[Arytenoid subluxation. Experience with a new voice therapy]

The systematic use of video-fibro-endoscopy techniques has made it possible to precisely define an uncommon laryngeal pathology of traumatic origin: arytenoid subluxation. This pathology general arises after anesthesiological intubation and is characterized by a pathological anteromedial shift of one arytenoid resulting in cord immobility. The symptoms of this disorder are dysphonia similar to recurrent nerve palsy. Differential diagnosis is not always easy. The treatment of choice indicated in the literature is based on invasive approaches (reduction under direct laryngoscopy or, less frequently, even more aggressive surgery) while voice treatment plays a marginal role. The authors offer an overall picture of arytenoid subluxation in view of the anatomophysiological aspects of the crico-arytenoid articulation and describe a new approach to voice rehabilitation. While watching himself in the video-fibroscopy monitor (visual feedback), the patient performs a particular exercise enabling him to raise the larynx, lifting the arytenoids and causing hyperadduction and vibration of the arytenoid hood. After having learned the exercise the patient continues with regular speech therapy sessions and voice therapy at home. Periodically the patient undergoes video-endoscopy and phoniatric-speech therapy check-ups until vocal function and cord motility have been restored. This type of approach was applied in 4 patients, all of whom responded relatively quickly with reactivation of the articulation and recovery of the voice. The authors conclude that voice therapy can achieve full healing in patients with arytenoid subluxation and should be given priority over other forms of treatment. The excellent results are explained asserting that particular movement of the larynx can achieve a reduction in subluxation by rearranging the articulatory surface.