Vocal Polyps Research Articles

The Preliminary Assessment for the Feasibility of CO2 Laser-assisted Phonomicrosurgery Using Computer-guided Scanner in Broad-based Vocal Polyps

The Preliminary Assessment for the Feasibility of CO2 Laser-assisted Phonomicrosurgery Using Computer-guided Scanner in Broad-based Vocal Polyps

Esophageal dynamic and laryngopharyngeal reflux play a role in pathogenesis of vocal cord polyps

Through monitoring esophageal dynamic change, and detection of laryngopharyngeal reflux(LPR) and gastroesophageal reflux events,to discuss the relationship of vocal cord polyps with laryngopharyngeal reflux. Thirty-two patients with vocal cord polyps were diagnosed by electronic laryngoscopy in Nanfang Hospital between October 2011 to May 2012. This study applied high-resolution esophageal manometry (HRM) and ambulatory 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH) to obtain the upper esophageal sphincter(UES) and lower esophageal sphincter pressure, characteristics of sectional esophageal motility; laryngopharyngeal reflux (LPR)and gastroesophageal reflux events, as well as the reflux properties of substances. Sixteen healthy volunteers were recruited as normal controls. UES relaxation duration, duration of UES relaxation time, UES relaxation recovery time and mean length of LES were all shorter than those of the control group (t were 2.244, 2.624, 2.310 and -2.397, P < 0.05). There were 40.6% (13/32) LPR and 50.0% (16/32) gastroesophageal reflux found in vocal polyp patients. Median number (M [P25; P75]) of laryngopharyngeal acid reflux events were 0.5[0.0;3.5] and 0.0[0.0;0.0] in vocal polyp group and the controls, median mean time of laryngopharyngeal acid exposure 0.1[0.0;1.7] and 0.0[0.0;0.0] min, median clearance time of laryngopharyngeal acid were 3.5[0.0;53.5] and 0.0[0.0;0.0] s, median scores of DeMeester were 14.8[1.6;31.3] and 1.8[1.1;4.1] and median frequency of total liquid reflux episodes were 46.5[25.3;69.0] and 32.5[20.0;36.3], respectively. The median numbers of laryngopharyngeal acid reflux events, time of acid exposure, time of acid clearance, DeMeester scores and frequency of total liquid reflux episodes were increased or higher in vocal polyp group than those in the controls (z were 2.481, 2.767, 2.767, 2.344 and 1.980, P < 0.05). There are upper esophageal sphincter and Lower esophageal sphincter dismotility in vocal polyp patients with LPR. LPR events were dominated by acid reflux in upright position.Esophageal dynamic disfunction and LPR should be considered in the study of the pathogenesis of vocal cords polyps.

Office-Based Potassium Titanyl Phosphate Laser–Assisted Endoscopic Vocal Polypectomy&lt;alt-title&gt;KTP Laser–Assisted Endoscopic Vocal Polypectomy&lt;/alt-title&gt;

Vocal polyps are common exophytic laryngeal lesions that usually necessitate microscopic laryngeal surgery under general anesthesia. Office-based indirect laryngoscopic procedures provide an alternative management option and can be performed comfortably under flexible endoscopic guidance. Combining angiolytic potassium titanyl phosphate (KTP) laser treatment and flexible endoscopic polypectomy should alleviate the risks of surgery under general anesthesia and expedite lesion regression. To combine angiolytic KTP laser treatment and endoscopic polyp removal and to evaluate the clinical applicability, treatment outcomes, and adverse effects of office-based KTP laser-assisted vocal polypectomy. Case series of KTP laser treatment (n = 16) and KTP laser-assisted polypectomy (n = 20). Patients underwent pretreatment and 2- and 6-week posttreatment evaluation with videolaryngostroboscopy (VLS), maximal phonation time, and a 10-item voice handicap index. Perceptual (GRB [grade, roughness, breathiness] scale) and acoustic analyses were performed before and 6 weeks after treatment. Tertiary teaching hospital. Thirty-six outpatients with unilateral hemorrhagic vocal polyps. Under local anesthesia, the KTP laser fiber was passed through the working channel of the flexible laryngoscope to photocoagulate the microvasculature of the polyp in all patients. Removal of coagulated vocal polyp using a flexible, endoscopic, blunt-ended grasping forceps immediately after KTP laser application was performed in the polypectomy group. Results of VLS, maximal phonation time, 10-item voice handicap index, and perceptual and acoustic analyses. Six weeks after KTP laser treatment with and without polypectomy, 19 and 12 patients, respectively, experienced complete recovery and much improvement of mucosal wave. Maximal phonation time and the voice handicap index improved significantly 2 weeks after KTP laser with polypectomy (P < .01), whereas significant improvements were noted 6 weeks postoperatively in both treatment groups (P < .05). Acoustic and perceptual analyses also revealed significant improvements in both study groups (P < .05). During follow-up, we did not notice significant adverse effects. Potassium titanyl phosphate laser-assisted vocal polypectomy is a safe, practical, and effective alternative option to treat hemorrhagic vocal polyps in the outpatient department, offering comparable but earlier therapeutic effects than KTP laser alone.

