Vocal Nodules Research Articles

A Cross-sectional Study on the Aetiology and Predisposing Factors of Hoarseness of Voice.

The primary objective of the study was to find out the aetiology of hoarseness and analyse people with hoarseness based on socio-demographic profile like age, gender, occupation and socio-economic status. Secondary objective was to find out the predisposing factors of hoarseness and to see their association between benign and malignant causes of hoarseness. The study was conducted for a period of one and half years in 178 patients who were above the age of 18 years of age and presented with hoarseness lasting for more than 2 weeks to the Department of Otorhinolaryngology. After obtaining a written informed consent, history was taken using a structured proforma and a proper clinical examination was done including indirect laryngoscopy. Nasopharyngolarygoscopy was done where indirect laryngoscopy was difficult. In a sample of 178 patients with hoarseness, 159 patients had structural lesions and 19 patients had movement disorders. Of the structural lesions, 86 patients were due to malignancy, 64 due to non-neoplastic causes, and 9 were due to premalignant causes. The most common malignant cause for hoarseness was Malignancy glottis, which had a male predilection. Smoking and alcoholism were found to be the main predisposing factors. The most common non neoplastic cause were vocal cord nodule and vocal cord polyp. The main predisposing factor was vocal abuse and was seen mostly in females. Vocal cord palsy was found to be the most common movement disorder. Hoarseness as a symptom if taken lightly can lead to serious consequences. Therefore it is important to avoid predisposing factors like smoking, alcoholism and also to educate the people regarding the proper use of voice.

Bilateral Vocal Nodules Multidimensional Assessment: Pre- and Post- Speech Language Pathology Intervention

(1) Background: Vocal fold nodules are bilateral lesions that can have an important negative impact on a person’s job performance, social interaction, and quality of life. This study aims to analyze multidimensional voice evaluation outcomes in a group of patients with bilateral vocal fold nodules who underwent voice therapy. (2) Methods: A retrospective analysis was performed in 42 patients on the following voice evaluations, before and after voice therapy: visual-perceptual (video-laryngostroboscopic evaluation), auditory-perceptual voice analysis based on the GRBAS scale, and aerodynamic voice analysis. Data were collected from January 2001 to December 2019. Data analyses were performed with non-parametric tests (Wilcoxon test) using α = 0.05. (3) Results: The patient average age was 33.6.1 ± 10 years (range 19–60), and 95.2% were female. Voice therapy was delivered by an experienced speech-language pathologist once a week, with an average of 9.8 ± 3 appointments (range 8–17). Vocal fold lesions disappeared in 40.4% of the patients after voice therapy, especially in participants receiving early voice therapy (p = 0.035). When comparing pre- and post-therapy audio-perceptual results, all parameters were improved with statistical significance (p < 0.05) except for the asthenic voice scale. Aerodynamic parameters were all improved but without statistical significance (p > 0.05); (4) Conclusions: Early timing to initiate voice therapy after the onset of symptoms or diagnosis seems to be an important factor for the success of voice therapy (absence of vocal fold nodules).

Comparison between Voice Disorders among Female Professional and Nonprofessional Voice Users Dealing with Early School Aged Children

