Vocal Nodules Research Articles

Benign Vocal Fold Lesions in Patients with Chronic Cough.

The objective of this study was to determine the prevalence of benign vocal fold lesions (BVFLs) in patients with chronic cough over a 1-year period. Case series with chart review. Tertiary academic medical center. A retrospective cohort study of patients with chronic cough seen in our tertiary multidisciplinary cough clinic from 2016 to 2017 was conducted. Patient characteristics, presence of BVFLs by laryngoscopy, and Leicester Cough Questionnaire (LCQ) were recorded. A total of 419 patients were included (average age: 61 years), and 67% of patients were female. Ten percent of patients had BVFLs: granuloma (5%), leukoplakia (3%), nodules (2%), and polyps (1%). Median cough duration was 2.9 years (interquartile range [IQR], 0.7-8.5); no significant difference in median cough duration was observed between patients with BVFLs and those with no lesions (2.6 vs 3.0 years, P = .86). In total, 178 patients (42%) had available LCQ data: median score of 10.2 (IQR, 7.9-13.9); no significant difference in median LCQ was observed between patients with BVFLs and those with no lesions (10.5 vs 10.1, P = .54). Prevalence of BVFLs in our cohort of patients with chronic cough was 10%, with posterior glottic lesions-granuloma-being the most common (5%). Prevalence of midmembranous lesions was as follows: vocal fold nodules (2%) and vocal fold polyps (1%). BVFLs were not associated with longer cough duration or more severe cough. We cannot determine a causative or noncausative relationship between BVFLs and chronic cough at this time due to lack of a control group.

Role of videolaryngoscopy in patients with hoarseness of voice

Introduction: Hoarseness is roughness of voice resulting from variations of periodicity or intensity of consecutive sound waves. Hoarseness is a symptom, not a disease per se therefore warrants a careful determination of the underlying cause in every case. Videolaryngoscopy is a very useful and effective method of evaluation and documentation of pathological conditions of the larynx. Aims and Objectives: The aim of the study is to evaluate the diagnostic value of videolaryngoscopy in laryngeal pathologies. Materials and Methods: An observational cross sectional study was carried out in the Department of ENT, tertiary level care Hospital, Ghaziabad, Uttar Pradesh. 106 patients presenting with hoarseness were included. All the patients were thoroughly evaluated and analyzed using video laryngoscopy. Result: Among 106 cases, age ranged between 12 and 80, 47 (44.4%) were males, largest group of patients were labourer / farmer (33%) followed by housewives (30%). In males, largest group was of labourer/farmer (54.10%). Vocal abuse was the most common predisposing factors in 30% of hoarseness. Other factors in descending order were smoking (26%), upper respiratory tract infection, and alcohol (10%), tobacco chewing (5%). It was found 76% patients had single risk factor, 20 % had two and 4% patients had multiple predisposing factors. Conclusion: A good videolaryngoscopy is a definitive investigation tool where stroboscopy cannot be done. It can provide accurate diagnosis in many laryngeal pathologies. Seeing is believing. Another useful advantage of videolaryngoscopy is that the patients are able to see the pathology which helps in their counselling and better compliance of patients is seen. Keywords: Hoarseness, Videolaryngoscopy, Vocal cord, Stroboscopy, Vocal nodule.

Laryngeal polyp associated with reflux disease: a\xa0case report

BackgroundAmong the most common benign laryngeal lesions are vocal nodules and polyps. Their etiology is related to vocal abuse. Gastroesophageal reflux disease is a common condition presenting with a broad spectrum of symptoms, among which are extraesophageal manifestations such as laryngeal polyps.Case presentationA 24-year-old Middle Eastern woman presented to the author’s institution with dysphonia and dyspepsia. She underwent endoscopy and was diagnosed with severe reflux disease. In addition, laryngoscopy revealed a polyp at the left vocal cord, and the patient underwent polypectomy. Histopathological examination revealed a laryngeal polyp of telangiectatic type characterized by hyperplastic epithelial covering with reactive atypia, prominent superficial acanthosis with neutrophils, and prominent chronic inflammation and thrombosed vessels in the stroma.ConclusionThis report focuses on the pathological findings associated with a laryngeal polyp in a young patient diagnosed with severe reflux disease. Acknowledging such characteristic changes in a laryngeal polyp could aid in the diagnosis of gastroesophageal reflux disease.

