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Anesthesia

Singer concerned-intubation for septopalsty

05/20/2008

Question:

I am 26 and I am scheduled to get a septoplasty surgey on May 28th and I am very concerned about the intubation process and how that could affect my vocal chords. I actually had trauma from intubation with my tonsilectimy and had to go through speach therapy for nearly a year when I was eight years old. What percentage of people have complications with this? My septal deviation blocks quite a bit of air in my left nostril, but the risk of damaging my vocal chords seems like it`s not worth a little more air.

Answer:

Your concern is very understandable.

I recall a rather bad movie from the 1980s starring Luciano Pavarotti in which he develops tonsillitis and needs surgery. He is extremely worried about the potential consequences for his voice. His worries disappear when he falls in love with his beautiful ENT surgeon.

Intubation involves passing a plastic breathing tube through the vocal cords. The tip of the tube then sits in the lower part of the trachea (windpipe). Studies have shown that even when intubation is done expertly a fairly large number of patients have minor injuries (bruising) to the voice box (larynx) from intubation. This is what accounts for the symptom of hoarseness often seen after general anesthesia. Fortunately, in the vast majority of cases, these minor injuries heal over days or weeks without treatment.

Ideally, a person who has had vocal cord damage from intubation should have their vocal cords assessed before being intubated again. Such an assessment may reveal a reason for the vocal cord injury, such as airway anatomy that makes intubation difficult and much more traumatic than usual. It will also show whether the cords are now normal or whether they are still showing signs of the previous injury. This type of assessment can be done by an ENT doctor using a fiberoptic scope and is usually accomplished in the doctor's office with topical anesthesia, that is local anesthetic sprayed into the throat.

Should you decide to go ahead with the surgery, you should know that it is possible to avoid endotracheal intubation. A device called a laryngeal mask airway (or equivalent, there being several such devices now on the market) is another type of breathing tube that differs from an endotracheal tube in that the tip of the tube remains ABOVE the voice box. The risk of damage to the vocal cords is therefore greatly reduced. One of the main concerns when using an LMA to secure the airway for a septoplasty or other ENT surgery is the risk of blood from the surgical site slipping past the LMA and into the lungs. There has however been quite a lot of experience to date with the LMA in these type of surgeries and the risk of this complication seems rather low, even in small children having their tonsils out (a rather bloody procedure).

It's best that you discuss your anesthetic options with your anesthesiologist ahead of the surgery to allay your concerns and decide on the safest choice for you and your larynx. You might even fall in love!

For more information:

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University