Clinical diagnosis and histological analysis of vocal nodules and polyps

Recent studies emphasize the importance of the clinical-histology correlation in laryngeal pathologies. ObjectiveTo compare the ENT diagnosis with the pathology diagnosis one of 132 surgical specimens, from 119 patients with vocal nodules and polyps. MethodRetrospective study. We investigated the paraffin blocks corresponding to the lesions of the operated patients. We made new histology cross-sections, totaling 396 new slides, divided into three groups: hematoxylin and eosin, Gomori trichrome and PAS. We analyzed the following histological parameters: epithelium, lamina propria, basement membrane, vascular changes. We compared the laryngological and pathological diagnoses, and we did the statistical analysis, checking the predominant histological aspects in each lesion. ResultsThere was an agreement between the clinical and pathological diagnoses in 123 (93.18%) of 132 lesions analyzed (42.42% nodules and 50.76% polyps). In the histological parameters we found: epithelial changes such as nodules hyperplasia (82.14%) and polyp atrophy (31.34%). Lamina propria: edema in polyps (71.43%), fibrosis in the nodules (57.14%). Basement membrane: thickened nodules (100%), thin/no change in polyps (100%). There was a predominance of vascular changes in the polyps. ConclusionWe found a high correlation between the ENT diagnosis and the pathology report. Histopathologically, the nodules presented with predominantly epithelial changes, lamina propria and basement membrane fibrosis, while the polyps by changes strictly on the lamina propria and vascular aspects.

Transnasal endoscopic steroid injection: A practical and effective alternative treatment for benign vocal fold disorders

Emerging literature has documented the effectiveness of intralesional steroid injection as an alternative treatment for benign vocal fold disorders. However, clinical application is frequently limited by the associated technical demands for adequate anesthesia and precise needle placement. This study investigated the applicability and effectiveness of the more practical and less technically demanding method of transnasal endoscopic steroid injection (TESI). Prospective case series. This study recruited 30 patients with vocal nodules and polyps. Dexamethasone was injected into the Reinke's space under local anesthesia via the operating channel of a transnasal flexible laryngoscope in an office setting. Treatment outcome were measured before, 1 month after, and 3 months after the injection, using videolaryngostroboscopy (VLS), maximal phonation time (MPT), 10-item voice handicap index (VHI-10), acoustic analysis, and perceptual evaluation. VLS examinations at 3 months post-treatment demonstrated that vocal lesions of 10 and 19 patients were resolved or reduced, respectively. Objective measurements showed increased MPT and decreased VHI-10 (P < .05 and P < .01, respectively). Acoustic analysis revealed significant decrease in jitter and shimmer (P < .05). Perceptual evaluation using the GRB (grade, roughness, breathiness) scale also showed improved voice quality (P < .01). Treatment outcomes were similar between vocal nodules and polyps (P > .05). Mild vocal hematoma occurred in three patients following TESI, but resolved spontaneously within 1 month. TESI is a simple and practical office-based treatment modality for benign vocal fold lesions, suitable for most otolaryngologists. Treatment outcomes showed significant subjective and objective improvements that were comparable to the results of other injection procedures reported in the literature. 4.

