The authors report their experience in the use of surgery for the treatment of dysphonia plica ventricularis, the vocal disorder which results when enlargement of the ventricular folds im airs true vocal cord apposition. Dia nosis was made by means of microlaryngoscopy under fxal anesthesia appl ing neuroleptic k g s . Surgery was reserved for those patients whose mucosal hypertrophy d i l not respond to medications, psychotherapy and persistent speech exercises. The sur 'cal technique employed consisted of grasping the central portion of the ventricular fold, pufing it medially, and excising the triangular portion of mucosa thus exposed. The underlying vocal cord was used as a point of reference for the excision. The raw surface was observed to reepithelialize rapidly. Cortisone inhalations were administered postoperatively in order to decrease the chance of scar formation. The 25 patients treated in this manner have done well during the one to four year follow-up period.

Excision of the hypertrophic ventricular folds was performed in 35 patients by means of laryngomicroscopy. In most of our patients this therapy promptly resulted in a clear voice. Correlating the laryngomicroscopic finding and the histological picture we were able to classify hypertrophy of the ventricular folds into three stages, each of which presents with a characteristical clinical and histological picture and thus requires approapriate therapy. In Stage I the histological changes are reversible and conservative phoniatric therapy leads to success relatively quickly. In the second stage histological changes may also be reversible, and the prolonged and persistent phoniatric therapy leads to success but we prefer microsurgical excision because of the direct effect. In Stage III, however, we found irreversible histological changes in the sense of connective hyperplasia which prompted us to conclude that microsurgical excision alone may lead to regression of the hoarseness.

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