Abstract Background Voice disorders are common among females; a main cause is their continuous communication with children as their caregivers. Teachers are exposed to voice abuse and misuse and so also housewives, both of them use their voice excessively to deal with children. Aim of the Work The aim of this study is to compare between voice disorders among female professional and non-professional voice users, in order to identify voice problems affecting nonprofessional voice users for prevention, early detection and proper management to avoid serious vocal health injuries. Study Design a comparative cross-sectional study. Patients and Methods This study included 100 adult female patients who complained of symptoms of voice disorders and were subjected for voice evaluation at the Phoniatrics Unit, Ain Shams University Hospitals. The participated patients were aged between 20 years to 50 years and were divided into 2 groups 50 in each group, group I (teachers) and group II (housewives). Detailed history taking, auditory perceptual assessment of voice (APA), video-laryngoscopic examination, documentation of the auditory perceptual assessment, acoustic analysis and application of Arabic VHI (voice handicap index) were done for all cases. Results The duration of the voice complaint was longer in teachers than housewives. There was nonsignificant difference between both groups regarding the presence of phonasthenic symptoms. The impact of compliant regarding patients own rating of the severity and effect on daily life was higher` in housewives than in teachers, but there was non-significant difference between both groups regarding the listener reaction. There was non-significant difference between teachers and housewives as regard the APA in the overall grade of dysphonia and voice quality. The most prevalent diagnosis of voice disorders among teachers was the vocal fold nodules, while phonasthenia was the most prevalent in housewives. There was a significant difference between the teachers and housewives as regard the total score, functional and emotional subscales of VHI. Results of the acoustic analysis revealed a significant difference between teachers and housewives as regard average F0, jitter % where teachers had higher scores than housewives. While there was non-significant difference as regard RAP, shimm%, APQ and NHR between both groups. A significant positive correlation was found between number of children and functional, emotional and total VHI score in housewives group. There was a significant positive correlation between number of students and patient’s own rating of severity and years of teaching in teachers group. Moreover, there was a highly significant positive relation between having children and emotional subscale of VHI in teachers group. Also, there was a significant positive relation between number of children and functional subscale of VHI in housewives group. Conclusion Voice disorders are common among housewives (Nonprofessional voice users) the same as in teachers (Professional voice users) especially when dealing with early school aged children. Recommendation There is need to increase awareness among the housewives about the importance of voice in their daily life, risk factors for voice problems, how to protect themselves from developing vocal pathologies and when to consult the medical professional.

Transoral Flexible Laser Surgery of the Larynx with Blue Laser.

Laser surgery of the larynx is currently the standard of clinical practice in a multitude of procedures. Lasers with photoangiolytic properties have a wide application in endolaryngeal lesions. One of their most prominent features is the ability to coagulate blood vessels, reducing unwanted tissue damage. Our objective is to expose the uses of the blue laser (445 nm) in the larynx. A retrospective study was carried out including 47 patients treated with blue photoangiolytic laser from October 2021 to January 2023 at a university hospital. Demographic data, type of lesion presented, date of intervention and scope of the procedure, as well as the parameters of the laser used, were recorded. The number of sessions received per patient, the result and complications were also collected. A total of 47 patients with laryngeal lesions were treated, including vascular angiomas, laryngeal sulcus vocali, vocal cord polyps, Reinke's edemas, laryngeal papillomatoses, subglottic stenosis, laryngeal synechiae, subglottic granulomas, glottic scars, vocal fold leukoplakias, laryngeal dysplasias and tracheostomal granulomas. The mean age was 52.5 years, and 64.3% of the patients were women. The range of power used in the resective surgeries was 2-10 Watts with a 20-millisecond window. The average number of sessions received was 2.1 (range 1-4). A satisfactory situation was obtained in 45 of the 47 patients treated (95.75%), and an evident decrease in lesions was seen in the remaining two. There was no evidence of any complications directly derived from the use of the blue laser. Twenty-seven cases (54%) were treated exclusively in-office. The blue laser is safe and effective in the treatment of a wide range of laryngeal pathologies. Its advantages include its portability, its photoangiolytic qualities as well as its ability to vaporize tissue in contact mode, which can treat subepithelial vessels or resect lesions.

Surgical management of broad-based sessile vocal cord polyps: Transnasal vocal fold polypectomy versus microlaryngoscopic surgery: Our experience in 159 cases.

In this study, we retrospectively reviewed and compared the treatment outcomes and complications of office transnasal vocal fold polypectomy (TVFP) with those of microplarygoscopic surgery (MLS) for different clinical and histopathological features of broad-based sessile vocal fold polyps. We retrospectively reviewed the records of 159 consecutive patients with broad-based sessile vocal fold polyps treated by TVFP or MLS. The differences in efficacy and complication between these two surgical techniques were compared according to the different types of vocal fold polyps. Satisfactory outcomes of both TVFP and MLS treatments were reported in patients with oedematous, gelatinous and vascular types of vocal fold polyps (p > .05). The efficacy of TVFP was slightly worse than MLS in fibrous polyps group (p < .05). The TVFP-treated patients did not exhibit obvious complications, whereas several MLS-treated patients had suffered different complications. The therapeutic effects of both TVFP and MLS on the treatment of broad-based sessile vocal cord polyps are related to their clinical characteristics and histological types. Satisfactory outcomes are achieved in oedematous, gelatinous, and vascular types of polyps after either surgical procedure. TVFP has fewer surgical complications than MLS which can be a preferred option for the treatment of broad-based sessile vocal cord polyps at outpatient setting. TVFP also can be an alternative surgery option for patients who could not tolerate general anaesthesia or laryngeal suspension. In contrast, MLS has proven to be a particularly advantageous treatment in patients who have fibrous type of polyps.