Voice Therapy for a Patient with Systemic Lupus Erythematosus Presenting Bamboo Nodes and Vocal Fold Nodules

Voice Therapy for a Patient with Systemic Lupus Erythematosus Presenting Bamboo Nodes and Vocal Fold Nodules

Experience with the management of pediatric laryngopharyngeal reflux in an Indian teaching hospital

Aim: Laryngopharyngeal reflux (LPR) is the retrograde flow of gastric content to the larynx and pharynx where these materials come in contact to the upper aerodigestive tract. This clinical entity is less studied among the pediatric population. The objective of this study is to evaluate the impact of LPR in the pediatric population. Materials and Methods: This retrospective study was done in between December 2016 and January 2019. Clinical data such as associated symptoms, endoscopic findings, laboratory testing, therapeutic interventions, and outcome were analyzed. Endoscopic findings were considered to be consistent with LPR in the pediatric age included: Lingual tonsil hypertrophy, postglottic edema, true vocal fold edema and congested and swollen arytenoids, congested inter-arytenoids area. Results: There were 212 children evaluated for dysphonia. There were 38 girls (52.77) and 34 boys (47.22%), and mean age at presentation was 9.32 years with a male-to-female ratio of 0.89:1. Out of 212 children who underwent endoscopy, 72 had shown LPR disease. Five children (6.94%) showed vocal nodules, 3 (4.16%) showed vocal fold cyst, and 2 (2.77%) children showed subglottic edema along with LPR. All the children were treated with anti-reflux measures. By second follow-up visit on 1 month, 68 children (94.44%) had improved symptomatically. Conclusion: LPR appears to cause laryngeal manifestations more commonly in children. In this study, all the children were presenting dysphonia, intermittent cough, foreign-body sensation in throat, and throat-clearing habit. All of them showing congested arytenoids and inter-arytenoid membrane. Early diagnosis and treatment often result in the improvement of hoarseness of voice and prevent complications. LPR in the pediatric population is almost a new diagnosis.

Changes in Nodal Lesions and Vocal Function after Voice Therapy for Vocal Nodules

Changes in Nodal Lesions and Vocal Function after Voice Therapy for Vocal Nodules

Clinical Application of Botulinum Toxin to Contact Granuloma and Vocal Nodule

Clinical Application of Botulinum Toxin to Contact Granuloma and Vocal Nodule

Effects of Vocal Intensity and Fundamental Frequency on Cepstral Peak Prominence in Patients with Voice Disorders and Vocally Healthy Controls

Cepstrum-based voice measures, such as smoothed cepstral peak prominence (CPPS), are influenced by voice sound pressure level (SPL) in vocally healthy adults. Since it is unclear if similar effects hold in voice disordered adults and how these interact with natural fundamental frequency (fo) changes, this study examines voice SPL and fo effects on CPPS in women with vocal hyperfunction and vocally healthy controls. Retrospective matched case-control study. Fifty-eight women with vocal hyperfunction were individually matched with 58 vocally healthy women for occupation and approximate age. The patient group comprised women exhibiting phonotraumatic vocal hyperfunction associated with vocal fold nodules (n=39) or polyps (n=5), and nonphonotraumatic vocal hyperfunction associated with primary muscle tension dysphonia (n=14). All participants sustained the vowel /a/ at soft, comfortable, and loud loudness conditions. Voice SPL, fo, and CPPS (dB) were computed from acoustic voice recordings using Praat. The effects of loudness condition, measured voice SPL, and fo on CPPS were assessed with linear mixed models. Pairwise correlations among voice SPL, fo, and CPPS were assessed using multiple regression analysis. Increasing voice SPL correlated significantly (P < 0.001) with higher CPPS in both patient (r2=0.53) and normative groups (r2=0.45). fo had statistically significant effects on CPPS (P < 0.001), but with a weak relation for the patient (r2=0.02) and control groups (r2=0.05). In women with and without voice disorder, CPPS is highly affected by the individual's voice SPL in vowel phonation. Future studies could investigate how these effects should be controlled for to improve the diagnostic value of acoustic-based cepstral measures.

