogram.Without
the need of general anesthesia, this procedure preserves major vocal membrane
and vocal layer, and allows for inserting an organic prosthesis in place.The EMG needle helps to spot and insert the
material, improving the voice dramatically almost permanently.
Advantages
of injection laryngoplasty are: general anesthesia is not necessary, it only
take 15-20 minutes, treatment is possible irrespective of patient’s health
condition, hospitalization is not required, no incision needed, different
treatments are available through different drugs in accordance to the patient’s
condition, and insertion in the right area is possible depending on the illness
of the patient.
Disadvantages
are high cost of the medical appliance, knowledge and experience on EMG is
needed, and high level of technique and experience is required.
MICROLARYNGEAL SURGERY
Microlaryngeal
surgery or phonomicrosurgery has been developed since the 19th
century as the observation of the larynx through reflecting mirrors began.Laryngeal mirrors provided the most
significant part of understanding and treating vocal fold diseases.
Benign
vocal fold diseases including vocal nodules, vocal polyp, sulcus vocalis, vocal
cyst, and adhesive vocal folds are limited to the lamina propria which affects
the movement of the epithelium that covers the vocal folds and the mucosa.
Submucosal
Infusion Technique
Submucosal
infusion is a technique which recovers the voice by separating the mucous
membrane with lesion and the lamina propia of the vocal folds and preserving
the lamina propia when performing the surgery.
Micro
Mini-flap Surgery
As
the microstructure of the vocal folds and the process of healing in benign
vocal fold diseases have been demonstrated, studies have proved the
significance of preserving the lamina propia of the vocal folds and the
importance of vocal rest and rehabilitation.As a result of these studies, surgical operations of the vocal folds
including the micro mini-flap surgery which can bring the voice to original
condition have been developed.
PULSED DYE LASER LARYNGEAL SURGERY
Yeson
Voice Center acquired the Photo Genica SV PDL from Cynosure Inc. US. This
equipment can perform laryngeal surgery without the need of general
anesthesia.PDL selects and solidifies
only blood vessels at vocal band.It
does not damage the healthy tissue.It
selects and destroys only the abnormal tissue.
The
585 nm Pulsed Dye Laser Surgery guides the PDL with optical fiber and connects
it through the digital electric laryngoscope channel so it does not harm
laryngeal and surrounding tissue.
Advantages
of PDL Surgery are: only local anesthesia is required, day surgery is possible,
no hospitalization required, bloodless surgery, safe and effective, excellent
in bleeding control, no damage to laryngeal tissue, excellent restoration of
tissue in surgical region, excellent in improving voice by rearranging
collagen, takes only 20 minutes for the procedure, and painless during and
after the surgery.
VOICE FEMINIZATION SURGERY
Voice feminization surgery is
changing one’s voice to a female, and it is for those who are physically built
as a male and also has a deep male voice, but whose actual sexual identity is a
female. This surgery therefore, are for those who have experienced
abnormal hormone functions as a child and got affected with adrogenital
syndrome or androphonia, or through the side effect of the hormone treatment
for aplastic anemia.
The common male voice
frequency is approximately 100-150 Hz and for females it is approximately
200-250 Hz. The reason why the male voice tone is lower than females is
because the males vocal cord is bigger and longer than the females.
Therefore, this treatment makes this vocal cord shorter and thinner on the
basis of the three factors.
The new method of voice
feminization surgery, called "Vocal Fold Shortening and Advancement of
Anterior Commissure," is the world's first treatment that does not incise
the skin and get the same result of modifying the vocal cord to a female shape
using an endoscope.
This treatment which was
developed by the Yeson Voice Center was presented at the Voice Foundation
Association in The United States on May 29, 2007. This VFSAAS differs
from the previous methods in that it leaves less damage on the vocal cord
tissue and incision is not required proving this is the best physiological
method in increasing one's vocal pitch.
