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February 17, 2013

What to Do and Care After Vocal Cord Surgery

When surgery is performed on the vocal cords, there are some very specific after-care that is required to allow for optimal healing. In order to understand the "why" such post-operative care is required, one must first understand how the vocal cords normally work. If you already know, just skip down to the bottom.

The vocal cords are arranged in the shape of a "V". When breathing, the vocal cords are open to allow air to pass through and down into the windpipe. When talking, the vocal cords come together and vibrate. Click here to watch a video.


When surgery is performed on the vocal cords, one is actually cutting into the actual organ that allows one to talk and make other noises.


As such, the care required after vocal cord surgery requires the elimination of any activity that may lead to damage to the surgery site and allow proper and safe healing.

I should mention that the following instructions are our opinion. Other laryngologists may have different after-care instructions.

Strict Voice Rest! 

This means absolutely no talking and whispering. Such activities cause the vocal cords to come together and "bang" against the surgery site. I even instruct patients to avoid even mouthing words as it causes the brain to "think" you are talking even if you are not. Essentially, the lips should always remain closed except when eating/drinking.

The analogy would be if you have surgery done on the heel of your foot, you should not walk or put any weight on the heel, otherwise risk improper healing.

Strict voice rest typically lasts for 1-2 weeks after surgery.

No Coughing or Throat-Clearing

Just as with talking, coughing and throat-clearing also causes the vocal cords to come together and should be avoided if at all possible. Narcotic strength cough-suppressants (ie, hycodan) are often prescribed to help suppress the urge to cough.

Take Reflux Medications

Reflux medications should be taken both before and after surgery to prevent any possibility of acid damage to the surgery site. Such medications should be taken EVEN IF you do not have any symptoms of acid reflux. I typically recommend patients to start such medications one week before surgery and to continue for as long as 3 months after surgery.

Voice Therapy

Voice therapy is recommended before surgery so that patients will understand what and how they are supposed to talk once cleared to do so after surgery. It's much easier to answer questions and practice proper talking technique before surgery rather than after surgery when you are on strict voice rest!

The rationale for voice therapy is to prevent continued phono-trauma to a freshly healing surgery site on the vocal cord. Often, if improper talking technique persists after surgery, the surgery site becomes damaged again or heals with abnormal scar tissue leading to the possibility of needing surgery again.

Voice therapy minimizes the likelihood of needing repeat vocal cord surgery in the future!

Restricted Voice Rest

Once the period of strict voice rest ends, the patient is slowly allowed to talk under voice therapy guidance. From this point forward over the next 4-6 months, the patient is under restricted voice rest.

Restricted voice rest is a fairly broad phrase, but essentially means to:

• NEVER abuse the voice (ie, yelling, screaming, loud talking, etc)
• Talk only when you must (ie, no social talking)

This period of restricted voice rest is important because it allows time for the new vocal cord tissue that has developed to not only heal, but also strengthen. Abusing the voice may tear the freshly healed surgery site which must be avoided at all costs!
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

10 comments:

  1. hi, i had a microlaryngoscopy 2weeks ago.my doctor removed some nodules and polyps.said he kind of scraped the cords.. i ried resting my voice however im 34 w 4 kids...very hard to do..i was told dont whisper.. so i did use my voice however had to push it out... now its been 2 weeks and if i softly try to use my voice,not whisper..nothing cpmes out.still sounds likea whisper.is this normsl at this point or should it have come back normal by now? im getting nervous that maybe i damaged something permanently. is this possoble or do i just need more time?

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  2. I would like to know the answer to your question because I am having this same surgery on April 10 and I am a nervous wreck. First of all I am a smoker. I have cut back but not completely. Second, my job requires a lot of talking. So how long did it take you to talk normal? Please let me know ok. Thank you very much.

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    Replies
    1. Denise, I am in the same boat as you, had my surgery 2 days ago, I am very swollen and sore, smoker as well (trying hard not to be). My job requires a lot of talking as well. I have 2 weeks off, hoping it will be enough. How have you healed?

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  3. I had the surgery on Feb 27 14, I have 3 kids and used my voice within days to make them settle down, healing is a long slow process, and healing with children is even longer, so i recommend you tell them when ever they hear your voice, its time out time. as far as you not speaking, go see the dr. ... The surgery was a success but even today i am still in recovering only getting the full vocal range back about 2 weeks ago, i still expierence a shortness of breathe, could be unrelated but surgery is not scary and its painless, especially if you dont talk after ward . I say it should take 6 months to be completely normal after.

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  4. I have just had vocal surgery today. I was appalled at the lack of information given to me prior and after surgery(so websites like this have been so helpful) they told me I could talk after 3 days, which in my mind is ridiculous, considering what I have read. I had one acid reflux tablet given to me pre-op and none after. The nurses did not know what op I had done so asked me questions, forcing me to whisper, on numerous occasions. I had brought a pad and pen and was told I could not bring it with me and my mother was not allowed to wait for me in the after care ward with my belongings. Appalled with Coventry university hospital today, the nurses were lovely but the system has let me down. I really hope the constant acid and whispering straight after op hasn't affected the healing process. I work in a special needs school, where talking is a must and a lot of the time at a loud level. I currently have 2 weeks off but I'm thinking I will need 3, so I don't put myself in a funny position? Thanks

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  5. Hey, I you have Android phones, I use Type and Speak, which is free. My doc liked the idea so much he wants to recommend it to all of his patients. I'm using it now. It is hard to scold to your kids with it tho. My daughter keeps laughing when I use it. It actually is becoming a game with the two of us but at least I have a "voice".

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  6. I recently had vocal cord surgery, July 18th. After the surgery my doctor told me to speak only 3-4 minutes every hour. Do not yell, do not scream, do not whisper, and do not over use my vocals. I am a fitness instructor so I am allowed to use a mic which I turn all the up so my participants can hear me and I am not yelling. At this time, I am seeing a Speech Therapist, who is great! I am not ALLOWED caffeine, no chocolate, no acidity foods, such as oranges, pineapples, tomatos, etc. Sleep with my held six inches up. I am not on acid reflux meds as long as I do what I am told. I feel great and my participants understand. There were two days apart that I found myself talking way too much.

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  7. Boy do I wish I had seen this before surgery. I am a singer and I have undergone it Feb. 3rd, and after a solid 10 days of complete vocal rest (ok I cleared my throat a few times) I went back to work, and now, my throat hurts and I'm pretty sure I messed up what had started healing. This is a serious intervention that would require people knew how long the recovering process can be and how dedicated they must be in order to respect the healing conditions.... I hope it's not too late for me!

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  8. I had surgery March 30th I didn't know how important it was to rest my voice. With no pain or discomfort I was talking several days later and teaching 10 days later. However I can tell when I have talk to much, I pray I didn't have have a set-back. I am ready to be healed. any comments please respond!

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  9. I had surgery on June 8, 2015, in Atlanta, to remove a polyp from my right vocal cord. The surgery went well. The Dr. did not remove the small reactionary bump on the left vocal cord because it should heal itself eventually. The confusing thing for me was the pre op nurse said rest the voice 1 week or so, but the Dr. said rest the voice for about 48 hours, concerned that atrophy might set in if I don't use the muscles for an extended period. So, after 48+ hours or so, I uttered a few words to my family, and my voice felt ok and easy, but then strain, discomfort, and a burning sensation on the right side of my throat. It scared me! Right then, I re-committed myself to rest for 1 full week or longer, maybe even until I return for my post-op appointment on June 17. I hope 48 hours wasn't too prematurely to speak. I pray my voice heals completely. I've kept my mini white board and marker handy ever since. This site has been very helpful in educating me.

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