The effect of Bombyx mori larvae extract in reducing the toxicity of methotrexate in pregnant female albino rats

Methotrexate (MTX) is an anticancer agent which is used alone or in combination with other anticancer agents in the treatment of breast cancer, epidermoid cancers of the head and neck, cutaneous T cell lymphoma, and lung cancer. Bombyx mori larvae have a huge value as health food especially for cardiac and diabetic patients, bronchial asthma, primary trigeminal neuralgia, vocal nodules and polyps and in the treatment of facial palsy and pain. In the present study meeting occurred under the normal conditions and about 40 pregnant female rats were used. Herein the pregnant females will be divided into five groups; group 1 will be used as negative control received distilled water, group 2 will used as positive control and recived buffer of Bombyx mori larvae extract, group 3 was treated with MTX at the 12th day of gestation (at organogenesis phase), group 4 was treated with Bombyx mori larvae extract at 7th , 9th , 11th ,13th and 15th days of gestation (during the oraganogensis period), &amp; group 5 was injected by MTX the 12th day of gestation as well as bombyx mori larvae extract at 7th ,9th ,11th ,13th &amp;15th days of gestation. Animals of all groups will be sacrificed at 20th day, the end of gestation periods. Then livers of all pregnant rats were removed for examination. The obtained results showed decrease in maternal body weight gain plus increase in the abortion rate and uterine weight in the MTX-treated group. In addition, MTX induced an elevation in the examined liver oxidative stress biomarkers plus myeloperoxidase activity and decrease in reduced glutathione content and catalase activity; in mothers. Histopathological studies of liver tissues showed congestion of central vein of mothers in MTX group showing ballooning degeneration of hepatocytes, perivascular inflammatory cells infiltration and strong deposition of collagen fibers. Noteworthy, Bombyx mori larvae induced marked improvement in injuries associated with MTX administration.&#x0D; Keywords: Methotrexate, Bombyx mori larvae, Pregnant female rats, Hepatotoxicity.

Application of ultrasonography in etiologic judgment of hoarseness after thyroidecomy

Objective:To explore the application value of ultrasound in etiologic judgement of hoarseness after thyroidecomy. Method:Sixty-three cases of hoarseness after thyroidecomy were examed by laryngeal ultrasonography. Vocal cord, arytenoid cartilage, pyriform fossa, thyroid operation area and recurrent laryngeal nerve pathway were evaluated. Regard electronic laryngoscope results as gold standard and compare the differences between the two methods. Result:Sixty-three patients were detected by ultrasound, then, 29 cases were diagnosed with left vocal cord paralysis, 24 cases with right vocal cord paralysis, 2 cases with bilateral vocal cord paralysis, 1 case with right vocal cord polyp, 3 cases with left vocal cord polyp, 1 case with renke layer edema, and 3 cases has normal laryngeal imaging. The accuracy of ultrasonography in determining the etiology of hoarseness after thyroidecomy is 92.1%, the sensitivity is 93.3%, and the specificity is 66.7%. Conclusion:The ultrasonography can not only show laryngeal structures, but also display thyroid operation area and recurrent laryngeal nerve pathway. Moreover, as an non-invasive method, ultrasonography has high accuracy in etiologic judgement of hoarseness after thyroidecomy and certain clinical application values.

