Vocal Nodules Research Articles

Coverage and Coding for Transgender Voice Treatment

Coverage and Coding for Transgender Voice Treatment

The Unheard Female Voice

The Unheard Female Voice

A rare case report: Ayurvedic management of vocal cord nodules

Vocal nodules are the consequence of functional voice disorders, which are also caused by vocal abuse or misuse. An increased vocal load, for example, due to the patient's profession, demands high-volume speech for the formation of nodules. In the present case report, a 26-year-old female patient acquired this disease followed by common cold cough. Her problems were aggravating by high-volume speech and getting fatigability also. This patient was given Anutaila Nasya with Sitopaladi Churna, Naradiya Laxmi vilasa Rasa, Yashtimadhu Ghanvati (for chewing), and Dashmoola Kwatha(Kavala). The patient was advised for strict voice rest and steam inhalation for better result. After 1 month of treatment, the patient got relief from all her complaints and gained normal voice. On examination, it was found that vocal nodules disappeared in direct laryngoscopy. Hence, this single case report shows that ayurvedic management of vocal cord nodules gives excellent result and improves patients' quality of voice.

Relation of RBH Auditory-Perceptual Scale to Acoustic and Electroglottographic Voice Analysis in Children With Vocal Nodules

The aim of this paper was to present an analysis of the feasibility of voice quality prediction on the roughness, breathiness, hoarseness (RBH) scale for children with vocal nodules on the basis of both acoustic parameters and electroglottographic (EGG) examination. The first step to achieve this goal involved the creation of a dedicated database, Voice Pathology Analysis Database (VPADB), containing voice recordings from patients, the EGG signal, medical diagnosis, and the classification of voice quality on the above-mentioned scale. The database also contains data concerning the patients' age and sex. The next step involved performing statistical analyses to test the relationship between the values of objective parameters, such as peak slope and normalized amplitude quotient, and the classification of voice quality. The study made use of voice recordings of 57 patients with vocal nodules and 37 healthy individuals. The RBH classification was carried out by two independent voice specialists. It was found that speech signal parameters can be used to predict expert evaluation with regard to roughness and hoarseness.

Resolution of vocal cord nodules with individualised homoeopathic treatment

Vocal Cord Nodules (VCNs) are localised benign, superficial growths on the medial surface of the true vocal folds resulting primarily from voice abuse, overuse or misuse and clinically manifested by progressive hoarseness of voice, with increased effort required to produce the voice, vocal fatigue and discomfort or pain in the throat. Conventional treatment methods include conservative voice therapy and surgical intervention. Both treatment methods are required for the resolution of VCNs with improvement of clinical symptoms. Here, a 44-year-old male teacher presented with a history of progressive hoarseness with vocal fatigue, discomfort in the throat during talking and bilateral VCNs since 8 months. There was no improvement after voice rest and voice therapy interventions for 5 months and he was finally advised for surgery, which he denied. He was, instead, successfully treated by individualised homoeopathic single medicine Hepar sulphuricum (30C, 200C and 1M) selected on holistic approach. Over the period of 5 months of homoeopathic treatment, the patient's presenting symptoms of VCNs were improved and with resolution of it. This case report suggests that homoeopathic intervention may be the treatment for the resolution of VCNs with its presenting symptoms.

Configuração acústico-articulatória das vogais de mulheres com nódulos vocais e vocalmente saudáveis

To analyze the acoustic-articulatory configuration of vowels in women with vocal nodules and with healthy voice. Twelve women with vocal nodules (EG) and twelve vocally health women (CG) participated of this study. All women recorded vehicle phrases with the vowels /a/, /i/, and /u/ in stress position, preceded and followed by the occlusive consonant /p/: "Digo papa baixinho", "Digo pipa baixinho", and "Digo pupa baixinho". Subsequently, the first three formants (F1, F2, and F3) were extracted from these vowel targets. Between the two groups studied, F1 measures differed for vowels /a/ and /u/, and F2 measures differed for the vowel /a/. Women with vocal nodules showed lower values for these measures compared to vocally healthy women. Patients with vocal nodules showed a smaller interval in F1 and F2 values between vowels /a/, /i/, and /u/ compared to vocally healthy women. Women with vocal nodules show lower F1 and F2 values and lower range of motion of the articulators during vowel production compared to vocally healthy women.

