Vocal Nodules Research Articles

The Application of I-Scan Imaging for Evaluating Benign Vocal Lesions

Current standard methods for evaluating benign vocal lesions, including white light laryngoscopy and video laryngostroboscopy, may struggle to identify smaller lesions. While histopathological results obtained from laryngeal microsurgery provide definitive results, their invasiveness can lead to scarring and impaired phonological outcomes. Intralesional steroid injection has recently gained acceptance, but it lacks pathological diagnostic capabilities. Therefore, there is a growing need for a simple examination that can enhance the diagnosis of benign vocal lesions. NBI, from Olympus Corporation, has shown promising outcomes in detecting and characterizing laryngeal lesions. The i-scan technology by PENTAX, while providing the ability to improve visual clarity during endoscopic procedures, has been addressed less in this field. Our study aims to further investigate the application of i-scan imaging in benign vocal lesions, enrolling patients diagnosed with vocal cysts, polyps, and nodules. We conducted i-scan imaging prior to office-based intralesional steroid injection, assessing the possibility of its providing additional diagnostic information for benign vocal lesions without additional burden.

Empirical Distribution of Glottal Edges (EDGE): A Statistical Assessment of Vocal Fold Kinematics Using High-Speed Videoendoscopy.

Although laryngeal high-speed videoendoscopy (HSV) is crucial for studying vocal fold vibrations, its translation to clinical practice has been hindered by the large volume of data it produces and the difficulty in interpreting current analysis methods. Although image processing techniques have been developed to map spatial-temporal data into two-dimensional representations, they alter the geometrical construction of the glottis and do not provide standard quantitative features, thus challenging clinical interpretation. In response, we propose a new visualization and analysis framework for assessing the dynamics of vocal folds based on the empirical distribution of the glottal edge using HSV. This procedure analyzes vocal fold oscillations by preserving the shape of the glottis and quantifying the asymmetry between right and left vocal fold displacements along the anterior-posterior axis. This method was evaluated on four groups of participants: ten with normal voices, ten with vocal fold nodules, ten with muscle tension dysphonia, and two with unilateral vocal fold paralysis. The proposed method produces distinct representations for normal and pathological vocal fold vibratory behaviors and derived features based on amplitude and phase asymmetry metrics that show statistically significant differences between normal and pathological groups. Comparative analysis with state-of-the-art techniques indicates that our proposed method can complement the assessment of vocal fold vibration and enhance the clinical translation of HSV.

Medidas espectrais e cepstrais em mulheres com disfonia comportamental

ABSTRACT Purpose To investigate whether there are differences in cepstral and spectral acoustic measures between women with behavioral dysphonia with and without laryngeal lesions and verify whether there is a correlation between such measures and the auditory-perceptual evaluation of voice quality. Methods The sample comprised 78 women with behavioral dysphonia without laryngeal lesions (BDWOL) and 68 with behavioral dysphonia with laryngeal lesions (vocal nodules) (BDWL). Cepstral peak prominence (CPP), cepstral peak prominence-smoothed (CPPS), spectral decrease, and H1-H2 (difference between the amplitude of the first and second harmonics) were extracted. They were submitted to the auditory-perceptual evaluation (APE) of the grade of hoarseness (GH), roughness (RO), breathiness (BR), and strain (ST). Results BDWL women had higher H1-H2 values and lower CPP and CPPS values than BDWOL women. More deviant voices had lower CPP and CPPS values. Breathy voices had lower CPP and CPPS values and higher H1-H2 values than rough ones. There was a weak negative correlation between CPP and RO, a moderate negative correlation with GH, and a strong negative correlation with BR. CPPS had a moderate negative correlation with GH, RO, and BR. H1-H2 had a weak positive correlation with BR. There was a weak positive correlation between spectral decrease and ST. Conclusion H1-H2, CPP, and CPPS were different between BDWOL and BDWL women. Furthermore, cepstral and spectral measures were correlated with the different APE parameters.