RZADKI PRZYPADEK PÓŹNO ROZPOZNANEGO ZESPOŁU WYDŁUŻONEGO WYROSTKA RYLCOWATEGO

BackgroundEagle's syndrome comes from the name of the American otolaryngologist – Watt Weems Eagle, who in 1937 was the first to distinguish a separate disease entity for symptoms associated with excessive elongation of the styloid process of the temporal bone.Case reportA 42-year old patient was admitted to the Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics in November 2018, in a planned mode, with persistent throat pain radiating to the right ear, right side head pain, tongue numbness and hoarseness. Symptoms of variable severity maintained for about 9 years, which is why the patient underwent bilateral tonsillectomy in October 2016. Due to persistent hoarseness, the patient was also qualified for micro-direct laryngoscopy with the removal of vocal cord nodules, the procedure was performed in March 2017. Despite the surgical treatment, the pain persisted. On the basis of the medical history, clinical observation, after analyzing the results of the tests with particular consideration of the neck CT scan with 3D reconstruction, the patient was diagnosed with right-sided Eagle's syndrome. The patient was qualified for surgery under general endotracheal anesthesia. In November 2018 partial resection of the right elongated styloid process was performed using an intraoral approach. After wound healing the patient reported complete pain relief.ConclusionsThe elongated styloid process syndrome is most frequently a diagnosis of exclusion. Lack of proper diagnosis often delays significantly the implementation of proper management and thus exposes patients to long-term struggle with pain. If non-specific throat pain persists, the Eagle’s syndrome should always be considered, which can be treated effectively.

Observation on nursing effect of nebulization inhalation in patients with vocal cord polypectomy under tracheal intubation and general anesthesia

Objective To observe the nursing effect of 2% lidocaine and dexamethasone mixture in patients with vocal polyp extirpation under tracheal intubation. Methods From September 2017 to March 2018, 68 patients who were selected to perform vocal cord polyp resection under supportive laryngoscope in the hospital were randomly divided into 4 ml of 2% lidocaine before surgery and 2 ml of 0.5% dexamethasone after atomization inhalation with tracheal intubation under general anesthesia (observation group) and conventional tracheal intubation with general anesthesia (control group), 34 cases of each group.The hemodynamic indexes of endotracheal intubation and operation , the Self-rating Anxiety Scale (SAS) of Ricker at trachea extubation, BCS comfort score and wake time 15 minutes after endotracheal tube extubation were observed. Results The hemodynamics of the observation group was more stable than that of the control group, and the difference was statistically significant(P 0.05). Conclusions The atomization inhalation of 2% lidocaine 4ml and 0.5% dexamethasone mixture before operation as an important preventive nursing intervention can reduce the hemodynamic fluctuation and improve the postoperative comfort. Key words: Atomization inhalation; Nursing effect; Vocal cord polyp extirpation; Lidocaine; Dexamethasone

Surgery for vascular laryngeal lesions

Vascular lesions of the larynx are those created by phonotrauma resulting in subepithelial bleeding. These are typically divided into 2 categories, hemorrhagic polyps and fibrovascular lesions (vocal nodules). Both of these types of lesions can disrupt the natural vibration of the vocal folds and cause dysphonia. In those patients whose voices are their livelihood, complete removal with preservation of as much normal superficial lamina propria and squamous epithelium is paramount. Here, we describe proper in office assessment with stroboscopy, options for treatment, and techniques in surgical excision.

Impact of Remnant Nodules on Immediate and Long-term Outcomes of Voice Therapy for Vocal Fold Nodules

In this study, we aimed to assess whether remnant vocal fold nodules (VFN) influence immediate and long-term voice outcomes after voice therapy. This is a retrospective cohort study evaluating immediate and long-term voice outcomes. Twenty-five adult patients with VFN who completed voice therapy were included in this study. Patients were classified into remnant (n = 18) and nonremnant (n = 7) groups according to the presence of remnant nodules immediately after completion of voice therapy. Acoustic and perceptual parameters, as well as voice handicap index (VHI), were compared between groups immediately (immediate outcome) and more than 3 months (long-term outcome) after completion of voice therapy. Immediately after voice therapy, there were no significant differences between groups in grade-roughness-breathiness-asthenia-strain (GRBAS) score, jitter, shimmer, noise-to-harmonics ratio, voice range profile, or s/z ratio. Postvoice therapy VHI scores did not significantly differ between the two groups (9.29 ± 8.94 in the nonremnant group vs. 12.78 ± 9.01 in the remnant group, P = 0.392). The overall GRBAS grade of all patients was maintained at 0 or 1 during long-term follow-up. There was no significant difference between the long-term VHI scores of the remnant group (10.00 ± 8.58) and the nonremnant group (5.67 ± 8.71) (P = 0.306). Immediately after voice therapy, perceptual scores, acoustic parameters, and VHI scores all significantly improved regardless of presence of remnant nodules. Favorable outcomes of voice therapy were maintained during long-term follow-up regardless of presence of remnant nodules after voice therapy.