Etiopathogenetic treatment of professional singers with vocal nodules

The article deals with optimization of treatment policy for professional singers. The survey sample is 67 singers with vocal nodules of the age from 24 to 42 and the length of time worked from 3 to 28 years. The following methods are used: questionnaire survey (professional anamnesis, voice evaluation according to Visual Analog Scale (VAS), Spielberg-Hanin test), microlaryngoscopy, video endolaringostroboscopy, voice acoustic analysis (MDVP Kay Pentax system). The algorithm and evaluation criteria of vocal nodules treatment efficiency for the singers taking into account the specific character of their professional activity are proposed.

Клинико-диагностический алгоритм работы врача-оториноларинголога с профессионалами голоса

Diagnosis and treatment of larynx diseases in voice professionals are an important task of otorhinolaryngology. 244 voice professionals have visited Phoniatric Department of Saint Petersburg Research Institute of Ear, Throat, Nose and Speech. The condition of larynx was assessed by videoendolaryngoscopic and videoendolaryngostroboscopy methods. Larynx pathology was found in 212 patients, 32 persons were healthy. The main causes of dysphonias were the continuous vocal stress, work in sick condition, the diseases of endocrine, gastroduodenal, respiratory, neural system. 77 patients with voice disorders were diagnosed with functional dysphonia, 61 patients – with acute or chronic laryngitis. The cause of hoarseness in 46 persons were the vocal fold nodules, and in 28 patients – the vocal fold polyps. The article describes the clinical manifestations of pathological changes of the larynx. Based on the studied voice disorder etiological factors and clinical picture of the larynx, the authors developed a clinical and diagnostic algorithm of otorhinolaryngologist’s work with voice professionals.

Vocal Fold Polyps: Literature Review.

Introduction Vocal fold polyps are one of the most frequent benign laryngeal lesions, impacting the quality of life of those affected by them, primarily the vocal production. Despite being a well-established therapy in conjunction with surgery, speech therapy alone may also be effective in treating these lesions. As such, otolaryngologists and speech therapists need updated bibliographic knowledge on the issue. Objective To describe the literature findings on vocal fold polyps that discuss prevalence, etiology, histology, physiopathology, vocal characteristics or treatment. Data Synthesis The present study is a review article based on a bibliographic search using platforms, databases and search engines, with no restrictions on means of publication, methodological quality or language. All the articles on vocal fold polyps pertaining to the object of study published in the past 15 years were included. Among the characteristics investigated, the most discussed were prevalence of men, smoking as an etiological cofactor, the possibility of histological differentiation from vocal nodules, the relationship with cover minor structural alterations, and the indication and effectiveness of different treatment options. Conclusion Despite the discrepancies found in the present literature review on vocal fold polyps, there has been a notable scientific progress in the otolaryngologic techniques and in the effectiveness of speech therapy as initial treatment, with direct and indirect techniques, corroborating the need for scientific investigation of the issue.

Laryngeal assessment of patients with rheumatoid arthritis using laryngeal photodocumentation

Objective The aim was to assess the prevalence of dysphonia and laryngeal changes upon videolaryngoscopic examination of patients with rheumatoid arthritis (RA). Background RA effects on larynx vary from mild asymptomatic effect to life-threatening conditions. Many authors have emphasized the need of studies in different communities on its effect. In Egypt, the knowledge regarding its manifestations on the larynx, as well as its laryngeal alterations, is limited. Patients and methods A total of 79 patients diagnosed as having RA in Menoufia University Hospitals from March 2015 to March 2017 were assessed by taking history and asking about different laryngeal complaints followed by telescopic videolaryngeal examination. Results The estimated prevalence of laryngeal complaints in patients with RA was 57%. The most frequent complaints were globus pharyngeus in 53.2% of patients followed by phonasthenic symptoms in 32.9% of the patients. Dysphonia prevalence was 25.3%. Regarding videolaryngoscopic findings, the prevalence of changes was present in 86.15% of the patients. Most common finding has been posterior laryngitis, which was found in 78.5% of patients, followed by glottic gap in 34.2% and vocal folds rheumatoid nodules in 26.6% of them. Conclusion Laryngeal complaints and videolaryngoscopic morphological findings are prevalent among patients with RA, with a prevalence rate of 57 and 86.15%, respectively. The most frequent complaints were globus pharyngeus in 53.2% of patients followed by phonasthenic symptoms in 32.9% of the patients. Most common videolaryngoscopic findings have been posterior laryngitis, which was found in 78.5% of our patients, followed by glottic gaps in 34.2%.

