The document discusses sulcus vocalis, a condition involving the invagination of vocal fold epithelium, which can be congenital or acquired and leads to poor vocal fold function. It classifies the condition into three types based on severity and provides a stepwise treatment approach ranging from voice therapy to surgical interventions. The information is based on personal experience at Choithram Hospital and is intended for medical students and ENT postgraduates.

1. Sulcus Vocalis
Dr Shrikant Phatak
Head of ENT Department
Choithram Hospital & Research Center
Indore

2. Sulcus Vocalis
• Invagination of vocal
fold epithelium into
superficial lamina
propria or deeper.
• Can be Congenital
• Acquired(VoiceAbuse
Smoking ,Ruptured VC cyst)
. Unilateral or Bilateral

3. Sulcus Vocalis
• Seen as a furrow
running parallel to the
free edge of the vocal
cord.
• Lamina propria is
reduced or lost that
leads to poor vocal fold
vibratory function

4. Sulcus Vocalis Types
.Ford & colleagues classified
it into 3 varieties
• Type 1 is physiological
Asymptomatic
• Type 2 Sulcus Vergature
.There is loss of superior
lamina propria with
extension to vocal ligament
.Dysphonia
• Type 3 indentation extends
even up to muscle. Severe
Dysphonia

5. Sulcus & Scar Symptoms
• Clinical features are
same but histologically
there is additional
deposition of fibrous
tissue in scar.
• Dysphonia (high pitch
voice)
• Increased vocal effort
• Vocal fatigue.

6. Sulcus Vocalis Stroboscopy
High pitch male voice130Hz Phonatory Gap 370Hz male voice.
This causes increased vocal effort

7. Sulcus Vocalis Stroboscopy
Sulcus 289Hz male patient Supraglottic Compensation

8. Pseudo Sulcus
Infra glottic oedema extending from anterior to posterior
end of larynx. Yellow. Interarytenoid band of congestion
due to Reflux

9. Sulcus Vocalis
• Treatment is stepwise from least invasive to
more invasive approaches.
• Depends on the vocal demands of the patient
• Taking care of Riflux, & comorbidities those
can affect voice.
• Voice therapy

10. Sulcus Vocalis
• Failure of conservative treatment surgical
intervention is advised.
• Vocal fold injection
• Medialisation
• Undermining sulcus
• Autologous tissue implant

11. Sulcus Vocalis
• Thank you

12. Disclaimer
• The information contained in the presentation is based on the personal
experience and cases collected at Choithram Hospital Indore over the last
20 years.
• It is intended for the use of Medical students ENT post graduates.
• The views expressed are purely on personal opinion. viewers can make
their own opinion. For any confusion please contact sole author.
• Everybody is allowed to copy or download the material best suited to him.
I am not responsible for any controversies arising out of the presentation.
• For any suggestions or corrections you may please contact
phatak_shrikant@yahoo.in