Etiological Factors of Hoarseness in Patients Attending Basrah General Hospital

Background: Hoarseness is a common symptom in otolaryngology practice, and it’s the earliest manifestation of a large variety of conditions directly or indirectly affecting the larynx, ranging from benign to most malignant. Aim: This study was undertaken to find out a clinical profile, the incidence of common predisposing and etiological factors of hoarseness. Methods: Two hundred cases of hoarseness for 18 months were studied. All cases were analyzed for detailed history and examination with visualization of the larynx through rigid video laryngoscopy or flexible nasopharyngolaryngoscopy and in some cases, direct laryngoscopy and biopsy were taken for histopathological study. The final results were analyzed by simple manual analysis with frequency and percentage using Microsoft Excel Software 2007. Results: A total of 200 patients were included in the study. Among them, patients in the age groups of 31–40 years and 41–50 years were the main sufferers of hoarseness. Similarly, among 200 patients 124 (62%) were males whereas 76 (38%) were females, with the male to female ratio of 1.6:1. Vocal cord nodules were the most commonly encountered etiology with a frequency of 17.5 % whereas tuberculous laryngitis was the least commonly encountered etiology with a frequency of 0.5%. Conclusions: There was an etiological variation in hoarseness ranging from simple laryngitis to the most life-threatening malignancies. It is important not to ignore the hoarseness and precise history, examination and investigations should be done to diagnose the early underlying pathological changes for prevention and accurate management.

The effect of swelling on vocal fold kinematics and dynamics.

Swelling in the vocal folds is caused by the local accumulation of fluid, and has been implicated as a phase in the development of phonotraumatic vocal hyperfunction and related structural pathologies, such as vocal fold nodules. It has been posited that small degrees of swelling may be protective, but large amounts may lead to a vicious cycle wherein the engorged folds lead to conditions that promote further swelling, leading to pathologies. As a first effort to explore the mechanics of vocal fold swelling and its potential role in the etiology of voice disorders, this study employs a finite-element model with swelling confined to the superficial lamina propria, which changes the volume, mass, and stiffness of the cover layer. The impacts of swelling on a number of vocal fold kinematic and damage measures, including von Mises stress, internal viscous dissipation, and collision pressure, are presented. Swelling has small but consistent effects on voice outputs, including a reduction in fundamental frequency with increasing swelling (10Hz at 30% swelling). Average von Mises stress decreases slightly for small degrees of swelling but increases at large magnitudes, consistent with expectations for a vicious cycle. Both viscous dissipation and collision pressure consistently increase with the magnitude of swelling. This first effort at modeling the impact of swelling on vocal fold kinematics, kinetics, and damage measures highlights the complexity with which phonotrauma can influence performance metrics. Further identification and exploration of salient candidate measures of damage and refined studies coupling swelling with local phonotrauma are expected to shed further light on the etiological pathways of phonotraumatic vocal hyperfunction.

Vocal Cord Nodule with Stromal Atypia: Case Report and Review of Literature.

Vocal cord nodule is a common reactive transformation of the laryngeal mucosa encountered routinely. Although benign, rare instances of stromal atypia have been demonstrated, which can often be confused with other spindle cell lesions. There is a dearth of literature explaining this peculiar transformation. Hence, the diagnosis of these lesions can be put-forth only after histopathological evaluation and appropriate immunohistochemical analysis. Herein, we report a case of a 55-year-old male who presented with vocal cord nodule with stromal atypia.