Benign Lesions of Larynx and Its Micro-Laryngeal Surgery - A Clinical Evaluation

BACKGROUND
 The larynx is a unique organ in the spectrum of functions it performs. Its role in normal respiration, maintenance and protection of the airway. Simple laryngeal lesions are not uncommon. The great majority of the cordal benign lesions are non-neoplastic, usually in a ratio of about 6:1. They are the product of some form of irritation and do not have the histological characteristics of true neoplasms. Therapy is directed at restoring as much normal function of the larynx as possible. Microlaryngeal surgery and postoperative voice rest offer a cost-effective, useful and safe approach to the management of benign laryngeal lesions.
 Objectives
 The study was undertaken to identify the common types of benign lesions of the larynx and the age, sex distribution, symptomatology, sites of involvement and histopathology of the lesions following micro-laryngeal surgery. Microlaryngeal surgery and postoperative voice rest offer a cost-effective, useful and safe approach to the management of benign laryngeal lesions.
 METHODS
 A prospective study was conducted from February 2017 to September 2019 at NRM ENT Hospital, Raichur, Karnataka and a secondary referral hospital. 30 patients with benign laryngeal lesions were included based on the patient’s clinical symptoms and findings on indirect laryngoscopy in the age group of 13–65 years. All non-operative cases and malignant cases were excluded. Routine preoperative surgical work-up and therapeutic micro-larnygoscopic procedures were employed.
 RESULTS
 A male preponderance with a male-to-female ratio of 1.3:1 was observed. The majority of the patients were in the age group of 31–40 years. Non-neoplastic lesions are much more common than neoplastic lesions. Vocal nodules, polyps, and angiofibromas with the same pathogenesis were common lesions. Abuse of voice, exposure to a known agent, and trauma were causative factors. Most of the lesions are solitary and unilateral, arising from the vocal cord. The right side is the common side, and sessile lesions are more numerous than pedunculated. Only 10% of cases are true neoplastic; vocal polyps, nodules, and angiofibromas with the same pathophysiology account for 70% of cases.
 CONCLUSIONS
 Benign lesions of the larynx are common in males, but in this series, amusingly, housewives are at the top of the list. Voice abuse, exposure to a known agent and trauma are the etiological factors. A common symptom is hoarseness of voice. On the basis of this study, it has been emphasized that the removal of the tumor should be flushed from the surface of the vocal cords to aviod any injury to the epithelium, which can be done either under microscopic or endoscopic view.

Surgical management of vocal cord nodules in children: Trends and outcomes

ObjectivesVocal cord nodules (VCNs) are the most common cause of dysphonia in school-aged children, with potential negative impacts on quality of life including diminished self-esteem and academic performance. The standard of care for VCNs is conservative management which ranges from voice hygiene to speech therapy with a focus on voice otherwise known as voice therapy, with surgical excision reserved for refractory cases. Thus, few studies have analyzed outcomes of surgical management of VCNs. The purpose of this study is to assess the prevalence and efficacy of surgical excision of VCNs when compared to speech therapy. MethodsChildren with VCNs seen at a single tertiary care institution between 2015 and 2020 were identified by ICD-9 code 478.5 and ICD-10 code J38.2. Demographics, objective voice assessment, intervention, and follow-up assessment data were reviewed. Frequencies, medians, and interquartile ranges were calculated. Time to resolution and improvement were assessed by Cox proportional hazards model. Univariate logistic regression was performed. A P value of <0.05 was considered statistically significant. ResultsThree hundred sixty-eight patients diagnosed with VCNs were identified. 169 patients received intervention for VCNs, with 159 (43.2 %) receiving speech therapy alone and 5 (1.4 %) receiving surgery alone. On bivariate analysis, there was no significant difference in demographic features between treatment groups, however speech therapy patients did have a longer follow-up time. 154 patients underwent objective voice assessment at the time of VCN diagnosis. Among these patients, 95 (61.7 %) received speech therapy and 59 (40.3 %) received no intervention. Speech therapy patients had significantly higher pVHI scores, however there was no significant difference in CAPE-V Overall Severity scores or computerized voice assessment analysis. On Cox proportional hazards analysis, surgical intervention was associated with faster resolution and faster improvement of dysphonic symptoms. On binary logistic regression, surgery was associated with a significantly greater proportion of patients reporting resolution of dysphonic symptoms, however there was no significant difference in proportion of patients reporting improvement of dysphonia. ConclusionFor most patients with VCNs, conservative measures such as voice hygiene and speech therapy remain first line, however certain patients may benefit from the rapid improvement and resolution of symptoms that surgical intervention may provide.

