Sulcus Vocalis Workup
- Author: John Schweinfurth, MD; Chief Editor: Arlen D Meyers, MD, MBA more...
Refer patients with symptoms of hoarseness, loss of range, or voice fatigue with no obvious laryngeal pathology to a laryngologist for further evaluation, preferably to an otolaryngologist with special interest and training in diagnosis and treatment of voice disorders. Sulcus vocalis is a challenging rare disorder and often is best treated by a subspecialist.
A laryngologist usually employs a team approach to the diagnosis and treatment of voice disorders (eg, speech pathologist, singing voice specialist) and has a variety of specialized endoscopes that allow for detailed examination of the larynx.
Videostroboscopy is an important tool used by the laryngologist. This imaging system is controlled in part by the patient's vocal pitch, allowing for slow-motion video recording of vocal fold vibration. Examination of the true vocal fold reveals a linear depression or an area of incomplete closure. Videostroboscopy reveals an area of decreased mucosal wave corresponding to the sulcus and more clearly shows associated incomplete closure.
Other diagnostic studies commonly employed by the laryngologist include acoustic and airflow measurements.
Acoustic analysis reveals some information about vocal production efficiency and voice strength.
Airflow measurements are useful in gauging vocal support and glottic constriction.
Nakayama M, Ford CN, Brandenburg JH, et al. Sulcus vocalis in laryngeal cancer: a histopathologic study. Laryngoscope. 1994 Jan. 104(1 Pt 1):16-24. [Medline].
Bouchayer M, Cornut G, Witzig E, et al. Epidermoid cysts, sulci, and mucosal bridges of the true vocal cord: a report of 157 cases. Laryngoscope. 1985 Sep. 95(9 Pt 1):1087-94. [Medline].
Lee A, Sulica L, Aylward A, Scognamiglio T. Sulcus vocalis: a new clinical paradigm based on a re-evaluation of histology. Laryngoscope. 2015 Nov 3. [Medline].
Welham NV, Choi SH, Dailey SH, Ford CN, Jiang JJ, Bless DM. Prospective multi-arm evaluation of surgical treatments for vocal fold scar and pathologic sulcus vocalis. Laryngoscope. 2011 Jun. 121(6):1252-60. [Medline]. [Full Text].
Yilmaz T. Sulcus vocalis: excision, primary suture and medialization laryngoplasty: personal experience with 44 cases. Eur Arch Otorhinolaryngol. 2012 Nov. 269(11):2381-9. [Medline].
Cantarella G, Baracca G, Forti S, Gaffuri M, Mazzola RF. Outcomes of structural fat grafting for paralytic and non-paralytic dysphonia. Acta Otorhinolaryngol Ital. 2011 Jun. 31(3):154-60. [Medline]. [Full Text].
Gray SD, Bielamowicz SA, Titze IR, et al. Experimental approaches to vocal fold alteration: introduction to the minithyrotomy. Ann Otol Rhinol Laryngol. 1999 Jan. 108(1):1-9. [Medline].
Paniello RC, Sulica L, Khosla SM, et al. Clinical experience with Gray's minithyrotomy procedure. Ann Otol Rhinol Laryngol. 2008 Jun. 117(6):437-42. [Medline].
Hwang CS, Lee HJ, Ha JG, et al. Use of pulsed dye laser in the treatment of sulcus vocalis. Otolaryngol Head Neck Surg. 2013 May. 148(5):804-9. [Medline].
Sataloff RT, Spiegel JR, Hawkshaw M, et al. Autologous fat implantation for vocal fold scar: a preliminary report. J Voice. 1997 Jun. 11(2):238-46. [Medline].
Archer SM, Banks ER. Intracordal injection of autologous fat for augmentation of the mucosally damaged canine vocal fold: a long-term histologic study. 2nd World Congress on Laryngeal Cancer. 1994.
Dailey SH, Ford CN. Surgical management of sulcus vocalis and vocal fold scarring. Otolaryngol Clin North Am. 2006 Feb. 39(1):23-42. [Medline].
Ford CN, Inagi K, Khidr A, et al. Sulcus vocalis: a rational analytical approach to diagnosis and management. Ann Otol Rhinol Laryngol. 1996 Mar. 105(3):189-200. [Medline].
Hammond TH, Zhou R, Hammond EH, et al. The intermediate layer: a morphologic study of the elastin and hyaluronic acid constituents of normal human vocal folds. J Voice. 1997 Mar. 11(1):59-66. [Medline].
Hsiung MW, Pai L. Autogenous fat injection for glottic insufficiency: analysis of 101 cases and correlation with patients' self-assessment. Acta Otolaryngol. 2006 Feb. 126(2):191-6. [Medline].
Tsunoda K, Kondou K, Kaga K, et al. Autologous transplantation of fascia into the vocal fold: long-term result of type-1 transplantation and the future. Laryngoscope. 2005 Dec. 115(12 Pt 2 Suppl 108):1-10. [Medline].
Varela DG, Grellet M. [Vocal fold superficial layer of lamina propria histology after the position of mucosa pediculated flap: canine experimental study]. Braz J Otorhinolaryngol. 2005 May-Jun. 71(3):318-24. [Medline].