Voice
pitch is determined by the size and length of the vocal fold. To help you
understand better, it is the same logic with a musical instrument, guitar.
Thick and long string makes a low pitch, thin and short makes a high
pitch. Male and female vocal fold sizes are different, male's is thick
and long while female's is thin and short. Vocal Fold Shortening and
Advancement of Anterior Commissure was developed in Yeson Voice Center.
The surgical procedure is dissecting the anterior 1/3 portion of the
vocal fold membrane, then it makes the high voice tone.
Their
average vocal frequency increased from 137.3 Hz to 211.5 Hz, showing a 74.2 Hz
increase in one’s voice frequency.Also,
different from the surgery methods described earlier, this treatment makes it
possible for maintenance of matural phonation and even singing after the
surgery.
There are no particular
complications after the surgery, but there might be some foreign body
sensations in the vocal cord and rough voice, pain in the neck, sputum and
cough; but these are all temporary and with proper medication and time it will
resolve.
Phonoplasty surgery should be
operated through the most suitable method for each individual patient, and for
this to occur, the vocal status after surgery must be predicted beforehand in
order to increase a better result.
Also, the tone quality of the
voice and resonance of the sound can be changed into a more female voice by
changing into a more female voice by changing the shape of the pharyngeal
cavity through the patient’s motivation, and by attending voice clinics and voice
rehabilitations.
The most important thing
about this process is that each patient should get voice feminization surgery
from an experienced voice clinic, and a clinic which can provide voice
rehabilitations; otherwise one cannot expect any voice improvement.Therefore, patients must get voice
feminization surgery by an experienced voice specialist.
With
the expertise of the doctors and the availability of the most advanced
diagnostic tools, Yeson Voice Center is able to meticulously define these
different voice disorders.
VOCAL
FOLD PARALYSIS
The
vocal folds of the larynx are the major source of sound in speech.This is controlled by cranial nerve 10, the
vagus nerve.The muscles of the larynx
and vocal folds move together naturally to produce sounds , for breathing, and
to prevent food from entering the trachea.These are innervated by the recurrent laryngeal nerve and superior
laryngeal nerve, both from the vagus nerve.
The
vocal folds are brought together by the action of the laryngeal nerves.The air pressure builds up beneath the larynx,
generating a sound through the rhythmic opening and closing of the vocal
folds.However, when the nerves are
paralyzed, the vocal folds do not open or close properly, leaving the airway
passage and lungs unprotected.This
causes hoarseness and coughing because of food that can get to the trachea.
This
condition is called Vocal Fold Paralysis, it can be unilateral wherein one side
is paralyzed, or bilateral wherein both the vocal folds are paralyzed.
Aside
from laryngeal nerve paralysis causing the abnormal movement of the vocal
folds, there are still many other causes of this condition that should be
carefully examined.These are laryngeal
mass, arytenoid dislocation secondary to trauma, damage to joints, congenital
malformation, inflammation, infection, and scarred vocal fold.
It
is important to examine the severity of the vocal fold paralysis, whether it
can still recover and the time of recovery.There are different procedures that can be done to evaluate the
paralysis according to its most likely cause.Brain computed tomography and brain Magnetic resonance imaging are
performed to examine brain disorder, brain tumors, disorder of the central
nervous system and the peripheral nervous system.Cervical computed tomography to identify neck
tumors and disorders in the blood vessels and nerves.Thyroid function test and ultrasonography can
also be done.Laryngoscopy and laryngeal
stroboscopy are done to identify congenital disorders, inflammatory diseases
and other functional disorders.
The
treatment for vocal fold paralysis started since 1911 by Dr. Wilhelm Brunings
when he treated vocal fold paralysis by injecting paraffin to the muscle.This treatment is used only mainly until
1970s because of its side effect, the formation of granuloma.In 1915,Dr. Erwin Payr then developed the method of operating the thyroid
cartilage.From then on, there was no
systematic theory until 1950.In
1974,Dr. Isshiki established
thyroplasty which became common.Arytenoid adduction was then performed to 12 patients by Dr. Slavit and
Dr. Maragos in 1992.
