Treatment of functional ventricular fold phonation by temporary suture lateralization

Ventricular fold phonation (VFP) is a phenomenon characterized by phonation using the false vocal folds. Besides a substitution voice due to loss of the true vocal folds-so called compensatory type-the noncompensatory types have a psychogenic, functional, or habitual background. Therapeutic options for these cases so far comprise voice therapy, pharmacological therapy (injection of anesthetics or botulinum toxin), and, in case of failure, surgical resection of the ventricular folds. Indication for aggressive surgical interventions is usually difficult, as there is always a risk of producing an irreversible state with an even worse situation. We present two cases of functional (psychogenic) VFP treatment refractory to conservative treatment. Lateralization of the ventricular folds by an endo-extralaryngeal temporary suture, similar to that used in bilateral vocal fold paralysis, was performed. Immediately after the procedure, a constant phonation at glottic level could be achieved in both cases. Sutures were removed 4 days after surgery, and phonation remained at the glottic level. Vocal fold phonation could be stabilized in the long run, and both patients recovered completely under additional voice therapy.