Laryngeal complaints and videolaryngoscopic laryngeal alterations in rheumatoid arthritis patients and its association with disease activity and duration

Background: Rheumatoid arthritis (RA) is an autoimmune systemic disease with a wide clinical presentation. The laryngeal manifestations are often masked by the articular disability often experienced in the early and late stages of the disease. Objective: Association between different laryngeal complaints and videolaryngoscopic laryngeal alterations in patients with RA, and disease activity and duration. Patients and methods: A retrospective study was conducted on 79 patients with RA. All subjects were recruited from the out-patient clinic of physical medicine, rehabilitation, and rheumatology in Al-Menoufia University Hospitals during the period from March 2015 to March 2017. All patients were subjected to both phoniatric and rheumatological assessment. Results: Patients with phonasthenic symptoms and globus pharynges had significantly (p=0.01, 0.008 respectively) higher disease duration than patients without. No significant association found between rheumatoid arthritis duration and different videolaryngoscopic laryngeal alterations, patient’s self-assessment of the impact of laryngeal complaints on their lives, and auditory perceptual assessment (APA) of patient’s voice characters. As regards rheumatoid disease's activity no significant correlation has been established (p>0.05) with different laryngeal complaints except for patients in remission who had higher prevalence of intermittent dysphonia than patients with low activities. Rheumatoid disease's activity had no significant association with different laryngeal findings except those with moderate activity; they had significantly higher prevalence of vocal folds nodules than patients with high activity and patients in remission. Conclusion: A significant association between the disease's duration and presence of laryngeal complaints, dysphonia, and its persistence has been established. Also, patients with phonasthenic symptoms and globus pharynges had significantly higher disease duration than patients without. Rheumatoid diseases activity had significant association with different laryngeal complaints in patients with remission that had higher prevalence of intermittent dysphonia than patients with low activities. No significant association between the disease activity and different laryngeal findings that has been found except for patients with DAS-28>3.2, they had significantly higher prevalence of rheumatoid nodules.

The Application of a Genetic Algorithm in the Noninvasive Assessment of Vocal Nodules in Children

The application of IT solutions in medicine makes it possible to develop new, more accurate, and noninvasive medical diagnostics. The aim of this study was to propose this kind of solution. It enables the accurate assessment of vocal nodules in children while measuring glottal insufficiency. The input data includes voice and electroglottographic recordings of patients' voices as well as diagnoses made by practitioners. The recordings were parameterized and used to develop a classifier to assess glottal insufficiency of vocal nodules. The classifier was designed with the help of a genetic algorithm. The diagnoses established thanks to the classifier show a 92% agreement with those reached through medical examination. Such effective performance renders the classifier a useful noninvasive screening tool. We compared our method with Deep Neural Network classifier and the Covariance Matrix Adaptation Evolution Strategy (CMA-ES) evolutionary algorithm. The solution that we propose offers a more accurate continuous diagnosis in comparison with the discrete diagnosis of a deep neural network as well as greater accuracy in relation to the CMA-ES algorithm. Another advantage of the proposed solution is the ease with which it can be implemented by healthcare professionals. A Visual Basic for the Applications (VBA) code for LibreOffice macro for the classifier is attached at the end of this paper.

Ambulatory assessment of phonotraumatic vocal hyperfunction using glottal airflow measures estimated from neck-surface acceleration.

Phonotraumatic vocal hyperfunction (PVH) is associated with chronic misuse and/or abuse of voice that can result in lesions such as vocal fold nodules. The clinical aerodynamic assessment of vocal function has been recently shown to differentiate between patients with PVH and healthy controls to provide meaningful insight into pathophysiological mechanisms associated with these disorders. However, all current clinical assessment of PVH is incomplete because of its inability to objectively identify the type and extent of detrimental phonatory function that is associated with PVH during daily voice use. The current study sought to address this issue by incorporating, for the first time in a comprehensive ambulatory assessment, glottal airflow parameters estimated from a neck-mounted accelerometer and recorded to a smartphone-based voice monitor. We tested this approach on 48 patients with vocal fold nodules and 48 matched healthy-control subjects who each wore the voice monitor for a week. Seven glottal airflow features were estimated every 50 ms using an impedance-based inverse filtering scheme, and seven high-order summary statistics of each feature were computed every 5 minutes over voiced segments. Based on a univariate hypothesis testing, eight glottal airflow summary statistics were found to be statistically different between patient and healthy-control groups. L1-regularized logistic regression for a supervised classification task yielded a mean (standard deviation) area under the ROC curve of 0.82 (0.25) and an accuracy of 0.83 (0.14). These results outperform the state-of-the-art classification for the same classification task and provide a new avenue to improve the assessment and treatment of hyperfunctional voice disorders.

