Subglottic stenosis (SGS) is a narrowing of the airway in the region of the cricoid cartilage below the vocal folds and above the tracheal rings. Individuals with SGS experience difficulty breathing at rest and during exertion both of which become increasingly difficult with the level of stenosis severity. Some individuals also experience negative voice changes. Individuals whose stenoses significantly impact breathing generally require medical procedures or surgery, either balloon dilation or cricotracheal resection (CTR). CTR has been shown to improve patients' ability to breathe, but it can also result in permanent vocal changes. Alternatively, balloon dilation results in similar breathing improvements but for a relatively short period of time. Many studies have been published on the effectiveness of CTR; however, only a few have examined the effects of CTR on vocal production. The purpose of this study is to quantify the acoustic and auditory-perceptual features of subglottic stenosis and examine possible acoustic and auditory-perceptual changes in voice production following a revised CTR aimed to minimize voice impact in a group of women. A retrospective chart review identified women with idiopathic SGS who received revised CTR at The University of Utah Voice Disorders Center between 2008 and 2014. Presurgical and postsurgical groups included patients with both pre and post recordings (n = 11) as well as patients with only pre (n = 6) or post (n = 9) recordings. Acoustic quantification of voice signal periodicity, as well as cepstral, spectral, and fundamental frequency (F0) analyses were performed. Auditory-perceptual ratings of overall quality and monotonicity were performed. Cross-sectional and pre-post surgery analyses were completed. Aggregate analyses revealed that both pre and posttreatment SGS patients demonstrated voice disorders in the mild to moderate severity range. Pre-post comparisons indicated no significant voice change after surgery. Mean fundamental frequency decreased from 215 Hz (SD = 40 Hz) to 201 Hz (SD = 65 Hz). Voice disorder severity based on the cepstral spectral index of dysphoniaTM for sustained vowels decreased (i.e., improved) from 41 (SD = 41) to 25 (SD = 21) points. Semitone standard deviation (2.2 semitones) was equivalent from pretreatment to posttreatment. Auditory-perceptual ratings demonstrated similar results. These preliminary results indicate that the revised CTR procedure is promising in minimizing adverse voice effects. Future research is needed to determine causative factors for pretreatment voice disorders, as well as to optimize treatments in this population.



College and Department

David O. McKay School of Education; Communication Disorders



Date Submitted


Document Type





subglottic stenosis (SGS), cricotracheal resection (CTR), voice disorders, semitone standard deviation (STSD)