In
1977, the method of partially resecting the omohyoid muscle which is connected
to the hypoglossal nerve branch and implanting it to the vocal fold muscle was
attempted by Dr. Tucker.This is also
the method of replacing the paralyzed nerve in the vocal fold with another
nerve.However, it is not commonly used
because it requires too much time for the vocal fold to recover its function.
Later
in 1984, Dr. Ford attempted the method of injecting collaged into the vocal
folds.In 1991, Dr. Mikaelin introduced
the method of using fat transplantation.
Today,
the newest operative method used is the Percutaneous EMG Guided Injection
Laryngoplasty.This is developed and
presented at the national and international conferences by Dr. Hyung Tae Kim,
the chairman of Yeson Voice Center.This
method involves the injection of artecoll to the vocal cord ligament layer
using electromyogram.
VOCAL
DYSPHONIA
VOCAL
NODULE
Vocal
fold nodules are caused by strenuous or abusive voice practices especially
those who use their voice in their profession.This usually occurs bilaterally and often symmetrically.
Continuous
hoarseness and fatigue are the main symptoms of vocal fold nodules.Nodules do not cause pain or difficulty when
swallowing food.The nodules usually
appear in the center of the vocal fold, the area that receives the most
pressure when the folds come together and vibrate.Vocal fold nodules do not grow over a certain
size and thus do not cause breathing difficulties.
In
this case, it is important to receive voice therapy that focuses on eliminating
voice abuse and teaching the proper use of voice.Nodules usually resolve with voice therapy
itself.When therapy fails, surgical
treatments are then necessary.Surgeries
include Microlaryngeal Surgery and CO2 laser.Currently, endoscopic microfracture surgery and pulsed dye laser are
performed.Postoperative voice rest is
very important.
VOCAL
POLYP
Like
vocal nodules, a vocal polyp is caused by voice abuse.It may be caused by a temporary damage or an
upper respiratory tract infection.Seen
more commonly in adults than in children.They can be sessile or pedunculated, edematous or angiomatous.
Vocal
polyps can cause hoarseness, and the symptoms may vary depending on the size
and its location.In some cases, the
symptoms occur broadly and severely, and disseminated polyps may result in
breathing difficulties.
This
lesion requires microlaryngeal surgery and pulsed dye laser to be removed.When the cause is voice abuse, voice therapy
should also be done.
VOCAL
CYST
Vocal
cyst is a mass made up of collection of mucus that is surrounded by a
membrane.It is found underneath the
mucosa, within the superficial lamina propia, the layer that is important for normal
voice production.
Cysts
generally cause painless hoarseness.The
hoarseness results from irregularities in the vocal fold closure and
vibration.In some cases, the voice
change may be accompanied by sensation of a foreign body at the level of the vocal
folds, or feeling of wanting to clear the throat or cough.
Cysts
are most commonly removed by microlaryngeal surgery and pulsed dye laser at the
same time.It is very important to
remove the root completely to prevent any recurrence.
GRANULOMATOUS
LARYNGITIS
Intubation
granuloma is caused after a laryngeal surgery, bronchoscopy or an endotracheal
intubation.It is usually found at the
back of the vocal fold over the part of cartilage.At the beginning, the granuloma becomes
larger in size but it later on regresses in size.In many cases, the granuloma occurs
bilaterally, and hoarseness is not severe.This is more commonly found in females.
Vocal
rest and steroids can improve the condition.While the granuloma is growing, antibiotics can be of help.If the granuloma does not improve after
these, a mocrolaryngeal surgery or steroid injection after an incision using
CO2 laser may be necessary.The recently
developed pulsed dye laser surgery can also remove the granuloma under local anesthesia.
