Vocal Tuning Surgery

Spasmodic dysphonia

Adductor Type

Introduction of thyroplasty type 2 (TP2)

Spasmodic dysphonia is one of the most difficult vocal disorders to both diagnose and treat. Injecting Botox is the most common treatment globally; however this also has some well-known drawbacks, including limited effectiveness, the necessity of repeated treatment, and an extended period of "breathiness" after the injection.

We at the Hiroshiba ENT Clinic have performed the surgical procedure called "Thyroplasty Type 2(TP2) or midline lateralization" on nearly 500 patients with AD/SD(2013/4 current). Prof. Nobuhiko Isshiki published an article on the effectiveness of this surgery for the first time in 2000, and the long-term results have dramatically advanced since the development of the "titanium bridge" in 2003.

This surgery is still not commonly known to the surgical world because of its specificity to Japan and the limited supply of titanium bridges. Furthermore, the details of this procedure are still not widely understood by most ENT surgeons. However, in our clinic, our doctors and speech consultants, including Dr. Isshiki, are completely familiar with this procedure.

The Hiroshiba ENT Clinic is strongly committed to treating vocal disorders, especially SD, and we fully expect all our SD patients to overcome this debilitating disease. This is our mission.

Comparative Chart of the Four Treatments

This chart shows the superiority of TP2 in intraoperative vocal adjustment, its reversibility, and patient recovery time. These points are described in detail below the charts.

  • The uniqueness of this procedure is that it is the only surgery that permits an intraoperative vocal adjustment. The patients receive a local anesthetic which allows them to be conscious and participate in their own vocal retuning (what we call "Tuning Phonosurgery".) This is the revolutionary, original method developed by Dr. Isshiki.
  • It requires shorter recovery time than the other treatments, including Botox injection, TAM (Thyroarytenoid muscle myectomy) and Slad/R(denervation/ reinnervation surgery). The downtime after surgery is usually only 1 week, in which time the patient will be able to speak with complete facility.
The comparison of the treatments for SD
  TP2 Botox injection TA Myectomy Slad/R
Reversibility reversible reversible non-reversible non-reversible
Intra-operative vocal adjustment possible impossible impossible impossible
downtime Short (days) Middle (weeks) Middle (weeks) Long (months)

Pre and Post Operative Voice

Abductor Type

This type of spasmodic dysphonia is relatively rare compared with adductor type. The laryngeal muscles which abduct the vocal cord are affected by dystonia, which cause weak or breathy voices.

We should distinguish between vocal cord paralysis and ABSD. Actually there is almost no treatments for ABSD except for Botox injection. Furthermore, the botox injection for ABSD is much more difficult than ADSD.

We apply thyroplasty surgery for ABSD patients (A movie is inserted). This procedure is still under trial, but must be effective in severely affected patients. If you have suffered from really severe breathy voice (maximum phonation time is within 5 seconds), please contact us.


66y.o, Female


Singer trainer

Present Illness

She has had breathiness for 6 years. She came to our clinic because botox injection didn’t work at all.

Intraoperative video

You can be sent your voice status using the inquiry form.

First, please answer the questions from the doctor.

© 2010 - 2019 HIROSHIBA ENT Clinic - ISSHIKI Memorial Voice Center all rights reserved.