Zeitels Steven M
1 Department of Surgery, Harvard Medical School, Boston, MA, USA.
2 Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA.
Ann Otol Rhinol Laryngol. 2019 Mar;128(3_suppl):7S-24S. doi: 10.1177/0003489418810697.
: Since the renowned opera maestro Manuel Garcia presented "Observations on the Human Voice" using mirror laryngoscopy in 1855, there has been an inextricable link between performing vocalists and laryngologists. Today, specialized laryngeal surgeons continue the tradition of integrating medical and surgical management of performers with those skilled in vocal arts, voice science, and voice therapy. With advances in surgical instrumentation and techniques, increasing opportunities have evolved to surgically restore lost performing voices. However, it is especially challenging because of a range of factors, including the need for optimal technical precision, management of expectations, complexity of informed consent, public visibility of these patients, and the economics related to the success and failure of surgery. A number of these key issues apply to phonomicrosurgical procedures in nonsingers as well. Consequently, reviewing the art and craft of phonomicrosurgery in elite performers provides valuable insights into the optimal management of any patient.
: A retrospective review was done of microlaryngeal procedures for the past 20 years, and 18 elite performers were identified who were Grammy Award winners. Microsurgical methods for different lesions are illustrated. Composite analyses of the group along with their associated pathology was done to provide insights into key issues.
: The 18 patients in this cohort have won 80 Grammy Awards, which were garnered from 242 nominations. All 18 had substantial deterioration in voice quality and could retain more than 1 pathology. Significant loss of superficial lamina propria (SLP) pliability was present in 15 of 18, varices and/or ectasias leading to vocal hemorrhage in 6, vocal polyps in 9, fibrovascular nodules in 6, arytenoid granuloma in 1, sulcus from prior microlaryngeal surgery leading to vocal fold SLP scarring in 4, sulcus from long-term phonotrauma leading to vocal fold SLP scarring in 4, benign cyst in 1, precancerous dysplasia in 2, and invasive carcinoma in 2. Subsequent to phonomicrosurgery, all reported improvement in their performance.
: Laryngologists and laryngeal surgeons have shouldered a burden of responsibility for elite performing vocalists since the origin of our specialty. Most lesions and diagnoses that are encountered result from phonotrauma. Optimizing singers' care provides surgeons with extremely complex technical, emotional, social, and financial challenges. Focused analysis of managing elite performing vocalists effectively integrates a range of essential issues, which provide key insights to assist clinicians treating nonperforming patients requiring phonomicrosurgery.
自1855年著名歌剧大师曼努埃尔·加西亚使用间接喉镜发表《关于人的嗓音的观察》以来，职业声乐表演者与喉科医生之间就有着千丝万缕的联系。如今，专业的喉科外科医生延续了将表演者的医学和手术管理与声乐艺术、嗓音科学及嗓音治疗领域的专业人士相结合的传统。随着手术器械和技术的进步，通过手术恢复受损表演嗓音的机会越来越多。然而，由于一系列因素，这一过程极具挑战性，这些因素包括需要达到最佳技术精度、管理期望、知情同意的复杂性、这些患者受到公众关注以及手术成败相关的经济问题。其中许多关键问题同样适用于非歌手的嗓音显微外科手术。因此，回顾精英表演者的嗓音显微外科技术与技巧，能为任何患者的最佳管理提供宝贵见解。
对过去20年的显微喉镜手术进行回顾性研究，确定了18位格莱美奖得主的精英表演者。展示了针对不同病变的显微手术方法。对该组患者及其相关病理进行综合分析，以深入了解关键问题。
该队列中的18名患者共获得80项格莱美奖，这些奖项来自242次提名。所有18名患者的嗓音质量均有显著下降，且可能存在多种病变。18名患者中有15名存在浅层固有层（SLP）柔韧性明显丧失，6名患者有静脉曲张和/或扩张导致声带出血，9名患者有声带息肉，6名患者有纤维血管性结节，1名患者有杓状软骨肉芽肿，4名患者因既往显微喉镜手术导致声带沟，进而引起声带SLP瘢痕形成，4名患者因长期发声创伤导致声带沟，进而引起声带SLP瘢痕形成，1名患者有良性囊肿，2名患者有癌前发育异常，2名患者有浸润性癌。嗓音显微外科手术后，所有患者均报告表演能力有所改善。
自我们这一专业诞生以来，喉科医生和喉科外科医生就一直肩负着为精英职业声乐表演者负责的重任。遇到的大多数病变和诊断都是由发声创伤引起的。优化歌手的治疗给外科医生带来了极其复杂的技术、情感、社会和经济挑战。对精英职业声乐表演者管理的重点分析有效地整合了一系列重要问题，为治疗需要嗓音显微外科手术的非表演患者的临床医生提供了关键见解。