REINKE”S
EDEMA
Reinke’s
edema is caused by chronic voice abuse and vocal damage.This is also related to smoking.The main symptom of this lesion is
hoarseness.Biopsy of the vocal fold is
used to help in the diagnosis.Reinke’s
edema causes the vocal folds to swell giving them a sac like appearance.
Conservative
treatment involves removing the source of irritant in the larynx, vocal
treatments, and smoking cessation.Surgeries include microlaryngeal surgery or CO@ laser which removes the
sumbucosal edema to help restore the normal vocal fold tissue.
SULCUS
VOCALIS
Sulcus
vocalis is thinning or absence of a tissue covering the vocal cord required for
vibration to produce sound.This can
produce a harsh, reedy hoarseness.People
with sulcus vocalis frequently exert unusual effort to produce voice, and to
find it more difficult to be heard over a background noise.
Microlaryngeal
surgery can be done to incise the sulcus vocalis.Other options are injection laryngoplasty and
recently, the pulsed dye laser surgery brings great outcome to patients.
LARYNGEAL
PAPILLOMA
Laryngeal
papillomas are benign epithelial tumors caused by infection with Human
Papilloma Virus (HPV) type 6 and 11.The
disease is more commonly found in children that may have contracted it through
vaginal childbirth from a mother with HPV.
In
adults, symptoms are hoarseness, or strained or breathy voice.Size and location of tumor dictate the change
in the voice.Breathing difficulties may
occur but are usually seen in children.
In
infants and small children, the symptoms of papilloma include weak cry, trouble
swallowing, noisy breathing, and chronic cough.Noisy breathing may be a stridor, which can sound like a whistle or a
snore, and is a sign that the laryngeal and tracheal parts of the airway are
narrowing.
Yeson
Voice Center has implemented the Photo Genica SV PDL from Cynosure Inc.
US.This is used to perform laryngeal
surgery without general anesthesia.This
pulsed dye laser selects and solidifies only blood vessels at vocal band and
does not damage the healthy tissue.It
only selects and destroys abnormal tissues.
LARYNGOPHARYNGEAL
REFLUX
Laryngopharyngeal
reflux (LPR) is the inflammation of the larynx or pharynx caused by stomach
acid or food backing up into the esophagus.Symptoms are chronic hoarseness, frequent or dry cough, sensation of
lump in the throat, and difficulty and pain swallowing food.
General
treatments for LPR are diet modification to reduce reflux, medications to restrain
stomach acid, and surgery to prevent reflux.
SPASMODIC
DYSPHONIA
Spasmodic
dysphonia is a voice disorder caused by the excessive tension in the laryngeal
muscles.They have breaking voice and
face difficulty to start and continue communication.Spasmodic dysphonia is often classified
according to the age when the symptoms develop.When symptoms develop before age 20, it is called infant type.If symptoms develop after age of 20, it is
called an adult type.
Many
doctors thought that mental problems were the cause of spasmodic dysphonia
because symptoms would get better when taking alcohol and tranquilizers, and
get worse when being stressed or talking on the phone.
In
the 1980’s, researches of the cranial nerve brought the thought that the cause
of spasmodic dysphonia was the abnormal spasm of the laryngeal muscles due to
the inharmonic function with the basal ganglia where the integration of the
central nerves take place.However, Dr.
Ludlow, from National Institute of Neurologic Disorder (NINDS) of National
Institute of Health (NIH), proved that the cause of spasmodic dysphonia is the
abnormal nerve system in the nucleus tractus solitaries, so patients lose
control of their vocal fold muscle which makes it hard to talk and breaks off
sounds.
Spasmodic
dysphonia is classified according to the symptoms and characteristics.Adductor type accounts for approximately
80%.It can be glottis, supraglottic,
dystonia tremor or an adductor type with tremor.This is the most common type and involves
spasm of the muscles that close the vocal folds.Glottis type reacts better than supraglottic
type to Botox.Abnormal involuntary
co-contraction of the vocalis muscle complex, resulting in inappropriate
adduction of the vocal fold exhibiting strained-strangled voice quality with
abrupt initiation and termination, resulting in short breaks in phonation.