Clinical analysis of 102 cases of pediatric vocal fold nodules

Objective:To evaluate the impact of vocal fold nodules on the quality of life of children, and to compare the efficacy between conservative management（voice hygiene education, etc.） and laryngeal microsurgery. Methods:A retrospective study was performed on 102 children with vocal fold nodules, who received treatment in Children's Hospital of Fudan University during the period from January 2020 to December 2022. According to the regime, the patients were divided into conservative management group and surgical treatment group; Cases are divided into pre-school age group （2-5 years old） and school-age group （6-12 years old） based on age. The pediatric voice-related quality of life （pVRQOL） was used to evaluate the impact of vocal fold nodules on the quality of life of children and differences in efficacy between two treatment regimens. Results:The pVRQOL scores of vocal fold nodule grades 1, 2, and 3 were 91.58±8.17, 78.87±12.49, 72.50±12.08, respectively. There were statistical differences between grade 1 and grade 2, and between grade 2 and grade 3. There were statistical differences between grade 1 grade 2, grade 2 and grade 3 （P<0.001）, suggesting that the higher the rating of vocal cord nodules, the lower the pVRQOL score of patients was. The pVRQOL score of the school-age group was 69.83±11.11, which is lower than that of the preschool group（87.59±8.63）, and the difference was statistically significant （P=0.042）. Vocal fold nodules had a significant impact on the pVRQOL score of school-age children. In the conservative management group, the pVRQOL scores before and after treatment were 83.99±12.66 and 87.26±9.58, respectively, and there was significant difference between the two groups（P=0.046）. Indirect voice therapy such as voice hygiene education could improve children's pVRQOL scores and was more effective for school-age children（P<0.001）. The microsurgical treatment had a more significant improvement in the pVRQOL score of children. Conclusion:The higher the rating of vocal fold nodules, the greater the impact on the quality of life of patients. Vocal fold nodules had a greater impact on the quality of life of school-age children than that of preschool children. Voice hygiene education could improve the quality of life of children, which was more evident in the school-age group. Compared with voice hygiene therapy, laryngeal microsurgery had a more significant effect on improving the pVRQOL score of patients. It is recommended to undergo laryngeal microsurgery for the treatment of vocal fold nodules for the requirement of improving the quality of life related to voice. During the 6-month follow-up period after surgery in this study, the short-term efficacy of laryngeal microsurgery in treating vocal cord nodules in children is clear, but the long-term efficacy needs further research.

Clinical comprehensive evaluation of Jinsang Sanjie Pills/Capsules in treatment of vocal nodule/polyp of vocal cord

