Clinical comprehensive evaluation of Jinsang Sanjie Pills/Capsules in treatment of vocal nodule/polyp of vocal cord / 中国中药杂志

This study used health technology assessment methods and multi-criteria decision analysis(MCDA) model, according to the guideline for clinical comprehensive evaluation of Chinese patent medicine, we developed this assessment tool. The comprehensive evaluation score of Jinsang Sanjie Pills/Capsules is calculated based on the additive model. This score is calculated by "quantitative evaluation software v1.0 for clinical comprehensive evaluation of Chinese patent medicines" which developed by the project team. The evaluation yielded the following results.(1)Effectiveness: compared with the control group, Jinsang Sanjie Pills/Capsules can improve the total effectiveness rate of vocal nodule/polyp of vocal cord, and improve the symptoms and signs.(2)Safety: Jinsang Sanjie Pills/Capsules did not show acute toxicity and long-term toxicity. The most common adverse reaction was gastrointestinal system damage, all of the adverse reactions were either improved or cured.(3)Economy: from the perspective of the health system, evaluating the single use or combination of Jinsang Sanjie Pills/Capsules with conventional medication in the treatment of vocal nodule/polyp of vocal cord is relatively effective and cost-effective compared to conventional medication, with a stable cost-effectiveness advantage.(4) Innovation: Jinsang Sanjie Pills/Capsules are used for the treatment of slow throat paralysis(vocal nodules, polyp of vocal cord, thickening of vocal mucosa) caused by heat toxin accumulation, Qi stagnation and blood stasis, and the resulting hoarseness. Jinsang Sanjie Pills/Capsules have good innovation and targeted indications.(5) Suitability: the investigated doctors, pharmacists and patients all believed that Jinsang Sanjie Pills/Capsules have good suitability.(6)Accessibility: Jinsang Sanjie Pills/Capsules are included in the category B of the National Basic Medical Insurance, Work Injury Insurance, and Maternity Insurance Drug Catalogue(2021 edition), which have good cost-effectiveness and affordability for medical insurance and self-paid patients. Jinsang Sanjie Pills/Capsules do not contain endangered animals and plants. The supply of raw materials can meet the demand of production at present. The comprehensive evaluation score is 76.06 points. Based on all dimensions of evidence, 71.4% experts consensus on Jinsang Sanjie Pills/Capsules is class A, which can be directly converted into decision making. This study comprehensively evaluated the clinical application value of Jinsang Sanjie Pills/Capsules in the treatment of vocal nodule/polyp of vocal cord, so as to provide evidence for their rational clinical use and regulatory decision-making.

The Study of Combined Voice Therapy with Intralaryngeal Injection

BACKGROUND AND OBJECTIVES: Though voice therapy is proven to be effective in academia, treatment results and satisfaction level are inconsistent in clinics. The inconsistency may rise from diverse vocal cords misuse patterns in patient population as they suffer from different diseases or have bad phonation habits. In order to overcome the limitation, we uniformized patients' vocal cords with injection laryngoplasty prior to voice therapy. The efficacy of voice therapy and consistency in treatment results after injection laryngoplasty were assessed. MATERIALS AND METHODS: Patients diagnosed with vocal nodules were either treated with injection laryngoplasty followed by voice therapy (combined treatment group) or voice therapy only (voice therapy group). Each group consisted of 15 patients. Acoustic measures (jitter, shimmer, NHR), aerodynamic measures (MPT, Psub, MAFR), and subjective auditory conscious measures (K-VHI, K-VRQOL) between two groups were analyzed. RESULTS: After treatments, both groups improved in terms of acoustic, aerodynamic, and subjective auditory conscious measures compared to pre-treatment. Combined treatment group had statistically significantly greater improvement in shimmer, P in K-VHI, and PF in K-VRQOL compared to voice therapy group. CONCLUSION: Injection laryngoplasty treatment prior to voice therapy synergizes in treating patients compared to voice therapy only.

Efficacy of Voice Therapy Combined with Drug Therapy in the Patients with Vocal Nodules / 听力学及言语疾病杂志

Objective To study the efficacy of voice therapy combined with Jinsangsanjie pill in patients with vocal nodule .Methods A total of 146 patients with vocal nodes were randomly divided into three groups :45 cases in group A(single Jinsangsanjie pill therapy) ,47 cases in group B(single voice therapy) and 54 cases in group C(voice therapy combined with Jinsangsanjie pill therapy) ,30 healthy adults were as a normal control group .The treatment lasted 1 month .The results were evaluated by voice handicap index ,voice acoustic analysis and electronic laryngo‐scope which were collected before and after 1 month treatments .Results The VHI ,jitter ,shimmer and NNE of all patients were reduced while the MPT was increased after the treatment .The differences were significant (P0 .05) .Conclusion The voice therapy combined with Jinsangsanjie pill in the treatment of vocal nodules is more efficiently ,and can improve patient’s pronunciation features .