The
abductor type accounts for 4%. This is
an action-induced inappropriate co-contraction of the posterior cricoarytenoid
muscles resulting ininappropriate
abduction of the vocal fold.This type exhibits
effortful voice quality with abrupt termination resulting in aphonic whispered
segments of speech.
Other
types are of mixed type for 11% and respiratory dysphonia for approximately 2%
or now known as paradoxical vocal fold motion..
For
the examination of patients with spasmodic dysphonia, first, one will receive
an acoustic vocal test.Then a test will
be performed to measure the muscular spasm of vocal cord when speaking, and
examine excessive spasm or tremor of the laryngeal muscle using a
laryngoscope.Next is to measure the
basic vocal frequency with acoustic tests and observe the vocal waveform
through spectrogram.Then an
electroglottography and measure of resistance of aerodynamic test are
done.Laryngeal stroboscopy examines the
movement of the larynx, and the laryngeal electromyography helps find the
abnormal movements of the larynx and the vocal fold muscle.High speed vocal fold filming system helps
find the exact location of spasm.
There
are 3 types of treatment for spasmodic dysphonia.Medical treatment uses anticholine drugs,
tranquilizer, baclofen, and dopamine antagonist.However, these has serious side effects and
are only used in serious myotonic disorders.Surgical treatment includes hemilaryngectomy, thyroid chondroplasty,
laser vocalis muscle cordotomy, and nerve stimulator transplantation.All surgical methods do not cure completely,
and it may relapse with few months or few years.The third treatment option is injection of
botulinum toxin (Botox) which is currently the most effective treatment.However, this is a temporary treatment which
improves the voice for a period of 3-6 months.This requires continuous injections to maintain good speaking voice.
Few
years ago, treatment involves injecting only certain muscles on the vocal fold
or in one side of the vocal fold.But
there was no study on the effect on the cerebrum and the other side of the
vocal fold tries to match the balance and creates spasm on the other side.Hence, this treatment might make the vocal
fold worse due to the side effect.
The
treatment now has changed to multiple laryngeal muscle injections with
Botox.It normalizes the voice by
injecting small amounts of Botox to the abnormal laryngeal muscles.This extends the period of having a good
voice and minimized the term of hoarseness after Botox injection, helping the
normalization of voice by cranial reflex rehabilitation.
FUNCTIONAL
DYSPHONIA
Functional
dysphonia is the abnormal use of voice despite normal anatomy and function of
the vocal folds and the larynx which produce the voice, and pharynx and mouth
which produce resonance.This can be
related to abuse or misuse of voice or habituation of compensatory techniques
developed from condition of the larynx.
This
is often classified into 5 types.The
conversion aphonia, habitual hoarseness, inappropriate falsetto, vocal
misuse/abuse syndrome, postoperative dysphonia, and relapsing aphonia.
Mutational
falsetto under a normal laryngeal system causes the voice to be high pitched
weak and thin like a voice of a female.The voice is easily fatigues.The
voice tone stays high, monopitched and high pith songs can’t be sung.
It
can be classified into 2 different factors.Functional factors are caused by psychological problems like young males
of pubertal age who fail to accept their adult role or suffer emotional stress
from changes.Organic factors are caused
by abnormality in the vocal membrane like contractions or scars in the mucosal
membrane of underdevelopment of the larynx.
When
functional dysphonia is caused by functional factors, the vocal folds appear
normal on laryngoscopy and stroboscopy.The outer laryngeal muscles are excessively used to make a sound and the
larynx elevates.In organic factors,
there are abnormalities in the mucous membranes or underdevelopment of the
larynx and vocal folds.