A clinical study on etiopathogenesis of hoarseness of voice

PURPOSE: To analyse the clinical profile of hoarseness of voice and to find out the common etiological factors and associated pre disposing factors. METHODS : 100 patients with hoarseness of voice were selected for the study based upon the inclusion and exclusion criteria. A thorough clinical history along with examination with indirect and video laryngoscopy, if necessary with direct laryngoscopy with /without biopsy were performed. Histo-pathological examination was performed for the needful. DISCUSSION: In our present study incidence of hoarseness voice was 0.27 % of total ENT cases. Maximum number of cases (31%) were in the age group of 41-50 years, among males common age groups was 41-50 years and among females is 31-40 years of age group. Hoarseness was commonly found in labourer class (48%). Both among males and females this was commonest group. Lower socio economic group was commonly noted among patients (40.00%), also both in males and females. Majority patients were from rural area (59%). Smoking was commonly encountered substance abuse among males (30.00%) and no substance abuse among females. Along with hoarseness (100%) other symptom with which patient presented were dysphagia (25%), neck swelling (14%), dry cough (10%), foreign body sensation in throat (10%), stridor (5%) and Hemoptysis (5%). Maximum number of patients presented with hoarseness of voice with duration of <1 month. On indirect laryngoscopic examination commonest finding was ulcero proliferative growth (33.33%).Indirect laryngoscopic examination done in 97% and video laryngoscopic examination in 41%. Among 73% patients of histo-pathological studies, commonest finding was squamous cell carcinoma (45.2%). Laryngeal malignancy was the commonest cause of hoarseness of voice (33%) and males were commonly affected. Smoking was noted in all male patients with malignancy (80%), along with alcohol consumption in 70% and chewing tobacco preparation in 65% of cases. Vocal cord nodules were found in 22% of patient and was the second most common disease with male to female ratio 1:2. Vocal cord palsy was found in 15% of cases and was common in females (29%). Chronic laryngitis and GERD was found in 10% and was found in 23% among males and 18% among females, with male to female ratio 1:1. Tuberculosis was found in 8%, all cases were males, with pulmonary tuberculosis. Vocal cord papilloma presented in 5% of cases and females were commonly affected (66%) with male to female ration 1:2. Vocal fold polyp was found in 3% of cases, each one in male (33%) and two in female (67%). Vocal cord cyst was presented in 2% of cases. Two cases (2%) presented with laryngeal trauma. CONCLUSION: Thus from this study, we conclude that, the symptom of hoarseness of voice should never be ignored as it is the most common symptom in laryngeal malignancy. Any patient with hoarseness should be thoroughly investigated to rule out malignant conditions and conditions that might cause respiratory distress leading to life threatening complications.