Evaluate the Efficacy of Ganju Bingmei Pill Combined with Voice Therapy in the Treatment of Vocal Nodules / 听力学及言语疾病杂志

Objective To investigate the efficacy of Ganju Bingmei Pill combined with voice therapy in the treatment of vocal nodules .Methods A total of 72 patients with vocal nodules and 60 health people in our hospital were included .Patients were randomly divided into two groups :Group A (36 cases) with Ganju Bingmei Pill thera‐py ,group B (36 cases) with Ganju Bingmei Pill combined with voice therapy .Taking method of Ganju Bingmei Pill was three times a day ,2 tablets every time ,two weeks as one course of treatment with a total of four courses .Voice therapy in Group B was two weeks for one course with a total of four courses .The results were evaluated by voice handicap index ,voice acoustic analysis and laryngostroboscopy .Vocal nodules disappear or significantly reduce indi‐cated that the treatment was effective .Statistical analysis was performed using t - test and chi - square test .Results In group A ,the scores of T ,F ,P ,E were reduced compared with before treatment (P 0 .05) .The VHI score in group B were significantly lower than those of in group A (P 0 .05) .The F0 of group B after treatment was higher than group A ,jitter and shimmer were lower than group A after treatment (P< 0 .05) . After treatment ,there were 28 cases of group A (77 .78% )of patients with vocal nodules disappear or significantly reduce .There were 35 cases of group B(97 .22% ) of patients with vocal nodules disappear or significantly reduce , the effective rate between group A and group B was statistically significant (P< 0 .05) .Conclusion Ganju Bingmei Pill therapy and Ganju Bingmei Pill therapy combined with voice therapy all have curative effect for the treatment of vocal nodules however ,Ganju Bingmei Pill therapy combined with voice therapy is more efficient .

The Effects of Botulinium Toxin in Vocal Nodules / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Vocal nodules are the most common voice disorder due to vocal misuses. Vocal nodules are primarily treated with voice therapy and are rarely removed through laryngomicrosurgery. Although the rate of recovery for individual patients may vary, 60-70% of them are fully treated. Because vocal nodules have many possible causes, 30-40% of patients remain untreated. Also, vocal nodules recurrence after the surgical treatment is sometimes observed. The author claims that incomplete contact between vocal cords during phonation is a major cause of the vocal nodules. Most vocal nodules do occur from incomplete contact between vocal cords during phonation, and various voice therapies are designed to improve habitual misuses of the vocal cords. However, vocal nodules tend to remain unhealed unless patients change their habitual misuses of the vocal cords. The cricothyroid muscle tension is known to hinder the contact between vocal cords. The author injected a restricted amount of botulinium toxin to the cricothyroid muscle to reduce the muscle tension and observed changes in vocal cords' movement. SUBJECTS AND METHOD: In this study, the author injected botulinium toxin to the cricothyroid muscle of 21 patients. For 2-4 weeks, we observed patients' responses to the treatment, by measuring changes in subglottal pressure, mean air flow rate, maximum phonation time, jitter, shimmer, noise-to-harmonic ration of patients and subjective evaluation of voice changes. In addition, the author conducted stroboscopy to evaluate the usefulness of the treatment. RESULTS: The improvement was in the subjective evaluation of voice changes and stroboscopic findings. CONCLUSION: The observation demonstrated a great improvement in vocal nodules after the injection of botulinium toxin into the cricothyroid muscle.

Usefulness of Voice Therapy on Vocal Nodules in Professional Voice Users Treated with Steroid Injection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A local steroid injected directly into the vocal nodules has recently come to the forefront as another treatment option, which is reported as useful and effective. However, vocal nodules are caused mainly by excessive voice use, and therefore, even if a marked improvement was shown after injection, recurrence can occur unless the voice abuse habit is changed. We hypothesized that voice therapy after steroid injection would reduce recurrence of vocal nodules in professional voice users. SUBJECTS AND METHOD: This prospective study included thirty female professional voice users with vocal nodules treated with vocal cord steroid injection on between May 2010 and March 2011. The experimental group (n=15) received the voice therapy after vocal cord steroid injection, and the control group (n=15) received only vocal cord steroid injection. Videostroboscopy, acoustic voice analysis, and Voice Handicap Index (VHI) were evaluated prior to the steroid injection and 4 and 8 weeks after steroid injection. RESULTS: Jitter, shimmer, noise-to-harmonics ratio, and mean VHI improved significantly after steroid injection in both group (p<0.05). There was no significant complication and voice discomfort after steroid injection in both groups. And, there were no significant differences in all parameters between the two groups. However, the experimental group (13.3%) showed less recurrence rate of vocal nodules than the control group (53.3%) after 8 weeks. CONCLUSION: Vocal cord steroid injection was useful treatment option of vocal nodules in professional voice users. And voice therapy after steroid injection would be effective in preventing a recurrence of vocal nodules than only steroid injection.