An Investigation of Vocal Tract Characteristics for Acoustic Discrimination of Pathological Voices

This paper investigates the effectiveness of measures related to vocal tract characteristics in classifying normal and pathological speech. Unlike conventional approaches that mainly focus on features related to the vocal source, vocal tract characteristics are examined to determine if interaction effects between vocal folds and the vocal tract can be used to detect pathological speech. Especially, this paper examines features related to formant frequencies to see if vocal tract characteristics are affected by the nature of the vocal fold-related pathology. To test this hypothesis, stationary fragments of vowel /aa/ produced by 223 normal subjects, 472 vocal fold polyp subjects, and 195 unilateral vocal cord paralysis subjects are analyzed. Based on the acoustic-articulatory relationships, phonation for pathological subjects is found to be associated with measures correlated with a raised tongue body or an advanced tongue root. Vocal tract-related features are also found to be statistically significant from the Kruskal-Wallis test in distinguishing normal and pathological speech. Classification results demonstrate that combining the formant measurements with vocal fold-related features results in improved performance in differentiating vocal pathologies including vocal polyps and unilateral vocal cord paralysis, which suggests that measures related to vocal tract characteristics may provide additional information in diagnosing vocal disorders.

The Usefulness of CO2Laser-Assisted Phonomicrosurgery Using a Computer-Guided Scanner in Broad-Based Vocal Polyp

Received July 10, 2013 Revised July 19, 2013 Accepted July 29, 2013 Address for correspondence Seung-Kuk Baek, MD Department of OtolaryngologyHead and Neck Surgery, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 136-075, Korea Tel +82-2-920-5485 Fax +82-2-925-5233 E-mail mdskbaek@gmail.com Background and ObjectivesZZNew computer-guided scanner (CGS) recently applied to CO2 laser micromanipulator allows the beam to sweep a given surface with extreme rapidity. Our aim in this study is to evaluate the efficacy and usefulness of CO2 laser-assisted phonomicrosurgery using a CGS in broad-based vocal polyp. Subjects and MethodZZThe current study enrolled 41 patients who underwent phonomicrosurgery for broad base polyp of vocal fold. Twenty patients underwent CO2 laser-assisted phonomicrosurgery using CGS (Group 1), and 21 patients underwent conventional phonomicrosurgery using cold instruments (Group 2). ResultsZZAll voice analysis parameters showed significant improvement after surgical treatment, except fundamental frequency and noise-to-harmonic ratio. Differences between preoperative and postoperative parameters of each voice analysis data did not differ significantly between the two groups. ConclusionZZAlthough no significant difference was observed between the two groups, CO2 laser-assisted phonomicrosurgery using CGS allow for performance of more accurate and delicate incision with a controllable depth of beam penetration. Korean J Otorhinolaryngol-Head Neck Surg 2013;56:511-5

Role of aerodynamic parameters in voice function assessment

To investigate the application and significance of aerodynamic parameters in voice function assessment. The phonatory aerodynamic system (PAS) was used to collect aerodynamic parameters from subjects with normal voice, vocal fold polyp, vocal fold cyst, and vocal fold immobility. Multivariate statistical analysis was used to compare measurements across groups. Phonation threshold flow (PTF), mean flow rate (MFR), maximum phonation time (MPT), and glottal resistance (GR) in one hundred normal subjects were significantly affected by sex (P < 0.05), while phonation threshold pressure (PTP), subglottal pressure (SGP), and vocal efficiency (VE) were not (P > 0.05). PTP, PTF, MFR, SGP, and MPT were significantly different between normal voice and voice disorders (P < 0.01), and there were no significant differences among the three disorders (P > 0.05). Receiver operating characteristic (ROC) analysis found that PTP, PTF, SGP, MFR, MPT, and VE in one hundred thirteen voice dis orders had similar diagnostic utility (P < 0.01), with PTP exhibiting the highest area under the curve. The aerodynamic parameters of the three degrees of voice dysfunction due to vocal cord polyps were compared and found to have no significant differences (P > 0.05). PTP, PTF, MFR, SGP and MPT in forty one patients with vocal polyps were significantly different after surgical resection of vocal cord polyps (P < 0.01). The aerodynamic parameters can objectively and effectively evaluate the variations of vocal function, and have good auxiliary diagnostic value.

