Hoarseness. Inability to speak loudly. Vocal fatigue. When I started losing my voice about 2 years ago, the symptoms would come and go. I figured seasonal allergies were the cause.
But by early 2022, these vocal distortions had become permanent. My voice was strained, breathy, and high-pitched. I sounded like Mickey Mouse going through the voice changes of puberty. It was frustrating, distressing, and even embarrassing.
By the end of each day, I could barely speak above a whisper. These voice changes were affecting my career as a writer, as well as my social life. That’s when I started to wonder if vocal cord surgery was an option for me.
Signs of Vocal Fatigue
Lose your voice by the end of the day
Use a lot of effort to talk
Sound raspy or breathy
Who Needs Vocal Cord Surgery?
You don’t have to be a professional singer to experience a vocal disorder. Teachers, pastors, and telemarketers may develop hoarseness or other signs of vocal fatigue.
But even if you don't use your voice a lot, you might need vocal cord surgery. Many conditions can affect your voice. These include:
- Acid reflux
- Colds and respiratory infections
- Neurological conditions, such as Parkinson’s disease or stroke
- Smoking
- Throat cancer
Could ALS Be the Cause?
I have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. ALS is an incurable neurological disease. It causes cells of the central nervous system to stop working or die. ALS can cause mobility and breathing problems.
But ALS also may cause speech and voice difficulties like:
- Decreased volume
- Hoarseness
- Hypernasal sound (from too much air escaping through the nose)
- Slurred speech
- Spastic or strained voice
For many ALS patients, voice dysfunction goes with swallowing disorders. But I had no problems with eating. Even so, I had to face the possibility that ALS was damaging my voice.
I love to sing. And talk. So I turned to experts to see if vocal cord surgery was an option for me.
Searching for Answers
My medical team at UVA Health’s ALS clinic supported my desire to rule out other potential causes of my voice problems. They referred me to UVA Health’s Voice and Swallowing Clinic. In October, I met with Patrick McGarey Jr., MD, (an ear, nose, and throat specialist, or ENT). I also saw Sam Olds, PA-C, and voice therapy specialist Joanna Lott, MA, CCC-SLP.
McGarey looked at my vocal cords using a laryngoscope. This is a thin, flexible tube with a camera. He guided the device into my nose and down to my voice box, viewing images on a small TV. He sprayed a numbing agent into my nasal passage. The procedure didn’t hurt at all.
Finding Weak Vocal Cords
The test showed that my left vocal cord was weak but not paralyzed. It also was much thinner than it should be. That meant my vocal cords (also called vocal folds) couldn’t touch in the middle of my airway to vibrate normally.
So a lot of air was escaping whenever I spoke, causing me to sound breathless. At the same time, my right vocal cord was overcompensating and trying to close the gap over my airway. That was causing vocal strain.
McGarey told me that ALS may have caused my voice problems. But he said it’s also possible that a respiratory infection — or some other factor — caused the damage.
Plumping Up Thin Vocal Cords
Have Voice or Swallowing Problems?
Our UVA Health ENT specialists can help.
The good news: McGarey recommended vocal cord augmentation for me. That means plumping up a thin vocal cord so it touches the other one and closes the gap in my airway. I had two options:
- Injection laryngoplasty – A filler, such as collagen, injected into the vocal cord fattens or thickens it.
- Medialization laryngoplasty – This surgery puts permanent implants in the vocal cord. They are made from flexible materials such as silicone or Gore-Tex.
McGarey believed I would benefit from vocal cord surgery with an implant. He graded my vocal cord injury as moderate-severe. Restoring my voice would mean restoring my quality of life.
ALS Not An Obstacle With Vocal Cord Surgery
Even though I have ALS, vocal cord surgery would be relatively low risk for me because it is done under sedation — not general anesthesia. When someone is under general anesthesia, it’s harder to breathe. ALS causes weak breathing muscles. So together, they create a bigger danger.
“It is a little atypical for someone with ALS to have this surgery, just given that they often have a host of other challenges due to their neurologic condition,” McGarey says. “A benefit of the vocal cord surgery being done under sedation is that it allows us to offer this option to patients who are older or who have more complex medical conditions.”
I was scheduled to undergo the outpatient procedure on December 21. I’ve never been so excited about having surgery.
Praying My Way Through Surgery
“Please God, help me not to freak out.”
That was the prayer that played over and over in my head as I lay on the operating table — slightly sedated, but definitely awake. For nearly 2 hours, I felt pulls, tugs, and pressure in my neck. I heard the intermittent whir of a tiny drill as McGarey and the surgical team placed an implant into my weakened left vocal cord.
Sound scary? Honestly, it wasn’t that bad.
Lying Still Was the Hardest Part
I didn’t feel any pain. The worst part was lying still for that long. But the vocal cord surgery team was compassionate and attentive to my needs. Anytime I seemed fidgety, the anesthesiologist would rub my feet. Occasionally, the head nurse stroked my forehead. McGarey even played 80s music during the procedure, at my request.
Before the surgery started, the anesthesiologist did put me to sleep for about a minute to administer the numbing drugs. That involves deep injections into the larynx, which would be uncomfortable.
But I had to be awake for the procedure so that I could speak to the surgeons as they determined out how much implant material to put in. McGarey had me count to 10 numerous times — each time listening to the quality of my voice as he sized the implant, which looks like a linguine noodle.
The process is very much an art form, like tuning a guitar.
My Voice Improved Immediately
I was able to go home the same day of the vocal cord surgery. I took prescription pain medications for one day after surgery. But after that, I was able to manage the discomfort with Tylenol. I felt better than I expected.
For the first week or so after surgery, I ate a lot of soup and had many milkshakes. Although swelling from the procedure can last for several months, I noticed improvements in my voice immediately after surgery.
McGarey told me this is one of the most rewarding procedures he does.
“The ability to see a result in real time on the operating table is pretty incredible,” McGarey says. "Many of the patients who undergo this procedure also have significant swallowing and breathing problems. The surgery can dramatically improve all of those. So it's really wonderful just to share that with them, especially once they've recovered and get back to their normal lives.”
After Vocal Cord Surgery, Ready for Karaoke
Christmas was just a few days after my vocal cord surgery. My fun-loving parents gave me a karaoke microphone as one of my gifts. Though I haven’t gotten on stage, I have gotten back to belting out Whitney Houston ballads and mimicking guitar riffs in the car. I feel like I can do anything after going through a 2-hour surgery while awake.
I’m so grateful to McGarey and his team for changing my life. With ALS, there are few wins. But for me, this was a homerun.
