arielproject

the ariel project

   resources and support
   for people with
   vocal fold paralysis

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Medialization

I can talk.

I have unilateral vocal fold paralysis, but I can speak loudly and clearly enough to be heard in a quiet environment, and I can sing in the shower.

But that’s impossible!

How do I do that?

When my diagnosis of vocal fold paralysis was confirmed, I was in the right place, with the right doctors, at the right time. I saw Dr. Peak Woo, a top laryngeal surgeon, voice expert, and pioneer in vocal fold medialization techniques.

What is medialization?

When a laryngeal nerve is damaged or destroyed, the vocal cord it controls no longer receives signals from the brain. It collapses in a neither-open-nor-closed position, where it eventually atrophies. It doesn’t open to allow easy breathing, and it doesn’t close to allow easy speaking. A person with VFP often can’t speak above a soft whisper because there is no way for the vocal cords to contact each other.

However, if the paralyzed cord can somehow be brought into contact with its partner, the happy result is audible speech. There are several ways to do this. The vocal cord itself can be shortened or repositioned surgically. A small custom-made piece can be inserted to give it structure. Or the cord can be injected with a substance such as saline, fat, or another material specifically designed for this purpose.

In my case, Dr. Woo suggested injecting the collapsed vocal fold with a toothpaste - like mixture of human skin cells, inert material, and saline called Cymetra. (This product is a type of Alloderm, a product used primarily to repair skin destroyed by burns or disease.) Normally, once a diagnosis of VFP is confirmed, the laryngologist will encourage the patient to wait and see if nerve function returns before performing surgery. (In most cases, it does, usually within three to twelve months). But if the paralysis is significant, using one of the injection techniques can be a real lifesaver. In my case, the gap between vocal cords was large, rendering me almost inaudible and posing a choking danger as I couldn’t effectively protect my trachea from liquid or food. I also wanted to be able to return to work, and my job involves a lot of talking.

So I eagerly booked the surgery. It turned out to be a terrific decision. Most of the material initially injected is slowly absorbed by the body, but what remains forms a “scaffold”, helping to support the paralyzed cord. Speaking is effortful but no longer impossible, I’ve returned to work, and my coworkers are now accustomed to my breathy-barky vocal quality.

Having some voice is fantastic, but medialization has its drawbacks, too. During my surgery, the cord was overinjected slightly to compensate for the eventual loss of some of the material. Because the injected cord can't move like its "live" partner, the opening to the trachea is narrower. It's more difficult to breathe, especially during exertion. Climbing stairs shortly after the surgery, for example, was harder because rapid breathing caused stridor (a high-pitched wheezing sound) and the sensation of struggling for air. This gradually lessened as the plumped-up cord lost some of its fullness, but I'm still aware of the narrowed airway. If you're considering medialization, discuss the balance between speaking and breathing with your doctor. With VFP, you will probably no longer be able to do both with equal ease.

Medialization can go a long way toward restoring normal-sounding speech, but it is not a "cure" for the underlying cause. This surgery doesn't repair nerve damage. You will still have vocal fold paralysis. You may need or want more than one procedure to get the best function possible. Your doctor should be able to explain what you can reasonably expect, and what your long-term prognosis is likely to be.