Hispanic Ethnicity as a Predictor of Voice Therapy Adherence

Voice therapy is a well-studied, evidence-based treatment in the management of voice disorders, yet it is known that adherence rates are generally decreased due to a variety of identified factors. In light of this fact, a high rate of nonadherence to voice therapy has been anecdotally observed in the Hispanic community comprising a sizable portion of the patient population in South Florida. We sought to analyze the rates of voice therapy attendance for patients who underwent treatment for benign vocal fold nodules at a single tertiary-care academic medical center. Based on our anecdotal observations, we hypothesized that Hispanic patients would have a significantly lower rate of voice therapy attendance compared to non-Hispanic patients. Retrospective cohort study. A retrospective chart review was performed for Hispanic and non-Hispanic patients aged 18 years and older who were diagnosed in a single hospital-based otolaryngology department with benign vocal fold nodules between 2013 and 2018. Patients with other glottic pathology or those who were not recommended voice therapy as initial treatment were excluded. Demographic data, including ethnicity, home address, and preferred language by self-report (English vs. Spanish), were obtained and analyzed. Median income levels for patients were determined by postal codes. "Adherent" status was given to patients who attended at least one voice therapy session. Statistical comparisons of continuous quantitative variables were made using Student's t test, ordinal quantitative variables using Mann-Whitney U test, and categorical variables using Fischer's exact test. Statistical significance was determined as P < 0.05. One hundred eleven patients met inclusion criteria. The population was 85% female, with an average age of 41 years. Overall voice therapy adherence rate was 68%. Forty-eight percent of patients self-identified as Hispanic, and of this cohort, 42% spoke Spanish as a preferred language. Differences in annual income levels were noted between non-Hispanic and Hispanic patients ($61,799 vs. $51,697, P = 0.017), as well between English-preferring and Spanish-preferring patients ($60,276 vs. $43,504, P = 0.0014). Thirty of 53 (57%) of Hispanic patients were adherent to voice therapy, compared to 45 of 58 (78%) non-Hispanic patients (P = 0.025). No significant differences were found in age, Voice Handicap Index-10 score, or number of sessions attended between the therapy-adherent patients in the Hispanic and non-Hispanic groups. Further differences in adherence rates were noted when the Hispanic group was subclassified into English and Spanish language preferences. Fifteen of 31 (48%) English-preferring Hispanic patients attended voice therapy compared to 45 of 58 (78%) non-Hispanic patients (P = 0.0085), while Spanish-preferring Hispanic patients had a 68% therapy adherence rate (15 of 22, P = 0.4). English-preferring Hispanic patients had higher average Voice Handicap Index-10 (22.0 vs. 14.9, P = 0.018) and lower total attended sessions (2 vs. 3.6, P = 0.024) than their non-Hispanic counterparts. We believe this is the first study demonstrating a significantly lower rate of voice therapy adherence in Hispanic versus non-Hispanic patients. Decreased utilization of a proven treatment strategy for vocal fold nodules puts these patients at increased risk of treatment failure and decreased voice-related quality of life. Clinicians must be aware of ethnicity-based healthcare disparities and encourage proven treatment adherence to ensure highest quality of life.

Prevalence of Voice Disorders in Primary Level School Teachers of Nepal: A Pilot Study

Introduction: Among professional voice users teachers are found to be at an exceptionally high risk of developing voice problems because of stress inherent in their occupation and the environmental conditions in which they work. In this pilot study conducted in the Terai region of Nepal we determine the prevalence of voice disorders in primary level school teachers and aetiological factors associated with it. Subjects and Methods: One hundred and thirty-seven teachers of primary level Government school of Morang district, Nepal irrespective of age and sex were enrolled in this study from December 2015 to November 2016 in the Department of Otorhinolaryngology and Head and Neck, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. All were subjected to detail history, clinical examination including indirect laryngoscopy(IL) and flexible nasopharyngolaryngoscopy(NPL). Informed consent and ethical clearance was taken from the ethical board. Observation: Out of 137 teachers included in study the sex, age, teaching experience, materials used in classroom, noise, habits of teachers were studied in regards to prevalence of voice disorder and vocal nodule. Prevalence of voice disorders was (47%) and vocal nodule was (12%). There was strong statistical significance with gender, teaching experience, tobacco use and noise in class room with P value of &lt; 0.05. Whereas increasing age of teachers has weak relation but significant P = 0.049. Conclusion: This study shows a high prevalence of voice disorders among teachers. There are various risk factors which are associated with it, some are non-modifiable such as age, gender. Some are modifiable such as tobacco use, noise in class-room and teaching duration.

Self-Assessment of Vocal Fatigue in Muscle Tension Dysphonia and Vocal Nodules: A Preliminary Analysis of the Discriminatory Potential of the Croatian Adaptation of the Vocal Fatigue Index (VFI-C)