This study used health technology assessment methods and multi-criteria decision analysis(MCDA) model, according to the guideline for clinical comprehensive evaluation of Chinese patent medicine, we developed this assessment tool. The comprehensive evaluation score of Jinsang Sanjie Pills/Capsules is calculated based on the additive model. This score is calculated by &quot;quantitative evaluation software v1.0 for clinical comprehensive evaluation of Chinese patent medicines&quot; which developed by the project team. The evaluation yielded the following results.(1)Effectiveness: compared with the control group, Jinsang Sanjie Pills/Capsules can improve the total effectiveness rate of vocal nodule/polyp of vocal cord, and improve the symptoms and signs.(2)Safety: Jinsang Sanjie Pills/Capsules did not show acute toxicity and long-term toxicity. The most common adverse reaction was gastrointestinal system damage, all of the adverse reactions were either improved or cured.(3)Economy: from the perspective of the health system, evaluating the single use or combination of Jinsang Sanjie Pills/Capsules with conventional medication in the treatment of vocal nodule/polyp of vocal cord is relatively effective and cost-effective compared to conventional medication, with a stable cost-effectiveness advantage.(4) Innovation: Jinsang Sanjie Pills/Capsules are used for the treatment of slow throat paralysis(vocal nodules, polyp of vocal cord, thickening of vocal mucosa) caused by heat toxin accumulation, Qi stagnation and blood stasis, and the resulting hoarseness. Jinsang Sanjie Pills/Capsules have good innovation and targeted indications.(5) Suitability: the investigated doctors, pharmacists and patients all believed that Jinsang Sanjie Pills/Capsules have good suitability.(6)Accessibility: Jinsang Sanjie Pills/Capsules are included in the category B of the National Basic Medical Insurance, Work Injury Insurance, and Maternity Insurance Drug Catalogue(2021 edition), which have good cost-effectiveness and affordability for medical insurance and self-paid patients. Jinsang Sanjie Pills/Capsules do not contain endangered animals and plants. The supply of raw materials can meet the demand of production at present. The comprehensive evaluation score is 76.06 points. Based on all dimensions of evidence, 71.4% experts consensus on Jinsang Sanjie Pills/Capsules is class A, which can be directly converted into decision making. This study comprehensively evaluated the clinical application value of Jinsang Sanjie Pills/Capsules in the treatment of vocal nodule/polyp of vocal cord, so as to provide evidence for their rational clinical use and regulatory decision-making.

Analysis of the clinical efficacy and voice outcomes of CO2 laser resection versus laryngeal microsurgery for vocal cord polyps

Objective To compare CO2 laser resection and laryngeal microsurgery for vocal cord polyps and provide evidence for the optimal surgical method. Methods This was a retrospective cohort study that included 74 patients with vocal cord polyps who underwent either CO2 laser resection or laryngeal microsurgery in our hospital from August 2018 to December 2021. According to their preference, 77 patients were divided into two groups: a CO2 laser resection group (n = 35) and a laryngeal microsurgery group (n = 39). Patients were evaluated two days before surgery, and follow-ups were conducted one, two and four weeks after surgery. The voice handicap index (VHI-10) score, voice acoustic analysis results and electronic laryngoscopy results were collected for each patient, and the differences between the two groups were evaluated. Results The basic demographic characteristics of the 74 patients were comparable, and all patients completed postoperative follow-up observations. A total of 30 (85.71%) patients in the CO2 laser resection group and 22 (56.41%) patients in the laryngeal microsurgery group were healed. The total effectiveness rate of the CO2 laser resection group (94.29%) was significantly higher than that of the laryngeal microsurgery group (82.05%), and the difference between the two groups was statistically significant (p = .037). Both surgical methods had a positive effect on reducing VHI-10 scores with the effect of CO2 laser resection being more obvious. The difference between the two groups in this regard was statistically significant (p < .001). The effects of each surgical method on the average fundamental frequency perturbation (jitter), amplitude perturbation (shimmer), maximum phonation time and dysphonia severity index were not statistically significant (p > .05). Conclusion CO2 laser resection and laryngeal microsurgery have similar effects on voice quality, but CO2 laser resection has higher clinical efficacy.

"Pre and Post Treatment Comparison of S/Z Ratio in Benign Laryngeal Lesions".