The effect of retinyl palmitate on healing of benign vocal fold lesions

The leading cause of vocal fold lesions such as nodules and polyps is phonotrauma, which causes microhematoma formation in the vocal fold cover that can initiate an inflammatory process. Vitamin A (Vit A) is essential for immunity, cellular differentiation and maintenance of respiratory epithelium. The aim of this study is to investigate the effect of Vit A (retinyl palmitate) on healing of vocal fold lesions, including vocal polyps and nodules. Eighteen patients with vocal fold lesions were included in the study. Of the patients, 13 had vocal polyps and 5 had vocal nodules. Patients received 90,000 IU oral Vit A in palmitate form daily for 2 months. In addition to Vit A treatment, only vocal hygiene recommendations were given to the patients, without any other medication or specific voice therapy. Pre- and post-treatment acoustic analysis [jitter % (jitt %), shimmer % (shim %), normalized noise energy (NNE), maximum phonation time (MPT), etc.] were performed. Lesion dimensions and stroboscopic findings were evaluated. Voice handicap index (VHI) was applied. Statistical analysis was performed between pre- and post-treatment measurements. Of the 18 patients, 8 had immature lesions (6 polyp-like lesions and 2 immature nodules) and 10 had mature lesion (7 polyps and 3 nodules). None of the patients showed complete healing. Partial response was seen in four patients with immature lesions. There were minimal changes in lesion dimensions, but this difference did not reach statistical significance. MPT of patients with immature lesions were close to significance level but overall MPT revealed no significant improvement (p = 0.051). Jitt %, shim % and NNE did not change significantly. In this study, the only statistically significant finding was VHI of the patients with immature lesions. Three of the patients complained of weight gain. Our data showed that Vit A at a given level of dose and duration seems to be ineffective in the treatment of benign vocal fold lesions. On the other hand, whether Vit A is effective on mature and immature lesions of vocal folds at higher doses and/or longer duration of treatment or not requires further studies.

Microsuture after benign vocal fold lesion removal: a randomized trial

PurposeRemoval of benign vocal fold lesions results in small to moderate-sized mucosal defect on vocal fold, which heals by secondary intention. Microsuturing this defect leads to primary wound healing with fastened recovery and less scar. However, its value has not been determined. Materials and methodsThis is prospective, randomized, and controlled study performed in university hospital. Forty adults with vocal polyp, cyst, and Reinke's edema were included. Preoperatively, all patients completed VHI (Voice Handicap Index)–30, had acoustic analysis with continuous /a/ and videolaryngostroboscopy (VLS). The patients were randomly assigned to study group (with 1 or 2 6/0 vicryl suture) (n = 20) or control group (n = 20). Postoperative follow-up was done at the first, second, and fourth weeks. During follow-up examinations, VLS was repeated; the patients completed VHI-30 and had an acoustic analysis again. ResultsAll patients recovered with normal VLS and without complications; all were satisfied with the treatment result. The VHI results and acoustic analysis parameters of the study group were statistically significantly better than those of the control group at the first postoperative week (P < .05) but not at the second and fourth weeks (P > .05). Normal VLS was obtained significantly more early in the study group compared with the control group (P < .05). ConclusionsMicrolaryngoscopic removal of benign vocal fold lesions is a safe, satisfying procedure with excellent to good results if done according to its principles. Microsuturing of the mucosal defect helps to speed up recovery, although final result remains to be clinically unchanged. It may be beneficial for professional voice users by making early return of vocal fold function possible.

