The Voice After Direct Laryngoscopic Operations, Laryngofissure and Laryngectomy

Abstract

Voice is the chief consideration in the treatment of most benign laryngeal conditions. In malignant conditions voice must obviously be relegated to second place, because the first and most urgent indication is to cure the cancer. It is necessary to explain this to the patient and his family, so that they may readjust their attitude and accept whatever vocal impairment may be entailed in the procedure required to obtain the proper prospect of cure. However, the fact remains that one of the things that the patient is most anxious to know before consenting to the necessary operation is whether he will lose his voice. Many people believe that removal of the vocal cords will make it impossible for them to talk, and the majority of those to whom total laryngectomy is advised are skeptical when assured that they will soon learn a new way of talking after the larynx is removed. It is explained that voice is relatively unimportant as compared with the cure of the cancer, which is inevitably fatal if untreated, but it is comforting to the patient and conducive to his fit condition for operation, as well as a consolation to his family, to know that he will not be doomed to use sign language or a pad and pencil the rest of his life to express himself.It seemed to me that it would be interesting and helpful to conduct a special follow-up on patients who have had the various laryngeal operations, by sending out questionnaires regarding postoperative vocal development. Of the first group of patients, those to whom direct laryngoscopic treatment was given, only one small series was questioned, patients for whom nodules of the vocal cords ("singers' nodes") had been removed. Of the second, those who had had more radical opera¬ tions, for the extirpation of cancer, all living patients operated on since 1929 were sent questionnaires. Replies were received from 51 patients who had had one or both cords removed by laryngofissure and from 30 patients on whom total laryngectomy had been performed.