The Diagnostic Rate and Phonetic Characters of Benign Vocal Fold Lesions with Sulcus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is not uncommon in patients with benign vocal fold lesions with voice change to accompany sulcus. The authors postulated that the coexistence of such benign lesions with sulcus would result in numerous problems related with phonation. The aim of this study was to recognize through voice analysis any particular phonation characteristics in patients with benign vocal fold lesions with coexisting sulcus, and to aid in diagnosis and treatment. MATERIALS AND METHOD: The study involved 574 patients who had been diagnosed with benign vocal fold lesions that accompanied voice change from Jan. 2001 through Sept. 2002. The diagnosis was made by videostroboscopy. The benign vocal fold lesions were observed in patients with sulcus and those without sulcus. Also specific benign vocal fold lesions were grouped into pairs determined by the existence of sulcus. Thus, patients with vocal nodules accompanied with sulcus were grouped as group NS and those without sulcus as group N: similarly, patients with vocal polyp and sulcus were grouped as PS and those without sulcus as group P: patients with Reinke's edema and sulcus as group RS and those without sulcus as group R, and patients with laryngeal edema and sulcus were grouped as group LS and without sulcus as group L. Each individual group went through psychoacoustic, acoustic and aerodynamic analyses and were compared against each other. RESULTS: Among patients with benign vocal fold lesions, about 50.2% had sulcus. It was observed that the rate of finding patients with sulcus increased when we began to have keen interest in sulcus. Among patients with benign vocal fold lesions without the accompaniment of sulcus, the most common form of benign vocal fold lesions was the vocal nodule. With coexisting sulcus, the most common form was laryngeal edema. In the psychoacoustic analysis group, the group NS exhibited more hoarseness than the group N: the group R exhibited greater hoarseness than the group RS. However, these results did not have statistical significance. In the acoustic analysis, the group NS had significantly higher shimmer score than the group N. In the aerodynamic analysis, the group NS and PS had exhibited significanlyt higher MFR scores than the groups N and P. CONCLUSIONS: The existence of sulcus in patients with benign vocal fold lesions has a clinical significance regarding treatment and prognosis. Although some acoustic analytic references may be useful in discovering the accompanying sulcus, careful observation of all vocal cords remains the most important component of such discoveries.

The Study of Asymmetric Laryngeal Movements / 대한이비인후과학회지

BACKMROUND AND ackground and Objectives: Voice is produced by the vibration of the vocal fold mucosa and laryngeal movements affect its vibration. It is speculative that asymmetric laryngeal movements might be the cause of inadequate vibration of the vocal fold mucosa. Using the pharyngogram, authors studied the relation between the asymmetric laryngeal movements and laryngeal nodule in functional voice disorders. MATERIALS AND METHOD: Thirty patients with laryngeal nodule and thirty normal subjects were evaluated. All subjects were evaluated by an acoustic analysis and maximum phonation time. Laryngeal movements were investigated with a laryngostroboscopy. And we investigated the asymmetric movement of larynx and perilarynx using /i/ phonation pharyngogram. RESULTS: Acoustic analysis and maximum phonation time of the patients with laryngeal nodule were different with that of normal subjects. Asymmetry of arytenoid movements and asymmetry of thyroid cartilage protrudings were more common in patients with laryngeal nodule during the examination of the laryngostroboscopy. Asymmetry of pyriform sinus was more common in the patients with laryngeal nodule in the examination of the /i/ phonation pharyngogram. CONCLUSION: Laryngeal asymmetry might affect more commonly the vibration of the vocal fold mucosa in the patients with laryngeal nodule.

Rheumatoid Arthritis of the Larynx: A Case Report / 대한이비인후과학회지

Rheumatoid arthritis is a destructive systemic disorder of unknown etiology. The disease follows a prolonged and fluctuating course. It is characterized by periods of remission and exacerbation. Typically articular manifestations are encountered in the smaller peripheral joints. It has been estimated that 25% of patients with rheumatoid arthritis will show clinical evidence of laryngeal involvement in the course of disease course. Postmortem studies suggest that the actual incidence of laryngeal arthritis may be as high as 50-80%. Yet the studies of laryngeal arthritis have not been reported in Korea. It is thought that because of the lack of interest in laryngeal arthritis, a lot of diseases caused by laryngits or vocal cord paralysis have been overlooked. Authors report with a review of the literature that a patient who suffered from voice change and cord palsy was confirmed to have laryngeal arthritis.

Videokymographic Findings of Non-Organic Voice Disorders / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Non-organic voice disorders are very difficult to diagnose. The authors attempted to find out the efficiency of videokymography (VKG) which has been newly developed to evaluate the vibratory characteristics of the vocal folds in non-organic voice disorders. MATERIALS AND METHODS: Eighty-seven patients who had voice changes without organic laryngeal pathology were evaluated. We ascertained the larynx to be free of organic disorders using the stroboscopy, following which the VKG examination was performed. The results of VKG were classified according to the common features. RESULTS: Type I showed the normal findings. Asymmetry in the amplitude of upper lips was seen in the type II. Type III showed thick glottal contact. Type IV showed level difference, thick glottal contact and asymmetry in the amplitude of upper lips. Type V had several different amplitudes of the upper lip seen in one cycle of the mucosal wave. Type VI had level difference with thin glottal contact and asymmetry in the amplitude of upper. CONCLUSIONS: Based on these results, we were able to see the different types of VKG and that VKG could be used as a supplementary diagnostic tool in the non-organic voice disorders.

The Correlation of Tongue Position with Voice / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The tongue acts as a swallowing moderator, articulator and resonance maker. The tongue may also affect voice production. Authors tried to determine the relationship between the tongue position and voice changes, MATERIALS AND METHODS: Fifty normal subjects (male : female is 23: 27, Group A) between the ages of 20 and 30 years, and 40 subjects (male : female is 20: 28, Group B) with abnormal position of tongue (eg. ankyloglossia) between the ages of 20 and 40 years participated in this study. Subjects were asked about the history of hyperfunctional laryngeal disorders, such as, voice fatigue, frequent voice changes, odynophonia and globus symptoms. Afterwards, we made sure whether the tongue protruded over the lower lip, whether the tip had dimple shape when subject protruded the tongue, whether examiners grasped the tongue easily during laryngeal examination, and whether examiners could see the larynx easily during laryngeal examination or not. At last, concomitant laryngeal disorders were evaluated. RESULTS: The symptoms of hyperfunctional laryngeal disorders were more frequent in the group B. Abnormal tongue movements and functional laryngeal disorders were also more frequent in the group B. CONCLUSIONS: These findings suggest that limited tongue movements may affect voice changes.