STUDY ON CLINICAL CHARACTERISTICS AND RESULT OF TREATMENT BENIGN VOCAL CORD TUMOR WITH RIGID LARYNGEAL ENDOSCOPIC SURGERY

Objective: Study on clinical characteristics and result of treatment benign vocal cord tumor with suspensive laryngeal endoscopic surgery. Materials and Methods: A prospective study was undertaken in 43 patients who had benign vocal cord tumor and performed a suspensive laryngeal endoscopic surgery at ENT Dept. of Hue University Hospital, from 3/2010 to 5/2011. Results: The most common was group was 31 - 45 (44.2%). There was no difference of gender. Moderate hoarness was 67.4%. Classification of benign laryngeal tumor: vocal nodules (13 cases), vocal cyst (18 cases), vocal polyp (10 cases) and Reinke’s edema (2 cases). The successful treatment rate of vocal benign tumor was 88.4%. Conclusions: Suspensive laryngeal endoscopic surgery was the best method to cure benign vocal cord tumor. The surgeon had a clear operative field, easy manoeuver, high rate of cure and less complication.

Psychogenic background of minimal associated pathological lesions of the vocal folds

BackgroundThere is clear clinical evidence that psychosocial factors may be encountered in the pathogenesis of some types of the Minimal Associated Pathological Lesions (MAPLs) of the vocal folds. ObjectiveThe purpose of this study was to assess cases of MAPLs of the vocal folds in order to explore the role of psychogenic stress in the pathogenesis of this clinical entity. MethodsTo reach our goal, 100 patients with MAPLs of the vocal folds were subjected to both voice and psychiatric protocols of assessment and the results obtained were compared with the results of 50 normal individuals who were subjected to the same assessment protocols. ResultsThe results showed that there were significant differences between both groups in some of the psychiatric scales. The results indicate that there is an evident psychogenic background for certain types of MAPLs of the vocal folds, namely: vocal folds nodules, vocal folds polyps and contact granuloma. ConclusionThis may necessitate a combined therapeutic program of behavior readjustment voice therapy as well as psychiatric management for these cases to get the best results and avoid relapse.

Japanese Version of Voice Handicap Index for Subjective Evaluation of Voice Disorder

Recently, the Voice Handicap Index (VHI), developed in the United States, has been highlighted as a means to assess a patient's perceptions of the severity of his or her voice disorder. The VHI is based on a self-administered questionnaire that quantifies the degree of a patient's disability related to his/her voice disorder. The questionnaire was translated into Japanese and applied to Japanese patients with various kinds of disordered voice or dysphonia. The results were analyzed and the usefulness discussed. In this study, 546 patients (281 males and 265 females) were included. Mean VHI scores were 36.2/120 in males and 44.1/120 in females. In the male patients, VHI scores were the highest among teens. However, VHI scores did not vary with age in the female patients. Patients with vocal fold paralysis, functional dysphonia, psychological dysphonia, and spasmodic dysphonia showed relatively high VHI scores, whereas those with laryngeal granuloma and laryngopharyngeal reflux disease showed low scores. In most diseases, functional and physiological scores were higher than emotional scores. In any treated patients, those with vocal nodule, vocal polyp, polypoid vocal fold, and recurrent laryngeal nerve paralysis, VHI scores decreased after therapeutic intervention. These findings suggest that the Japanese VHI is a useful tool for monitoring a patient's psychological status, choosing appropriate treatment, and assessing the therapeutic outcome.

Benign Mucosal Fold Lesion as a Cause of Hoarseness of Voice - A Clinical Study

Hoarseness of voice is a common disorder seen in day to day practice of Otorhinolaryngologist. Although, occasionally it can be a symptom of underlying malignancy, there are a variety of benign lesions causing the same. We analyzed a total number of 100 patients with history of hoarseness of voice for at least six months in whom the cause of hoarseness was the presence of a benign vocal fold lesion. Malignancies, vocal cord paralysis and Neurological lesions were excluded from the study. We found that vocal nodules were the commonest benign mucosal vocal fold lesion, (37% patients); followed by vocal polyps in 26%, LPR 23%, Reinke’s edema in 4%, intracordal cyst in 4%, contact ulcer in 3%, saccular cyst in 2% and papillomatosis in 1% of the patients.