Misdiagnosis of Vocal Fold Nodules

Benign vocal fold masses (BVMs) include nodules, polyps, cysts, and other pathology. Nevertheless, some otolaryngologists and other physicians utilize "vocal fold nodules" as an umbrella diagnosis for vocal fold masses. Patients subsequently evaluated by a laryngologist are found to have a different vocal fold mass, which often has a different prognosis and treatment plan compared to nodules. The purpose of this study was to investigate the rate at which vocal fold nodules are misdiagnosed. Adult voice patients who presented to our voice center having been evaluated elsewhere by an otolaryngologist and diagnosed with vocal fold nodules, or prenodules, were included in this retrospective study. Strobovideolaryngoscopy (SVL) footage from each patient's first visit or prior to any treatment at our center was compiled and de-identified. Three blinded physician raters evaluated the videos to determine if the mass(es) was/were nodules on a binary scale, with 1 indicating a nodule. If the mass was not a nodule (0), the raters were asked to identify it based on a list of five different mass types. There were 56 cases (11 male and 45 female) included in the retrospective cohort. The average age was 38±14.8 with a range of 11-65. Reliability between all raters was fair (κ=0.3). Individually raters 1 and 2 had very good reliability (κ=1) and rater 3 had good reliability (κ=0.6). In 100% of cases, two raters agreed that none of the masses were nodules. Only one rater identified two masses as vocal fold nodules, indicating that at least 97% of cases were not vocal fold nodules and had been misdiagnosed. The most frequently identified mass and the most frequently agreed upon mass by all raters was vocal fold cyst or pseudocyst, followed by fibrous mass. Only one rater was unable to identify the mass type in some cases (n=7). Vocal fold nodules are frequently misdiagnosed. Proper identification of vocal fold masses requires high levels of expertise and SVL. Since treatment of BVMs varies with mass type, accurate diagnosis is essential.

The Occurrence of Laryngeal Pathologies in a Treatment-Seeking Pediatric Population

The purpose of this study was to 1) describe the age- and sex-specific occurrence of laryngeal pathologies in a treatment-seeking pediatric population in the voice unit of Ghent University Hospital, Belgium, and 2) describe this population in terms of vocal parameters, vocal complaints, influencing factors, and treatment history and recommendation. Retrospective, observational study. All patient records were analyzed for children (0-18 years) who consulted the ear, nose, and throat department of Ghent University Hospital for the first time between July 2015 and June 2021 with complaints of dysphonia. In total, 103 children (66 males, 37 females) with a mean age of 10.01 years (SD: 3.4, range 3.93-17.96) were included in this study. Laryngeal pathology was diagnosed using a flexible videolaryngo(strobo)scopy. The influence of age and sex on laryngeal etiology (organic/functional voice disorder) was examined using a Welch-modified t test and a Fisher's exact test, respectively. Organic lesions were observed in 77.7% of the participants, with vocal fold nodules (VFNs) being the most common diagnosis (66.0%). A functional voice disorder was diagnosed in 22.3% of the children. Children with a functional voice disorder are significantly older than children with an organic voice disorder. There was no statistically significant difference between males and females in laryngeal etiology. Mean dysphonia severity index was -2.7 (SD: 3.2, range -9.3 to +3.7), the mean acoustic voice quality index 4.70 (SD: 1.5, range 2.35-8.27), and the mean pediatric voice handicap index 29.8 (SD: 13.6, range 5-60). The occurrence of vocal misuse was mentioned in 80.6% of the patient records. Organic voice disorders, especially VFNs, are predominant in treatment-seeking children with dysphonia. Functional voice disorders become more common with increasing age during childhood. A disordered vocal quality, reduced vocal capabilities and reduced voice-related quality of life were found.

Blue light laser recontouring for pediatric benign fibrovascular vocal fold lesions

