Vocal Polyps Research Articles

애성환자의 임상통계적 관찰

A clinico-statistical study was performed on 333 cases with chief complaint of hoarseness at the department of otolaryngology, Red Cross Hospital, Seoul during the past 5 years from Jan. 1986 to Dec. 1990. The results were as follows: Among the total new out-patients of 11, 351 who visited the dept, of otolaryngology, the patients with hoarseness were 333 cases(2.9%). The underlying diseases causing hoarseness in order of frequency were laryngeal nodule(70 cases, chronic laryngitis(68 cases, 20.4%), vocal polyp(40 cases, 12%), acute laryngitis(35 cases, 10.5%)，vocal cord paralysis(24 cases, 7.2%)，laryngeal cancer (13 cases, 3.9%)，laryngeal tuberculosis(11 cases, 3.3%). Also, the normal finding on physical examination of larynx were seen on 32 cases(9.6%) and unknown etiology were 21 cases(6.3%). Among above 333 cases, male were 179 cases and female were 154 ones. The incidence was slightly higher in male than female with ratio 1.16 to 1 in sex distribution. Particulary, larygeal cancer and vocal polyp were extremely high in male but the others were equally distributed in both sex gorup. The incidence of age causing hoarseness in order of frequency were 3rd decade (100 cases, 30%), 4th decade(88 cases, 26.4%), 2nd decade(42 cases, 12.6%) and 5th decade (41 cases, 12.3%). The highest incidence of the duration from the onset of hoarseness to consultation was between lldays to 1 month in 64 cases(l9.2%). The number of patients who visit hospital within 3 months were 162 cases(48.6%) and over 1 year were 48 cases(l4.4%). The highest incidence of associated symptom with hoarseness was sore throat(62 cases, 18.6%) and in decreasing order were sputum, foreigh body sensation, swallowing difficulty, cough and dyspnea. Hoarseness without associated symptom were seen on 162 cases(48.6%). A great number of patients with ployp or nodule were not related to abuse of voice in our outpatients group.

病的音声の音響分析による研究

Acoustic analysis of the voices of 195 patients with vocal polyps, unilateral recurrent laryngeal nerve paralysis, and laryngeal carcinoma were performed. Five acoustic parameters were derived: pitch perturbation quatient (PPQ), amplitude perturbation quatient (APQ), normalized noise energies a and b (NNEa, NNEb), and spectral slope (LD). Analyses were performed both before and after treatment. Size of the lesion and the dimensions of the glottal gap during phonation were determined from fiberstroboscopic video images before treatment. Results were as follows: (1) PPQ, APQ, NNEa, NNEb, and LD varied greatly within each disease group, and there was overlapping of parameter values among the disease groups. Therefore, the selected acoustic parameters did not prove to be useful in differential diagnosis. (2) Polyp size was significantly correlated to PPQ, APQ, NNEa, and NNEb. (3) Post-treatment changes were found in PPQ, APQ, NNEa and NNEb in cases of polyps; in APQ, NNEa, and NNEb in cases of carcinoma; and in NNEb in cases of paralysis.

Phonosurgery for singers

Phonosurgery for singers poses some delicate problems, particularly concerning surgical indications, surgical techniques, and postoperative follow-up. Our own experience includes 101 cases of adult singers operated upon over the last 15 years: 19 nonclassical singers (pop, rock, etc.); 54 nonprofessional classical singers (music teachers, choir leaders, choir members, and singing students); and 28 professional classical singers (operatic or oratorio). Our work brings out a point that is often missed: lesions found in singers are not all side effects of vocal strain, like nodules or polyps, but also include a large number of congenital lesions, particularly epidermoid cysts. Phonosurgery for singers poses some delicate problems, particularly concerning surgical indications, surgical techniques, and postoperative follow-up. Our own experience includes 101 cases of adult singers operated upon over the last 15 years: 19 nonclassical singers (pop, rock, etc.); 54 nonprofessional classical singers (music teachers, choir leaders, choir members, and singing students); and 28 professional classical singers (operatic or oratorio). Our work brings out a point that is often missed: lesions found in singers are not all side effects of vocal strain, like nodules or polyps, but also include a large number of congenital lesions, particularly epidermoid cysts.

Ultrastructural Features of Vocal Fold Nodules and Polyps

Earlier investigation did not show any clear distinctive pathological features that differentiate vocal polyps from vocal nodules. The light microscopic distinctive features between the two lesions point in the direction of a more pronounced epithelial reaction and a more fibrous stromal change in vocal nodules. In the present study, 19 vocal polyps and 11 vocal nodules were subjected to ultrastructural examination aiming at finding distinctive features that may be pathognomic for each of these clinically distinct entities. The study was carried out by EM Philips 400 T. The results demonstrate that nodules showed epithelial changes in the form of gaping of the intercellular junctions and absence of the basal lamina in parts. These changes are less apparent in polyps, whereas the stromal changes are more pronounced and varied. The significance of these results and their interpretation are discussed.