Zaburzenia procesu komunikatywnego w praktyce otolaryngologicznej

Summary Disorders of communication process concerns voice, speech and hearing problems. The most common voice disorder in ENT practice is dysphonia. Mostly it is acute inflammation, but also functional dysphonia in which an abnormal voice is produced in the absence of vocal pathologies, either structural or neurogenic. It could be also vocal folds paralysis dysphonia or voice disorders due to benign organic vocal fold lesions. Some of those organic changes (vocal nodules, polyps, hypertrophy and thickening of vocal folds epithelium) frequently appears in cases with vocal abuse or inappropriate vocal use. Children's speech development closely depends on hearing, intelligence average, central nervous system function as well as on articulation organ morphology. Hearing problems as a etiological factor of communication process disorders in ENT practice, supposed to focus on early detection and management of hypacusis in newborns (screening stages) as well as on a proper diagnosis and treatment of conductive hearing loss or unilateral deafness.

Microflap Technique

The microflap technique for vocal fold lesions is an innovation that originally began in the mid 1980’s, and became established between the mid 1990’s and 2000. The concept is to preserve as much tissues as possible in vocal fold surgery under microscopy. Vocal function is the most important aspect, and post operative form of the vocal folds follows function. Microfalp technique consists of a superficial cordotomy, dissection of the lesion preserving healthy tissues in the lamina propria and the epithelium, removal of the lesion, and realignment of the remaining tissue. The microfalp technique is feasible and useful for a variety of vocal fold lesions including vocal polyp, nodule, cyst, Reinke’s edema, leukoplakia, carcinoma in situ, scar, sulcus, etc.

Clinico-pathological study of 50 cases of tumours of larynx.

The larynx serves to protect the lower airways, facilitates respiration and plays a key role in phonation. Based on anatomic location, the larynx is divided into the supraglottic larynx, the glottis or glottic larynx, and the subglottic larynx. The tumours of larynx can be divided into benign or malignant. Laryngeal granulomas, Vocal cord nodules, Vocal cord polyps are tumour-like lesions of larynx. Benign laryngeal tumors include a large number of lesions like papillomas, hemangiomas, fibromas, chondromas, myxomas, and neurofibromas. About 95% of laryngeal carcinomas are typical squamous cell tumours. Rarely adenocarcinomas are seen, presumably arising from mucous glands. The exact cause of laryngeal cancer is still unknown. Diagnosis is based on direct or indirect visualization of the larynx, supplemented by CT scan and confirmed by histopathological examination. The aim of the present study was to study the clinical aspects, histopathological patterns of tumours of the larynx to study the various predisposing factors of laryngeal tumours. The present study was undertaken on 50 patients clinically diagnosed as cases of tumour of larynx. These patients were made to undergo direct laryngoscopy and the biopsy taken from the growth in the larynx was sent to the department of pathology for histopathological examination. Smoking played the main role in benign growths (25%). The main predisposing factor (73.2%) for malignant growths was smoking, tobacco chewing and alcohol abuse. The most common benign tumour of larynx was the vocal polyp. Out of the 30 cases of squamous cell carcinoma, 15 (50%) were well differentiated, 8 (26.6%) were moderately differentiated and 3 (10%) were poorly differentiated. The symptoms of laryngeal tumours can vary from mild hoarseness of voice to life threatening respiratory distress. All available methods of study should be utilized to make the diagnosis as early as possible. Early diagnosis of the lesion can lead to effective management.

Afecções laríngeas, tempos máximos de fonação e capacidade vital em mulheres com disfonia organofuncional