Aerodynamic Measure of the Phonation in Patients with Vocal Polyps and Vocal Nodules / 听力学及言语疾病杂志

Objective To investigate the aerodynamic characteristics of vocal polyps and vocal nodules.Methods Aerodynamic parameters of 58 patients with vocal polyps or vocal nodules and 30 normal adults were measured by Aerophone Ⅱ Voice Function Analyzer.The mean airflow rate,intraoral pressure,glottal resistance,glottal efficiency were compared among different group.Results The mean airflow rate,glottal resistance and glottal efficiency of vocal polyps,vocal nodules and normal adult were 254.50±36.02 ml/s,33.55±4.63 cmH_2O/(L·S),2.46±1.49,177.45±25.93 ml/s,38.83±8.88 cmH_2O/(L·S),7.75±3.71,118.44±29.98 ml/s,53.04±8.64 cmH_2O/(L·S),9.17±3.87,respectively.The difference between them was significant(P＜0.01).The difference of intraoral pressure between vocal polyps (8.97±1.36 cmH_2O) and normal adult (6.24±0.99 cmH_2O) was significant (P＜0.01).The mean airflow rate,glottal resistance,glottal efficiency were significantly different between vocal polyps and vocal nodules(P＜0.01).Conclusion The degree of vocal fold adduct and the effciency of voice production in vocal polyps is worse than that of vocal nodules.The aerodynamic parameters can make quantifiable,objective assessment in voice function of vocal polyps and vocal nodules.

The Application of Remifentanil Intravenous Anesthesia in Vocal Nodule Extirpation / 医学研究杂志

Objective To study the application of doses of remifentail intravenous anesthesia in vocal nodule extirpation.Methods Sixty ASAⅠ～Ⅱpatients with vocal nodule were selected and randomly divided into three groups. Group F were given anesthetic induction with fentanil and maintenance with isoflurane; Group L were given anesthetic induction and maintenance with remifentail at the dose of 0.5?g/(kg?min); Group H were given anesthetic induction and maintenance with remifentail at the dose of 1?g/(kg?min).The anesthetic induction time,blood flow dynamics during maintenance phase,recovery time and quality were recorded. Results (1)Anesthesia produce less circulatory fluctuation in group H than in group F and L.(2) Group L and H were faster than group F on recovery profile including the time of response to verbal commands,autonomous breathing,tracheal extubation and discharging from operating room. The OAA/S score was higher in group L and H than in group F 5 min after intubation. There were no significant differences between group L and H. Conclusions Remifentanil intravenous anesthesia can achieve better recovery profile from anesthesia than fentanyl in vocal nodule extirpation. 1?g/(kg?min) remifentanil can inhibit the stress responses to tracheal intubation and laryngoscope inserted effectively with a stable circulatory function.

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.

A Case of Giant Vocal Nodule / 대한이비인후과학회지

Vocal nodule is a common otolaryngological disease characterized by hoarseness and vocal fatigue. It occurs as discrete, 3-5 mm, excrescence at the junction of the anterior and middle third of the vocal folds in general. We report a recently encountered case of giant vocal nodule arising from the left vocal cord. The nodule was 3X3 cm in diametera and was found in a 43 years old male patient. The tumor mass was sucessfully removed by microlaryngeal surgery with CO2laser under general anesthesia. Immunohisto-chemical staining proved that it was a vocal nodule.

Type IV Collagen and Fibronectin Deposition of Basement Membrane and Lamina Propria in Benign Laryngeal Lesion / 대한이비인후과학회지

Benign laryngeal injuries have been usually differentiated by the clinical finding. Traditionally the pathologic findings between the polyps and nodules by hematoxylin and eosin(H and E) staining looks alike. So we have used immunohistochemical technique to differentiate the laryngeal response to injury. We have studied 25 paraffin embedded tissues(20 cases: vocal polyps, 5 cases: vocal nodules) to compare their distribution of fibronectin and type IV collagen in vocal fold lamina propria by using their monoclonal antibodies. We have chosen fibronectin, a critical structural glycoprotein in the lamina propria, because of its deposition as a result of tissue injury and type IV collagen because of its location only in the basement membrane zone. The results were as follows: 1) In vocal polyps there were sparse fibronectin(less than normal) staining in superficial layer of lamina propria and the type IV collagen staining in basement membrane zone shows thin, normal thickness band form. These suggests that the injury often seems to be confined to the lamina propria only without basement membrane zone disruption. 2) In voal nodules there were intense fibronectin staining(more than normal) in the superficial layer of the lamina propria and the type IV collagen band in basement membrane shows thick and often coupled with disruption injury. The above results represent only two structural proteins, but it may be possible to suggest that the pathogenesis and the development origin of these laryngeal injuries are different. The deposition of fibronectin may explain why some nodules do not respond to voice therapy and suggest the following better treatment.