Benign laryngeal lesions like vocal nodules, vocal polyp, vocal fold cysts are mostly found in patients complaining of change in voice. S/Z ratio has become the most frequently used clinical tool to assess phonatory mechanics. This study shows the pre-treatment and post-treatment comparison of S/Z ratios in patients with benign laryngeal lesions. To evaluate the outcome of microlaryngeal surgery in patients with benign laryngeal lesions using S/Z ratio as an outcome parameter. During this study, 65 patients with complaints of change in voice, with clinical evidence of benign laryngeal lesions underwent microlaryngeal surgery. Improvement in symptoms were measured preoperatively and postoperatively using S/Z ratio. This ratio was calculated by asking the patient to to maximally sustain 'S' and 'Z', repeated thrice. S/Z ratio was calculated by dividing the maximum duration for which /S/ was sustained by the maximum duration for which /Z/ was sustained. A ratio of more than 1.4 suggested a vocal cord disorder. There was statistically significant difference observed in S/Z ratio values, from pre-treatment to 6months post-treatment, with P value 0.001. Pre and post treatment assessment of patients with benign vocal fold lesions showed significant improvement in S/Z ratio postoperatively. It is the simplest and a reliable objective method of voice assessment and can also be used in assessing the outcome of the treatment.

Efficacy and safety of acupuncture for vocal nodules: A systematic review and meta-analysis with trial sequential analysis.

In this study, we aim to evaluate the efficacy and safety of acupuncture for vocal nodules, concerning qualitive overall efficacy and quantitative improvement on quality of voice. Four English and four Chinese databases were searched up to December 10th, 2022. Risk of bias among the included trials were evaluated by the Cochrane ROB tool. Systematic reviews and meta-analyses were conducted based on the Cochrane systematic review method by using RevMan 5.4 Software, and trial sequential analyses were performed by TSA 0.9. Meta-influence analyses, subgroup-analyses, meta-regression, and evaluation of publication bias were performed for exploration of heterogeneity by Stata V.14. Quality of the results was accessed through the GRADE-pro GDT. Cluster analyses and correlation coefficient were performed by R 4.1.3. Finally, 15 trials involving 1,888 participants were included. Results showed that compared with western medicine alone or Chinese herbal medicine alone, acupuncture alone yielded significantly (p<0.05) higher clinical effective rate and more improvement on scores of voice analyses. However, reduction on scores of grade, roughness, and breathiness and voice handicap index during follow-ups, and results of clinical effective rate suggested that acupuncture was inferior to voice training. In addition, meta-regression and sub-group analyses firstly revealed advanced efficacies of acupuncture when performed with local and remote acupoints, compared with local acupoints only. Acupuncture specified adverse event was denied in six trials while it was not mentioned in other nine trials. Results of cluster analyses and correlation coefficient showed that Kai yin yi hao and He gu (LI-4) were the most frequently applied matching-acupoints in trials. In conclusion, compared with western medicine (level of evidence: low ⨁⨁◯◯, GRADE C) and Chinese herbal medicine (level of evidence: moderate ⨁⨁⨁◯, GRADE B), acupuncture is safe and of better efficacy for patients with vocal nodules, while there is also need for RCTs with improvements on designing and interventions in experimental and controls.

Prevalence of Benign Vocal Fold Lesions: Long-Term Results From a Single European Institution

Hoarseness and limited voice capacity are often associated with benign vocal fold (VF) lesions. Despite their high clinical prevalence, epidemiological investigations focusing on these structural alterations are rare. The aim of the study was to present current European data on five typical lesion types (VF nodules, polyp, cyst, contact granuloma, Reinke´s edema). Retrospective investigation. Video recordings of laryngoscopies from all patients with one of the above-mentioned VF pathologies were subjected to a review process. Data collected arose from a single institution over a period of 13years. They were evaluated statistically with respect to lesion type, sex, age at first diagnosis, and affected side. In a total of 535 patients, VF polyps occurred most frequently, followed by Reinke's edema and nodules. Each of the lesion types studied was significantly associated with sex and, except VF cysts, all diagnoses were also significantly related to age. Female sex was a risk factor for VF nodules, cysts, and Reinke's edema, whereas male sex was associated with polyps and contact granulomas. VF nodules occurred predominantly in young patients, VF polyps in middle-aged, Reinke's edema, and contact granulomas in later adulthood. The predominantly affected side (bilateral, right, or left VF) depended on sex. Different prevalences from previous studies resulted from inconsistencies in terms of classification framework, terminology, and definition. In addition to endoscopic findings, socio-cultural backgrounds must also be considered when studying benign VF lesions. Prophylactic voice care education for all populations and concomitant efficacy studies are required. Further research is needed to verify possible correlations between sex and the affected side. A non-binary view could broaden the spectrum of phoniatric research issues.