OBJETIVO: verificar e correlacionar os tempos máximos de fonação (TMF) de vogais, a capacidade vital (CV) e os tipos de afecções laríngeas (AL) de mulheres com disfonia organofuncional (DOF). MÉTODO: pesquisa retrospectiva, transversal, exploratória, não experimental, quantitativa, com banco de dados de medidas de TMF [a, i, u], de CV e de AL de mulheres com DOF; e os testes estatísticos Qui- quadrado e exato de Fisher, para verificar as diferenças entre as variáveis e suas relações e o teste binomial, a fim de verificar a significância de proporção ou percentual da análise descritiva, com p&lt;0,05. RESULTADOS: a maioria (22; 75,86%) apresentou TMF significantemente reduzidos (p=0,0053) e sete (24,14%) TMF normais. A CV normal foi estatisticamente significante (p=0,0001) (26; 89,66%), mas três mulheres (10,34%) a apresentaram reduzida. Houve predomínio significante dos nódulos vocais (p=0,0016) (22; 75,86%), seguido de edema de Reinke (6; 20,69%) e de pólipo vocal (1; 3,45%). Dentre as 22 mulheres (75,86%) que mostraram TMF reduzidos, houve predomínio com CV normal (19; 86,36%), embora sem significância estatística (p=0,558). Das mulheres com TMF normais, todas apresentaram CV normal (7; 100%). A maioria com DOF apresentou CV normal, embora sem significância estatística (p=0,199). CONCLUSÃO: nas mulheres com DOF deste estudo, os TMF reduzidos, a CV normal e a presença de nódulos vocais foram significantes e não houve relação entre as variáveis TMF, CV e AL.

The Importance of Preoperative Laryngeal Examination Before Thyroidectomy and the Usefulness of a Voice Questionnaire in Screening

The objectives of this study were to emphasize the importance of preoperative laryngeal examination before thyroidectomy by investigating the incidence of coincident abnormal laryngeal conditions that impair the quality of voice, and evaluate the usefulness of the "thyroidectomy-related voice questionnaire" as a screening tool. Five hundred consecutive patients scheduled to undergo thyroidectomy underwent preoperative laryngeal examination and voice analysis and completed the questionnaire. According to the laryngeal examination results, patients were classified into normal and abnormal groups. Acoustic-analysis results and questionnaire scores were compared between the two groups, and correlations between acoustic parameters and questionnaire scores were evaluated. The cutoff score of the questionnaire that can effectively discriminate between the two groups was also determined. The incidence of abnormal laryngeal conditions was 35.8%. The most common finding was laryngopharyngeal reflux (27.2%) followed by vocal nodule (4.8%), vocal polyp (1.8%), vocal cord palsy (1.2%), Reinke's edema (0.4%), vocal cyst (0.2%), and vocal sulcus (0.2%). The perceptual grade of voice quality (0.33 ± 0.49 for normal group vs. 0.65 ± 0.62 for abnormal group, P = 0.000) and the questionnaire scores (3.21 ± 5.47 for normal group vs. 13.41 ± 11.67 for abnormal group, P = 0.000) of the two groups were significantly different, and there was a significant correlation between objective voice parameters and questionnaire scores. A questionnaire score of 5 showed the best sensitivity (74%) and specificity (71%) in discriminating between the two groups. The incidence of coincident abnormal laryngeal conditions is relatively high; therefore, voice screening before thyroidectomy is important. The "thyroidectomy-related voice questionnaire" is a simple and effective screening tool to detect preexisting laryngeal disorders that can affect the quality of voice.

Efficacy of percutaneous vocal fold injections for benign laryngeal lesions: Prospective multicenter study

Conclusion: Percutaneous steroid injection (PSI) may be a useful alternative modality for treatment of benign vocal fold lesions. Objectives: When patients refuse general anesthesia or voice therapy for benign vocal fold diseases (Reinke's edema, vocal polyp, nodule, and scarring), there are no other options available. We conducted an analysis of the effects of PSI as an alternative treatment for benign vocal fold diseases. Methods: From October 2008 to March 2010, 130 patients with benign vocal fold disease who refused general anesthesia or showed no response to voice therapy underwent PSI. From this group, the present study included 115 patients who completed the evaluation before PSI and at the first and third month after PSI and also an additional 25 patients who completed evaluation at the sixth month after PSI. Results: Among 115 patients in the study, 40 cases (34.8%) showed complete remission and 57 cases (49.6%) showed partial remission. As a result, overall improvement rates were 84.4%. Almost all objective and subjective parameters showed statistical improvement at the first and third month after PSI (p < 0.05). Jitter and all subjective parameters maintained statistical improvement until the sixth month. No severe complications, such as fold atrophy, were observed.