Up to 40% of children with hoarseness due to benign fibrovascular vocal fold lesions do not respond to voice therapy and could benefit from further intervention to improve their communication abilities. Currently there are limited surgical options for children too young to comply with post-operative voice rest. We have begun using the 445 nm laser to recontour benign fibrovascular vocal fold lesions without post-operative voice rest in young children with hoarseness due to vocal fold nodules that is unresponsive to voice therapy. This report presents pilot data on the effect of this treatment on pediatric voice-related quality of life.Pediatric patients with benign fibrovascular lesions and severe subjective dysphonia (per parents or teachers) were given the option of undergoing surgery or continuing voice therapy. Those that opted for surgery underwent 445 nm laser recontouring of their vocal folds. They were discharged home the same day with no voice rest required. Pre- and post-demographic, acoustic measures, auditory perceptual assessments, and validated patient quality of life measures were collected.Four patients (ages 3-8y, all male) were selected for surgery. The mean pre- and post-op PVRQOL scores were 59.4 (range: 22.5-80) and 98.1 (range: 97.5-100), respectively (low scores suggest lower voice-related QOL), and a mean change of 38.8 (previously established minimum clinically important difference: 12). Pre- and post-acoustic and aerodynamic measures similarly reflected this improvement.This pilot case series addresses a commonly seen population (children with benign fibrovascular lesions and significant dysphonia despite voice therapy) where the best practice for timing and types of surgical intervention is unclear. Photoangiolytic lasers (including the 445 nm laser) are gaining popularity for the treatment of benign laryngeal pathologies, and their use may expand treatment possibilities for children with severe dysphonia due to benign vocal fold lesions that do not respond to voice therapy. Further longitudinal investigations are necessary to confirm the safety and efficacy.

Efficacy of the DoctorVox Voice Therapy Technique for the Management of Vocal Fold Nodules.

Vocal fold nodules (VFNs) are among the most common causes of dysphonia. Phono-laryngeal microsurgery, pharmacological treatments, and voice therapy (VT) have been used for treating VFNs. VT has been advocated as the primary treatment of choice. This study investigated the efficacy of the DoctorVox Voice therapy technique (DVT) for treating VFNs. A total of 38 patients with VFNs and 40 individuals without any voice problem (control group) were included. All patients received the DVT program. Otorhinolaryngology examination, videolaryngostroboscopy (VLS), and acoustic analysis (SPL, mean F0, jitter %, shimmer %, NHR) were performed at pretreatment, one and six months after the end of treatment. The voice handicap index-10 (VHI-10) and the GRB scales were used for perceptual voice evaluation. GRB and VLS scorings were done blindly. Compared with the pretreatment values, the first- and the sixth-month values after treatment demonstrated a significant decrease in VHI-10 (19.5 vs. 5.1), GRB (2.3 vs 0.68 for G value) and VLS scores, SPL (54.4 vs 66.1 dB), F0 (201 vs. 227 Hz), jitter % (1.46 vs 0.85), shimmer % (3.27 vs 2.51), NHR (1.15 vs. 0.46) values among patients. Most of the voice parameters in the sixth month after the DVT program did not differ significantly from those of the control group. The DVT was found to be an effective method in VFN treatment.

Incidental findings of bilateral vocal cord polyps and asymptomatic pulmonary embolism during EBUS-guided mediastinal staging: a case report highlighting teamwork in management decision making

We report on two significant incidental findings in a patient during the course of a routine Endobronchial ultrasound (EBUS) guided trans-bronchial needle aspiration (TBNA) procedure, namely smoking related bilateral vocal cord polyps, and pulmonary embolism. We discuss the sequence of events, the needed reassessment of risk/benefit analysis of the planned procedure and the rationale behind the decisions made as the case has evolved. Thoughtful stepwise approach to diagnosis and management through a real-time multidisciplinary collaboration resulted in a favorable outcome despite the complex medical scenario.

Application of Nursing Intervention Based on the Information-motivation-behavioral Model in Rehabilitation after Vocal Cord Polypectomy

Background: Vocal cord polyps are common benign lesions that cause voice disorders, particularly hoarseness, which can interfere with daily communication. Objectives: The present study aimed to determine the effect of applying a nursing intervention based on the information-motivation-behavioral (IMB) model on rehabilitation after vocal cord polypectomy. Methods: A total of 76 patients who underwent vocal cord polyp resection in Wuhu Second People's Hospital between January 2019 and September 2021 were selected by convenience sampling as the study participants. A random number table was used to assign the patients to two groups, an intervention group and a control group (n=38 in each group). Patients in the control group were given routine postoperative nursing, whereas those in the intervention group received an IMB-based nursing intervention based on that of the control group. The data collected regarding self-care ability, vocal cord recovery, and voice disorder severity of the two groups after surgery were compared in January and February. Results: The Exercise of Self-Care Agency scale scores of the intervention group were higher than those of the control group both one and two months after surgery, and the difference was statistically significant (97.1±26.1 vs. 84.6±19.8, 103.3±28.4 vs. 85.6±20.0, P&lt; 0.05), indicating the superior self-care ability of the intervention group. The Voice Handicap Index scores of the intervention group were lower than those of the control group both one and two months after the surgery, and the difference was statistically significant (35.8±9.2 vs. 39.8±13.9, 24.6±6.2 vs. 29.7±7.3, P&lt;0.05), indicating that voice disorder severity was lower in the intervention group than in the control group. Moreover, the effective rates (recovery and improvement) of the intervention group were higher than those of the control group one and two months after the surgery. Conclusion: As evidenced by the obtained results, nursing intervention based on the IMB model for patients who undergo vocal cord polyp resection can effectively improve self-care ability, reduce the severity of voice disorders, and promote the recovery of vocal cords.

