. ▁by ▁meas uring ▁parameters ▁such ▁as ▁trans gl ott al ▁pressure ▁and ▁the ▁gl ott al ▁air flow ▁wave form ), ▁per cept ually ▁( e . g . ▁by ▁rating ▁the ▁voice ▁in ▁terms ▁of ▁dimensions ▁such ▁as ▁rough ness , ▁breath iness , ▁a est hen ia ▁and ▁stra in ), ▁in ▁terms ▁of ▁effect ▁on ▁quality ▁of ▁life ▁measures , ▁or ▁using ▁any ▁combination ▁of ▁the ▁above . ▁ ▁Finally , ▁rec urrence ▁of ▁vocal ▁fol d ▁nod ules ▁after ▁behaviour al ▁treatment ▁is ▁always ▁a ▁possibility , ▁particularly ▁if ▁nod ules ▁were ▁not ▁completely ▁resolved ▁or ▁if ▁skills ▁gained ▁during ▁treatment ▁were ▁not ▁carried - over ▁outside ▁of ▁ther apy ▁sessions ▁or ▁maintained ▁after ▁ther apy ▁blocks . ▁ ▁S urg ery ▁ ▁When ▁behaviour al ▁treat ments ▁have ▁been ▁de emed ▁in effect ive ▁for ▁a ▁voice ▁user , ▁surg ical ▁inter vention ▁is ▁often ▁considered . ▁S urg ical ▁treat ments ▁are ▁considered ▁in ▁cases ▁of ▁un resol ved ▁d ys ph onia ▁which ▁neg atively ▁impact s ▁the ▁patient ' s ▁quality ▁of ▁life . ▁Rem oval ▁of ▁vocal ▁fol d ▁nod ules ▁is ▁a ▁relatively ▁safe ▁and ▁minor ▁surg ery . ▁However , ▁those ▁who ▁sing ▁profession ally ▁or ▁otherwise ▁should ▁take ▁serious ▁consideration ▁before ▁having ▁surg ery ▁as ▁it ▁can ▁affect ▁the ▁ability ▁to ▁sust ain ▁ph on ation , ▁as ▁well ▁as ▁alter ▁the ▁vocal ▁range . ▁While ▁the ▁patient ▁is ▁sub du ed ▁under ▁general ▁an est hes ia , ▁long