In this paper the authors hypothesize that the intensity of subjective experience of vocal fatigue (VF) potentially reflects primary (hyper) functional vocal disorders (primary muscle tension dysphonia - MTD) differently than structural vocal disorders of functional etiology (MTD type 2a). Given the reported benefit of self-evaluation in the quantification of VF, the goal of this study was to test the potential of the Croatian adaptation of the Vocal Fatigue Index questionnaire (VFI-C) in order to show different VF intensities for the two above-mentioned diagnoses of vocal disorders. In total, 69 vocal nonprofessionals of both sexes (average age 41.5 years, ±13.8 years), with phoniatrically determined vocal disorders of varying etiology and 50 vocal nonprofessionals of both sexes without vocal disorders (average age 44 years, ±14.7 years), recruited at otorhinolaryngological clinics at medical centers in Zagreb and Split, completed the VFI-C. Psychometric characteristics of the VFI-C were determined by calculating Cronbach's alpha and the intraclass correlation coefficient , and by employing factor analysis, and the nonparametrical Mann-Whitney U test. Considering the favorable psychometric data, a descriptive analysis of the VF self-evaluation results was done for groups of participants with MTD diagnoses (10 people with an average age of 33.4, ±5.9 years) and vocal nodules ( 21 people with an average age of 37.3, ±12.8 years). A comparison was made of the average results of the MTD and vocal nodules groups using the nonparametric Mann-Whitney U test. Given that perceived VF was found to be greater in the MTD group, it appears that the self-evaluation of VF has a discriminatory potential for different vocal difficulties, which justifies the further verification of the complementary usefulness of VF gradation in clinical descriptions of different vocal disorders.

The application of parental version of pediatric voice-related quality of life in children with voice disorders

Objective:To evaluate the influence of voice disorders on children's quality of life through the parental version of pediatric voice-related quality of life（pVRQOL）. Method:Three hundred and eighty-six children from August 2017 to December 2018 were enrolled in this study. A total of 214 parents of children had voice disorders（dysphonic group）, and 172 parents of children were without voice disorders（control group）. Both groups were filled out the questionnaire containing the parental version of pVRQOL. Result:① The most common disease in children with voice disorder was vocal fold nodule, and boys were more susceptible to voice disorder than girls（71.5%, 28.5%）; ②In dysphonic group, the scores of total（91.40±8.63, 97.94±4.23）, physiology and function（87.55±10.98, 96.99±6.10）, social emotion（98.86 ±3.29, 99.73±1.08） were lower than those in control group（P<0.01）; ③In dysphonic group, there was a correlation between the parents' overall evaluation of the children's voice quality and the three dimensions of the parental version of pVRQOL（total: r=-0.398, P<0.01, physical function: r=-0.448, P<0.01, social-emotion: r=-0.125, P<0.05）. Conclusion:Voice disorders could cause a negative impact on children's voice related quality of life. pVRQOL could be applied to assess the voice-related quality of life in children with voice disorders.

Laryngeal Microsurgery for the Treatment of Vocal Nodules and Cysts in Dysphonic Children

Introduction: Vocal nodules and cysts are frequent causes of infantile dysphonia. Vocal therapy is the first treatment. Microsurgery has restricted indications, especially for nodules. Objective: To describe our experience with microsurgery for nodules and cysts in children. Methods: Dysphonic children (aged 4–18 years) with the diagnosis of nodules and vocal cysts were initially selected. Of these children, only those were included who had undergone microsurgery. For nodules and cysts, the microsurgery was indicated in cases of failure of vocal therapy and in cases of voice worsening or doubts about the diagnosis. All children were submitted to auditory perceptual vocal analysis and videolaryngostroboscopy (before and after surgery, after 6 months). Surgical outcomes were: total improvement (disappearance of vocal symptoms and of the laryngeal lesions); partial improvement (partial improvement of symptoms and/or maintenance of lesions); no improvement (maintenance or worsening of the symptoms and/or persistence of the lesions). ­Results: There were 78 children with vocal nodules and 27 children with vocal cysts. Surgery was indicated for 12 children with vocal nodules (15.4%) and 12 children with cysts (44.4%). Total improvement registered for nodules and cysts was 75 and 83.4%, respectively. Partial improvement for both lesions was 25 and 16.6%, respectively. Conclusion: The best outcome for laryngeal microsurgery in dysphonic children was for vocal cysts. So, we encourage laryngologists for this conduct in vocal cysts. The success of microsurgery for vocal nodules was lower, and in these cases voice therapy seems to be the best treatment.