Monitoring the Outcome of Phonosurgery and Vocal Exercises with Established and New Diagnostic Tools

Figure 4

Example of phonosurgery-induced changes of laryngeal and vocal findings in a 49-year-old female dental assistant suffering from persisting dysphonia and dysodia. (a) Preoperative VLS shows a marginal edema of the right vocal fold with a glottal gap during phonation, asynchronous oscillations, and impaired mucosal wave propagation. The preoperative VRP pattern displays envelope curves for the loudest (black lines) and softest (blue lines) singing voice and for the speaking voice at different vocal intensity levels (green lines) with little dynamic and frequency ranges. The singer’s formant levels (red lines) are low, characterizing the impaired concentration of acoustic energy by resonator amplification of certain frequency ranges in the vocal tract. The values of all objective voice parameters (DSI: dysphonia severity index; VEM: vocal extent measure; MPT: maximum phonation time) and subjective voice parameters (RBH: roughness, breathiness, overall grade of hoarseness; VHI-12: twelve-item voice handicap index) are reduced. (b) Three months after phonomicrosurgical removal of the edema, the treated vocal fold shows a straight margin. The glottal closure is complete, and the oscillations have normalized (mucosal wave propagation regular and symmetric). The patient reveals higher dynamic and frequency ranges of speaking and singing voice with considerably improved objective and subjective parameters.

(a)

(b)