Flexible Nasopharyngolaryngoscopy for the Assessment of Upper Airway Disorders

Introduction: Upper airway problems are frequently encountered in ENT practice. It is difficult to diagnose upper airway pathology by conventional methods. So use of fibreoptic flexible nasopharyngoscopy (NPL) is very helpful in both diagnosis and treatment of upper airway disorders. The aim of this study is to observe the usefulness of flexible NPL in patients with upper airway problems as an outpatient procedure. Materials and Methods: A cross sectional descriptive study was conducted in the department of ENT at KIST medical college teaching hospital during the period of 2years. A total of 138 patients who had persistent upper airway symptoms and underwent NPL were included in the study Detail history, clinical examination and required investigations were done. Data were recorded and analysed.Results: Total 138 patients suffering from upper airway disorders underwent NPL. Among them 65(47.1%) were males and 73(52.9%) were females. Age range was from 16 to 82 years. Most common problem observed was laryngopharyngeal reflux disease accounting for 41 percent of cases followed by vocal cord nodule and polyp.Conclusions: Flexible fiberoptic nasopharyngolaryngoscopy (NPL) is safe and noninvasive outpatient department procedure for the assessment of upper airway disorders.

소아 성대 결절에 대한 음성 치료의 효과

소아 성대 결절에 대한 음성 치료의 효과

Expression and role of EGFR, cyclin D1 and KRAS in laryngocarcinoma tissues.

Epidermal growth factor receptor (EGFR), cyclin D1 and KRAS proto-oncogene, GTPase (KRAS) genes serve roles in the occurrence and development of tumors. The aim of the current study was to investigate the expression levels of EGFR, cyclin D1 and KRAS in laryngocarcinoma tissues and their association with clinical features. In addition, correlation between the expression levels of EGFR, cyclin D1 and KRAS was analyzed in laryngocarcinoma tissues. The expression levels of EGFR, cyclin D1 and KRAS in 46 patients with laryngocarcinoma and 20 patients with vocal cord polyps as the control group were determined using Super Vision immunohistochemical staining assay kits. The differences in clinical and pathological parameters between groups were statistically analyzed using SPSS software version 16.0. The expression rates of EGFR, cyclin D1 and KRAS were 71.7, 52.2 and 39.1%, respectively in laryngocarcinoma tissues, and 10.0, 5.0 and 10.0%, respectively in vocal cord polyps. There was a positive correlation between the expression levels of EGFR, cyclin D1 and KRAS. The expression of these genes was also closely associated with the clinical stage, treatment response and prognosis of patients with laryngocarcinoma. Multivariate analysis of prognosis using the Cox regression model indicated that EGFR expression in laryngocarcinoma tissues and the clinical stage of patients with laryngocarcinoma were closely associated with patient prognosis. The results of the current study indicated that EGFR, cyclin D1 and KRAS were synergistically involved in the occurrence and development of laryngocarcinoma, directly affecting the prognosis of patients. Additionally, high expression of EGFR, cyclin D1 and KRAS facilitated the invasion and metastasis of laryngocarcinoma cells. The expression of EGFR in laryngocarcinoma tissues and clinical stage were two independent risk factors affecting the prognosis of patients.

Prevalence, Characterization, and Impact of Voice Disorders in Fado Singers

Fado is a genre of urban folk music from Portugal characterized by some particularities. Some indictions in the study point this population of singers to be at higher risk of developing voice disorders. This study aims to provide estimates of the prevalence of voice disorders in Fado singers, and to characterize the professional practice and the impact of voice disorders on their careers. This is a cross sectional study based on a self-administered questionnaire split into six parts and 55 questions. A gender-balanced sample of 111 singers was achieved. Most of them recorded at least once. Winter and spring were found to be the most difficult seasons in which to sing. The overall prevalence of self-reported voice disorders was 39.6%, significantly higher in females. Almost all sought clinical guidance. Vocal fold nodules, functional dysphonia, and vocal fold polyp were the most common diagnoses. Vocal fatigue and hoarseness were the main symptoms reported. Nearly half of the singers had to cancel shows due to voice disorders. Fado singers reveal both a relative high prevalence of voice disorders and related concerns, even though some discrepancies were found regarding other apparently similar singer populations. These results lead support the need for further investigation regarding the risk or protective factors influencing voice disorders.

Importance of timely diagnosis of diseases of the larynx during initial examination performed by an otorhinolaryngologist

Diagnosis and treatment of diseases of the larynx in patients with dysphonia are an urgent task of modern otorhinolaryngology. The reason for this is the constant growth of professions with high requirements for voice quality. The modern methods of diagnosis in diseases of the larynx are based on endoscopic diagnostic techniques. The article provides detailed description of the clinical and endoscopic signs of functional and organic diseases of the larynx that are significantly more prevalent in voice professionals: hypotonic and hypo-hypertonic functional dysphonia, soft and hard vocal fold nodules, acute and chronic occupational laryngitis, and vascular pathology of vocal cords. The article presents the main approaches to the treatment of diseases of the larynx, including using the drug Homeovox. The article will be useful to the otorhinolaryngologists of the outpatient network to establish the diagnosis and assign а therapy to the voice and speech professionals.

