Case histories - vocal sulcus

Case histories: Sulcus History Vocal Capability Testing Laryngeal exam Treatment Medical Behavioral Surgical History Complaints 5th decade female artist/secretary Lifelong hoarsenes cannot be heard above background noise unpredictable voice easy vocal fatigue previous ENT exam - told she had normal vocal folds Speech therapy - tested for psychological problems Medical history Nonsinger tobacco - none alcohol - none caffeine - 6 cups per day reflux symptoms - none Character talkativeness scale: 4 loudness scale: 3 vocal commitments 4 hours talking at work Vocal capabilities Reading voice coarse Pitch range Anchor pitch (F0) - G3 Low pitch - G3 High pitch - C5 (short segment phonation with missing notes in between) Maximum phonation time at G3 : 7 seconds (normal is 10-40 seconds) Stroboscopic Examination of the Larynx bowed vocal folds with long linear looking sulcus on both sides (often called sulcus vergiture) lip of a central sulcus opens during inspiratory phonation
	ABducted vocal folds during rapid inspiration. The left sulcus is barely visible.
	Inspiratory phonation at pitch G4. The sulcus is pulled open on its lower lip on the left vocal fold. Click for a larger view with arrows to sulcus.
	Quicktime movie of phonation at a high pitch of E5. The voicebox will be upside down compared to the picture and the sides will be reversed. The extreme bowing will be evident as the vocal folds never touch each other. In addition, at this pitch, the front and the back of the vocal folds vibrate separately, separated by a central stiff area. There is also a long groove in both vocal folds, often called a sulcus vergiture.

Treatment Medical No medications were recommended. Behavioral Physician treatment information Patient treatment information This seems like a complex issue to me, having a component of bowing and a sulcus, that may have been congenital. Surgical Physician treatment information Surgery is likely to involve both augmenting the vocal folds as well as excising or freeing up the central sulcus or scar tissue.

Contact the author: James P. Thomas, MD

Updated 14 April 2004