Dynamic Voice Computed Tomography for Dysphonia Disproportionate to Clinical Findings

OBJECTIVES: Accurate evaluation of glottic anatomy in adults with dysphonia can be challenging when videostroboscopy is limited by altered anatomy, supraglottic hyperfunction, or posterior glottic pathology. We sought to evaluate the clinical utility of Dynamic Voice Computed Tomography (DVCT) in complex adult voice patients with prior laryngeal framework surgery or suspected posterior glottic insufficiency (PGI). METHODS: Retrospective cohort study of 15 adult patients undergoing DVCT for evaluation of dysphonia at a tertiary laryngology practice between February 2025 and February 2026. Demographics, prior surgical history, standardized voice measures, videostroboscopy findings. RESULTS: Fifteen adults underwent DVCT (mean age 62.8 years; 40% female). Ten had prior thyroplasty, and five had known or suspected PGI. All had abnormal acoustic and perceptual voice measures out of proportion to stroboscopy appearance. DVCT imaging findings and clinical management were analyzed. DVCT provided additional clinically relevant anatomic information beyond videostroboscopy in all patients. Imaging most commonly identified posterior glottic insufficiency, vertical height mismatch, implant malposition, or arytenoid malposition not fully appreciated on stroboscopy. CT findings influenced surgical decision-making in the majority of patients, confirming candidacy in 47%, altering planned procedures in 33%, and avoiding surgery in 13%. CONCLUSIONS: DVCT is a useful tool in the evaluation of dysphonic adults with prior laryngeal framework surgery or PGI, providing complementary characterization of glottic anatomy that informs surgical decision making.