A Rare Case of Intravascular Papillary Endothelial Hyperplasia (Masson's Tumor) of Vocal Cord.

Intravascular papillary endothelial hyperplasia (IPEH) also known as Masson's tumour named after Pierre Masson is a benign lesion of vascular origin which is characterized by reactive proliferation of endothelial cells with papillary formation. It is an extremely rare entity which can present anywhere in the body but is particularly found in the extremities and head and neck regions most commonly the lips, oral mucosa, tongue, gingiva, or buccal mucosa and due to its close resemblance to Angiosarcoma, it becomes important to distinguish between these two entities to avoid unnecessary aggressive treatment. Here, we describe a case of 23-year-old male who presented with change in voice since 8 months. Preoperatively, laryngoscopic examination showed right vocal cord polyp in the anterior one-third of the cord with hemorrhagic changes. He underwent micro-laryngeal surgery using suspension laryngoscope and the lesion was excised completely. Histopathological report was consistent with IPEH. Herein, we describe a rare benign case of IPEH arising from the vocal cord and we provide a brief review of relevant literature and a detailed report of this rare entity.

Investigation of the effect of endolaryngeal vocal cord surgery on voice level and life quality of patients

Objectives: The study aimed to investigate the efficiency of the performed surgery for patients with vocal cord polyps or intracordal cysts according to their own evaluations and to analyze the effects of surgery to patients’ life quality. Patients and Methods: This retrospective study was performed with 56 patients (32 males, 24 females; mean age: 35.2±15.95 years; range, 19 to 61 years), of whom 35 had vocal cord polyps and 21 had intracordal cysts, between March 2015 and January 2018. Improvements in voice level and life quality were preoperatively and postoperatively investigated by the life quality index and other subjective evaluations. Results: After the surgery, patients’ own evaluation for their voice quality from 0-10 points increased from 4.8 to 8.3, and the change was statistically significant (p&lt;0.05). Improvements were determined in subparameters other than pain, vitality, physical function, and physical role difficulty according to the life quality scale (p&lt;0.05). Conclusion: Although pathologies that cause dysphonia are mostly not life threatening, they functionally or psychosocially effect patients’ life quality. It is possible to increase life quality in benign pathologies by surgical treatment.

A Voice Disease Detection Method Based on MFCCs and Shallow CNN

The incidence rate of voice diseases is increasing year by year. The use of software for remote diagnosis is a technical development trend and has important practical value. Among voice diseases, common diseases that cause hoarseness include spasmodic dysphonia, vocal cord paralysis, vocal nodule, and vocal cord polyp. This paper presents a voice disease detection method that can be applied in a wide range of clinical. We cooperated with Xiangya Hospital of Central South University to collect voice samples from 352 different patients. The Mel Frequency Cepstrum Coefficient (MFCC) parameters are extracted as input features to describe the voice in the form of data. An innovative model combining MFCC parameters and single convolution layer CNN is proposed for fast calculation and classification. The highest accuracy we achieved was 92%, it is fully ahead of the original research results and internationally advanced. And we use advanced voice function assessment databases (AVFAD) to evaluate the generalization ability of the method we proposed, which achieved an accuracy rate of 98%. Experiments on clinical and standard datasets show that for the pathological detection of voice diseases, our method has greatly improved in accuracy and computational efficiency.