Awake Intubation for Excision of Vocal Cord Polyp in an Antenatal Patient: A Case Report

Awake Intubation for Excision of Vocal Cord Polyp in an Antenatal Patient: A Case Report

Visual-perceptive assessment of glottic characteristics of vocal nodules by means of high-speed videoendoscopy

ObjectiveVisual-perceptive assessment of glottic characteristics of vocal nodules by means of high-speed videoendoscopy. MethodsDescriptive observational research with convenience sampling of five laryngeal videos of women with an average age of 25 years. The diagnosis of vocal nodules was defined by two otolaryngologists, with 100% intra-rater agreement and 53.40% inter-rater agreement and five otolaryngologists as judge assessed the laryngeal videos based on an adapted protocol. The statistical analysis calculated measures of central tendency and dispersion, as well as percentage. The AC1 coefficient was used for agreement analysis. ResultsIn high-speed videoendoscopy imaging, vocal nodules are characterized by amplitude of the mucosal wave and muco-undulatory movement with magnitude between 50% and 60%. Non-vibrating segments of vocal folds are scarce, and the glottal cycle does not show a predominant phase, it is symmetric and periodic. Glottal closure is characterized by the presence of a mid-posterior triangular chink (double chink or isolated mid-posterior triangular chink), without movement of supraglottic laryngeal structures, with irregular contour of the free edge of vocal folds, which are vertically on-plane. ConclusionVocal nodules present mid-posterior triangular chink and irregular free edge contour. Amplitude and mucosal wave were partially reduced. Level of evidenceLevel 4 (Case-series).

The effect of sound field amplification systems on vocal demand response in teachers during lessons

Purpose Sound pressure level (SPL), fundamental frequency (F0), time dose (Dt), cycle dose (Dc), and distance dose (Dd) are components affecting a vocal demand response. The study aimed to investigate the impact of sound field amplification systems (SFAS) on teachers’ vocal parameters and determine the user comfort of SFAS use in teachers. Methods Twenty female teachers underwent long-term voice dosimetry with Vocal Holter Med (PR.O.Voice Srl) during everyday teaching activities. The SFAS PentaClassRuna (Certes) was installed in classrooms. Voice dosimetry was provided in two different acoustical conditions—without the use of SFAS (one to two days) and with SFAS (one to three days). Teachers underwent voice acoustic and laryngoscopic evaluation before voice dosimetry. Two teachers’ groups were formed: teachers with and without vocal nodules. The visual analogue scale measured the user comfort of SFAS. Results There were no significant differences in vocal parameters and vocal doses between teachers with and without vocal nodules. Voice amplification significantly decreased average F 0(−4.4 Hz), Dt%(−3.1%), Dc (−0.4 kcycles), and Dd (−1.3 m) in teachers without vocal nodules and F 0 (−8.9 Hz) in teachers with vocal nodules. Vocal doses (Dt%, Dc, Dd) significantly decreased in classrooms with longer reverberation time. The user comfort of the SFAS during the lessons was high in both teachers groups. Conclusions SFAS was a mediator between the classroom’s environment and the teacher’s vocal demand response; it changed teachers’ voice production parameters and reduced vocal demand response to satisfy the communication requirements. In addition, voice amplification was more beneficial for teachers without vocal fold lesions.