An evaluation of residue features as correlates of voice disorders

Two experiments were conducted to assess the correlations of residue features with some perceptual properties of voice disorders. First, 90 samples of the vowel /a/ produced by patients with various vocal pathologies were analyzed to obtain the residue features, and severity judgments of these vowel samples were obtained. The results of linear multiple regression analysis indicated that the features were highly correlated with the severity ratings. Second, an attempt was made to correlate the residue features with voice qualities. The features were calculated for the vowel /a/ produced by patients with vocal nodules, vocal fold paralysis, and vocal polyps and by normal talkers. Each vowel sample was rated on ten scales of voice quality. The results revealed high correlations among the quality scales so that discrete subject groups could not be formed. Thus, residue features may be useful in assessing the degree of vocal impairment, but their use as correlates of voice quality must await further research.

職業歌手（Ｐｒｏｆｅｓｓｉｏｎａｌ Ｓｉｎｇｅｒ）における音声障害の臨床的研究 外科的治療の適応について

From 1976 to 1985, many professional singers visited our clinic and were phonosurgically and conservatively treated. A follow-up study with statistical and histopathological methods was carried out on 212 cases with complete clinical data, selected from all the cases.The results obtained were as follows:(1) The vocal polyp was more prevalent in male than in female.(2) The vocal nodules were prevalent in female singers.(3) Professional singers had a tendency to suffer from vocal nodules more than average people.(4) The histopathological study revealed that an edematous change in the submucosa was most dominant among many kinds of histological changes in female patients who are tend to suffer from vocal nodules, while hemorrhagic and infectious changes were found in addition to edematous ones in male patients who are tend to suffer from vocal polyps.(5) In 97% of the patients who were laryngomicrosurgically treated, normal restoration of the voice was obtained.From the results above mentioned, it would be emphasized that surgical resection of lesions under laryngomicroscopy could be carried out even for professional singers.

Clinical Study of Polypoid Vocal Cords

Microsurgery of the larynx has been widely performed on many larygeal lesions since the precise operation is practicable through the operating microscope. Experienced in more than 1300 cases in clinic, this is believed the most effective operative procedures.The study of the postoperative results, however, revealed that excellent restoration of the voice is not always obtained in the case of polypoid vocal cords in comparison with vocal polyps, vocal nodules or the like. This fact let the author make an attempt to devise new surgical procedures to be employed in microsurgery of the larynx for the treatment of polypoid vocal cords.Recent histopathological or histochemical study showed that, in the case of polypoid degeneration of the vocal cord, epithelium of the vocal cords is usually unaffected.This new surgical procedure, hence, is carried out without removal epithelium of the vocal cords. Excision of the epithelium was longitudinally performed on the almost midline of the vocal cords. And then, pathological mucous substances under the epithelium were just removed by suction.It should be emphasized that this procedure is performed without removal any epithelium. In addition to that, from the author's histochemical study it seems most likely that tnis procedure might stimulate the mechanism of healing pathologic conditions as shown in polyps, polypoid degeneration or the like.In this paper, this new surgical procedure was reported and discussed from the viewpoint of histopathologic study and postperative phonetic results.

Comments on Surgical Removal of Vocal Polyps and Nodules, Especially on the Lacal Anesthesia

Comments on Surgical Removal of Vocal Polyps and Nodules, Especially on the Lacal Anesthesia

Objective voice analysis for vocal polyps following microlaryngeal phonosurgery

Vocal polyps are the products of voice overuse, misuse and abuse as the most common causative factors. Treatment generally advised for them are voice therapy and Microlaryngeal Phonosurgery (MLPS). The improved or changed quality of voice is generally assessed perceptually and can cause intra rater variability. In this study we compared and analysed the acoustic characteristics before and after MLPS. The purpose of the study was to acoustically determine the changes in voice quality of a group of patients before and after the surgery. The following patients group were studied prior to and in between 3 and 4 weeks of surgery. Altogether there were 23 patients with either unilateral or bilateral vocal polyps. Voice recording and analysis were performed with Dr. Speech acoustic software (Tiger electronics, USA). The parameters analyzed were in terms of perturbation (Jitter and shimmer), harmonic-to-noise ratio (HNR) and fundamental frequency (F0). The results showed that shimmer, HNR and F0 decreased significantly (p<0.05) following MLPS, but jitter though reduced, was not statistically significant (p = 0.694). The acoustic output generally improved after MLPS as evidenced by decreased values of all the four acoustic parameters. The study also stress that voice quality can be improved through the phonosurgical procedures. This multidimensional voice analysis can be very helpful in our ability to provide objective clinical analysis of voices with vocal polyps, and following their surgical treatment.

Vocal nodules and polyps: laryngeal tissue reaction to habitual hyperkinetic dysphonia.

Vocal nodules and polyps: laryngeal tissue reaction to habitual hyperkinetic dysphonia.