Objective tools in pediatric voice therapy: A path to improved outcomes

This is an invited presentation in the Special Session titled, “Voice therapy: objective measurement science and clinical efficacy.” Pediatric dysphonia (hoarseness) is a common condition with prevalence estimates ranging from 1.4% to 23.9%. Dysphonia can be detrimental to children both psychologically and academically; hence, early identification and restoration of optimal vocal health is critical. Direct visualization of vocal fold vibratory patterns is fundamental for appropriate diagnosis and treatment of vocal fold pathology. Thus, evaluation of vocal fold structure and cycle-to-cycle vibratory motion through techniques of direct visualization of the vocal fold is essential for clinical assessment and measurement of treatment outcomes. This session will discuss the most recent advances in objective voice assessment and measurement of voice therapy outcomes in children. The focus will be on discussing an innovative approach that leverages high-speed videoendoscopy and a cutting-edge custom developed laser projection system for quantitative evaluation of lesion size and comprehensive evaluation of opening and closing phase dynamics of the glottal cycle before and after voice therapy in children with vocal fold nodules.

Spectrographic Vocal Characteristics in Female Teachers: Finger Kazoo Intensive Short-term Vocal Therapy

Verify the results from intensive short-term vocal therapy using the Finger Kazoo technique about the spectrographic vocal measurements of teachers. Controlled and randomized trial. Spectrographic vocal assessment was performed by judges before and after intensive short-term vocal therapy with Finger Kazoo. Sample was composed of 41 female teachers. There were two study groups (with vocal nodules and without structural affection of the vocal folds) and the respective control groups. For the statistical analysis of the data, nonparametric tests were used (Mann-Whitney test and Wilcoxon test). After intensive short-term vocal therapy with Finger Kazoo, improvement in voice spectral parameters, such as improvement in tracing (color intensity and regularity), greater definition of formants and harmonics, increased replacement of harmonics by noise, and a greater number of harmonics, mainly in the group without structural affection of the vocal folds. There was an improvement in the spectrographic vocal parameters, showing greater stability, quality, and projection of the emission, especially in female teachers without structural affection of the vocal folds.

Large Vocal Cord Polyp and Anesthetic Considerations: A Case Report

Background: Vocal cord/fold lesions include growths such as polyps, nodules, and cysts, which are mostly benign in nature with various shapes, vascularity, and histological characteristics. Safe management of such cases depends on planning the anesthesia accordingly to the availability of resources and coordination with the surgeon. Description: We present a 55-year-old female, 110 kg, hypertensive on medication, presented to the ear, nose, and throat outpatient department with a history of progressive dyspnea and dysphonia for 2 years, a case of right vocal polyp posted for polypectomy. Intervention: The various safety measures involve an attempt to visualize the vocal cords throughout the intubation, avoidance of forceful intubation, and use of alternative devices to secure the airway. Lesson Learnt: It is thus advised to have a thorough preanesthetic assessment as well as photo documentation of the lesion preoperatively.

Laryngopharyngeal Reflux and Benign Vocal Fold Lesions: A Systematic Review and Meta-analysis.

There is a link between laryngopharyngeal reflux (LPR) and the formation of benign vocal fold lesions (BVFLs). However, previous studies have mainly focused on LPR suggested by symptoms and signs, rather than objectively diagnosed LPR via pharyngeal pH monitoring. We, therefore, conducted a Meta-analysis to evaluate the association between pharyngeal pH monitoring diagnosed LPR and the odds of BVFLs. Relevant observational studies were identified by searching PubMed, Embase, Cochrane Library, and Web of Science. We evaluated between-study heterogeneity using the Cochrane Q test and estimated the I2 statistic. Random-effects models were used when significant heterogeneity was observed; otherwise, fixed-effects models were used. Thirteen datasets from 9 studies were included. Among them, 493 were diagnosed with LPR and 344 had BVFLs. LPR was related to a higher odds of BVFLs (odds ratio: 3.26, 95% confidence interval: 1.84-5.76, P < .001) with moderate heterogeneity (P for Cochrane Q test = .006, I2 = 57%). Subgroup analyses showed that the association was similar in studies with only pharyngeal pH monitoring (Restech), with double-probe or 3-site pH monitoring, and with 24-hour multichannel intraluminal impedance-pH monitoring (P for subgroup difference = .15). In addition, subgroup analysis showed consistent results in studies from Asia and Europe (P for subgroup analysis = .12), and the association seemed to be consistent for vocal Reinke's edema, nodules, and polyps (P for subgroup difference = .09). Pharyngeal pH monitoring diagnosed LPR is associated with the formation of BVFLs.