Immunohistochemical analysis of vocal cord polyps applying markers of squamous cell carcinogenesis

ObjectiveThe aim of the study was to perform a pathohistological and immunohistochemical analysis of squamous cell (SC) carcinogenesis markers on epithelial linings of vocal cord polyps.The vocal box, being a heavily burdened organ with intensive cell renewal and regenerative processes, is therefore a favourable environment for constant epithelial growth and hyperplasia. In our ongoing projects on laryngeal carcinogenesis and research on laryngeal tissue, we encountered atypia on diagnosed nodules and polyps that are usually considered as benign formations, resulting from the above-mentioned cell renewal and regeneration, which lead to further investigation.The purpose was to see if changes in molecular markers of SC carcinogenesis follow, or, may appear in immunohistochemical (IHC) analysis, before histological atypia in standard haematoxylin-eosin (HE) staining, and contribute in early diagnosis of potentially suspect polyps. MethodsAfter classical pathohistological (PH) analysis on HE slides, IHC analysis of EGFR, cyclin D1, p53, Ki-67, and IMP3 was performed on tissue microarrays of laryngeal tissue (50 samples), ranging from normal to hyperplastic lesions with no atypia (34 samples), low-grade atypia (11 samples), and high-grade atypia (5 samples). ResultsThis study established an increase and correlation of EGFR, cyclin D1, p53, Ki-67 and IMP3 IHC expressions with pathohistological findings of dysplasia in glottic polypoid lesions. Low and high-grade dysplasia had statistically higher percentages of EGFR-positive cells than normal epithelium and simple hyperplasia (SH) (low vs. normal/SH P = 0.007; high vs. normal/SH P = 0.001). High-grade dysplasia had statistically more positive cells than low-grade dysplasia (P = 0.004), and low-grade dysplasia had statistically more positive cells than specimens without atypia (P = 0.007). The percentage of positive cells was statistically higher for cyclin D1, p53 and Ki-67 in high-grade dysplasia versus low-grade dysplasia (cyclin D1 P = 0.011, p53 P = 0.002; Ki-67 P = 0.026; respectively) and versus normal epithelium and SH (cyclin D1 P = 0.003; p53 P = 0.001; Ki-67 P = 0.002; respectively). An increase of IMP3-positive cells with an increase of atypical changes in the laryngeal epithelium, from superficial towards basal layers was noticed, contrary to the usually seen positivity pattern of SC carcinogenesis markers from basal to superficial layers. A statistically significant difference of IMP3 IHC staining between the pathohistological groups (P = 0.003) was recorded. ConclusionOnly polyps that present with simple hyperplasia as the greatest mucosal change can be considered as benign formations.Pathohistologically detected atypia in polypoid changes of vocal cords, confirmed by molecular atypia with an increase of SC carcinogenesis markers, suggest their inclusion in studies of laryngeal carcinogenesis.Our results suggest that in problematic cases IHC analysis could be of interest in detection of biological aggressiveness in polypoid laryngeal tissue and beneficiary for polyp patients’ follow-up.Further research of laryngeal carcinogenesis markers and their meaning in fibrovascular polyps is of interest.

A Bayesian decision analysis approach to assess voice disorder risks by using acoustic features.

Vocal fold nodules are recognized as an occupational disease for all collective of workers performing activities for which maintained and continued use of voice is required. Computer-aided systems based on features extracted from voice recordings have been considered as potential noninvasive and low cost tools to diagnose some voice-related diseases. A Bayesian decision analysis approach has been proposed to classify university lectures in three levels of risk: low, medium, and high, based on the information provided by acoustic features extracted from healthy controls and people suffering from vocal fold nodules. The proposed risk groups are associated with different treatments. The approach is based on the calculation of posterior probabilities of developing vocal fold nodules and considers utility functions that include the financial cost and the probability of recovery for the corresponding treatment. Maximization of the expected utilities is considered. By using this approach, the risk of having vocal fold nodules is identified for each university lecturer, so he/she can be properly assigned to the right treatment. The approach has been applied to university lecturers according to the Disease Prevention Program of the University of Extremadura. However, it can also be applied to other voice professionals (singers, speakers, coaches, actors…).