Efficacy of straw phonation exercises with breathing exercises and indirect approaches for dysphonic adults with benign vocal fold lesions

Background: The voice is essential to a people’s daily life, especially in occupational voice users who are at risk for benign vocal fold lesions. It is important to use the proper vocal therapy techniques on a dysphonic patient who has benign vocal fold lesions in order to reduce behaviors that will aggravate the voice disorder and enhance behaviors that help improve voice quality. Objectives: The purpose of this study was to evaluate the efficacy of straw phonation exercises with breathing exercises and indirect approaches in dysphonic adults with benign vocal fold lesions, including vocal nodules; vocal polyps, and vocal cysts. Materials and methods: This study was a pilot study. Twelve participants who had benign vocal fold lesions received vocal hygiene guidance, abdominal breathing exercises, muscle relaxation, and straw phonation voice therapy. All participants received 8 weekly therapy sessions: 30 minutes per session. The vocal assessment data was collected before the first voice therapy session, and immediately after the eighth session, by subjective vocal assessment, and objective vocal assessment with Dr. Speech software version 5. Results: The results after therapy showed significant improvements against the GIRBAS scales in terms of the subjective vocal assessment, in the values of SD F0, jitter, NNE, and MPT of the objective vocal assessment. Conclusion: This result indicates straw phonation with breathing exercises and indirect approaches as being a worthwhile alternative method for voice therapy in dysphonic patients with benign vocal fold lesions.

Efficacy of straw phonation exercises with breathing exercises and indirect approaches for dysphonic adults with benign vocal fold lesions

Background: The voice is essential to a people’s daily life, especially in occupational voice users who are at risk for benign vocal fold lesions. It is important to use the proper vocal therapy techniques on a dysphonic patient who has benign vocal fold lesions in order to reduce behaviors that will aggravate the voice disorder and enhance behaviors that help improve voice quality. Objectives: The purpose of this study was to evaluate the efficacy of straw phonation exercises with breathing exercises and indirect approaches in dysphonic adults with benign vocal fold lesions, including vocal nodules; vocal polyps, and vocal cysts. Materials and methods: This study was a pilot study. Twelve participants who had benign vocal fold lesions received vocal hygiene guidance, abdominal breathing exercises, muscle relaxation, and straw phonation voice therapy. All participants received 8 weekly therapy sessions: 30 minutes per session. The vocal assessment data was collected before the first voice therapy session, and immediately after the eighth session, by subjective vocal assessment, and objective vocal assessment with Dr. Speech software version 5. Results: The results after therapy showed significant improvements against the GIRBAS scales in terms of the subjective vocal assessment, in the values of SD F0, jitter, NNE, and MPT of the objective vocal assessment. Conclusion: This result indicates straw phonation with breathing exercises and indirect approaches as being a worthwhile alternative method for voice therapy in dysphonic patients with benign vocal fold lesions.

Preliminary analysis of the effect of individualized voice therapy on pediatric voice disorders

Objective:To determine the effectiveness of individualized voice therapy in persistent pediatric voice disorders. Methods:Thirty-eight children who were admitted to the Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University due to persistent voice disorder from November 2021 to October 2022 were included. All children were evaluated by dynamic laryngoscopy before voice therapy. Two voice doctors performed GRBAS score and acoustic analysis on the children's voice samples to obtain the relevant parameters including F0, Jitter, Shimmer, and MPT; All children were given personalized voice therapy for 8 weeks. Results:Among 38 children with voice disorders, 75.8%（29 cases） were diagnosed with vocal nodules, 20.6%（8 cases） were vocal polyps, and 3.4%（1 case） were vocal cysts. And in all children. And 51.7%（20 cases） had the sign of supraglottic extrusion under dynamic laryngoscopy. GRBAS scores decreased from 1.93 ± 0.62, 1.82 ± 0.55, 0.98 ± 0.54, 0.65 ± 0.48, 1.05 ± 0.52 to 0.62 ± 0.60, 0.58 ± 0.53, 0.32 ± 0.40, 0.22 ± 0.36, 0.37 ± 0.36. F0, Jitter, Shimmer decreased from（243.11±39.73） Hz, （0.85±0.99）%, （9.96±3.78）% to（225.43±43.20） Hz, （0.33±0.57）%, （7.72±4.32）%, respectively MPT was prolonged from（5.82±2.30） s to（7.87±3.21） s after treatment. All parameters changes had statistical significance. Conclusion:Voice therapy can solve children's voice problems, improve their voice quality and effectively treat children's voice disorders.