A Comparative Study of Fiberoptic Laryngoscopy (FOL) and Indirect Laryngoscopy in the Diagnosis of Patients with Vocal Cord Lesions

Background: Change of voice is one of the common complaints in ENT practice and hoarseness of voice is the commonest symptom of changed voice quality. Hoarseness is invariably the earliest manifestation of conditions directly or indirectly affecting the voice apparatus. Though most common causes of hoarseness are benign and vocal abuse is the commonest among them, but we should always investigate for more sinister pathology like malignancy. The aim of this study was to compare the diagnostic yields of fibreoptic laryngoscopy (FOL) with that of indirect laryngoscopy in the diagnosis of vocal cord lesions. Objectives: To compare fibreoptic laryngoscopy (FOL) and indirect laryngoscopy in the diagnosis of vocal cord lesions as the cause of voice change. Methods: This is a cross-sectional study which has been conducted in the Department of ENT and Head Neck Surgery, SSMC Mitford Hospital with a sample size of 87 cases for a period of six months from 10th February’ 2020 to 9th August’ 2020. The patients with vocal cord lesions were selected according to the eligibility criteria by purposive sampling. Results : On indirect laryngoscopic examinations, 29.89% were vocal cord polyp, 16.09% suspected vocal cord neoplasm, 14.94% vocal cord edema, 11.49% vocal cord nodule, 5.74% vocal cord palsy and 2.61 were ulcerative lesion of vocal cords whereas poor view were in 18.39% cases. On fibreoptic laryngoscopy (FOL), 29.89% were vocal cord polyp, 19.54% suspected vocal cord neoplasm, 17.24% vocal cord edema, 16.09% vocal cord nodule, 8.04% vocal cord palsy and 6.90% were ulcerative lesion of vocal cord. 2.30% revealed normal study. Study showed that fibreoptic laryngoscopic examination is superior to indirect laryngoscopy in diagnosing vocal cord lesions. Conclusion : Fibreoptic laryngoscopy (FOL) is significantly superior to indirect laryngoscopy in the diagnosis of vocal cord lesions. Indirect laryngoscopy sometimes may miss to diagnose a sinister disease like malignancy. Bangladesh J Otorhinolaryngol 2023; 29(1): 24-31

Nationwide Multicenter Consensus on Practical Percutaneous Steroid Injection

Background and Objectives We evaluated the current status of percutaneous steroid injection (PSI) procedure for benign vocal fold lesions performed in Korea in order to achieve consensus about the indications, contraindications, anesthesia, complications, and the role of PSI.Subjects and Method An email-based questionnaire survey consisting of 11 questions was administered to 20 experienced laryngologists.Results The most commonly used indication was small vocal nodule (32.7%). The most common contraindication was vocal fold lesion with atrophy (46.9%). Triamcinolone injection under local anesthesia by cricothyroid was usually used in the PSI procedure. Following the procedure, vocal fold atrophy was the most prominent complication (39.1%). The role of PSI is still not well established; however, most laryngologists considered it to be an adjunctive treatment (61.9%).Conclusion The survey results provide an insight into the general consensus of opinion about PSI that guidelines for the indications, contraindications, anesthesia, and complications associated with this treatment option should be facilitated.