The Usefulness of Postoperative Direct Voice Therapy in Vocal Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Previous studies have suggested the usefulness and importance of postoperative voice therapy, for which there are indirect and direct methods. The aim of this study was to evaluate the efficacy of treatment according to different voice therapy methods. SUBJECTS AND METHOD: Patients with vocal polyp were divided into three groups. Group 1 received direct voice therapy after phonomicrosurgery and Group 2 indirect voice therapy after phonomicrosurgery. Group 3 did not receive any voice therapy. RESULTS: Perceptual, acoustic, aerodynamic voice outcome parameters differed significantly between pre and post-operative treatments. In almost all of the voice analysis, Group 1, who underwent direct voice therapy, improved more significantly compared with Group 2 and 3. CONCLUSION: Postoperative voice therapy following phonomicrosurgery may be an effective adjuvant treatment in patients with vocal polyps. In particular, direct voice therapy can be effective for improving postoperative voice outcome.

Acoustic and Auditory-Perceptual Evaluation as Predictor of Voice Recovery after Laryngeal Microsurgery in Patients with Vocal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate acoustic (acoustic voice quality index, AVQI) and auditory-perceptual evaluation (grade, rough, breathy, asthenic, strained; GRBAS and consensus auditory-perceptual evaluation of voice; CAPE-V) as a predictor of voice recovery after laryngeal microsurgery (LMS) in patients with vocal polyp. SUBJECTS AND METHODS: A total of 68 patients with vocal polyp participated in this study. Voice samples were analyzed for AVQI by Praat and auditory-perceptual ratings were performed by three speech language pathologists. Voice handicap index-10 (VHI-10) was evaluated by patients themselves. RESULTS: Decreased AVQI, VHI-10, overall severity (OS), and increased smoothed cepstral peak prominence (CPPS) values were measured and statistically significant changes were noted after LMS. The ratio of Grade 0 and Grade 1 was increased. AVQI was correlated with CPPS, Grade, and OS, but not with VHI-10. The voice recovery of pedunculated polyp appeared in all vocal polyp sizes after LMS, but statistically significant differences were found only in small and medium sizes. After LMS of sessile polyps, AVQI, VHI-10, and OS decreased whereas CPPS increased; however, statistically significant difference was confirmed only in VHI-10 and OS. The receiver operating characteristic curve analysis showed the following results: AVQI [cutoff=5.5, sensitivity=61.8%, specificity=76.5%, area under the curve (AUC)=0.712], CPPS (cutoff=5.0, sensitivity=89.7%, specificity=48.5%, AUC=0.743), VHI-10 (cutoff=13.0, sensitivity=77.9%, specificity=89.7%, AUC=0.893), Grade (cutoff=2.0, sensitivity=70.6%, specificity=69.1%, AUC=0.728), and OS (cutoff=51.0, sensitivity=86.8%, specificity=66.2%, AUC=0.833). CONCLUSION: Acoustic and auditory-perceptual variables showed significant positive changes and predicted recovery of voice. In this study, we believe that the acoustic and auditory-perceptual evaluations.

Fiberoptic Laryngeal Laser Surgery

With recent developments in medical technology and the introduction of various types of lasers, the role of fiberoptic laryngeal laser surgery (FLS) in laryngology has been significantly expanded. FLS are typically performed under local anesthesia, and patients may return to normal activities immediately after the procedure. This corresponds to the current trend of minimally invasive surgery and may limit unnecessary general anesthesia, reduce medical costs, and increase patient compliances. Main indications of FLS procedure were vocal polyp, recurrent respiratory papillomatosis, vocal fold granuloma and vocal fold dysplasia. In this review, we discuss practical tips and unique value of FLS.

A Case of Sarcomatoid Carcinoma of the Larynx Mimicking Vocal Polyp

Sarcomatoid carcinomas are biphasic tumors which have surface epithelial changes and an underlying spindle-shaped neoplastic proliferation. A 62-year-old male with hoarseness came to our hospital for evaluation. A single smooth polypoid lesion was detected on his right true vocal fold by larnygoscope. The patient was diagnosed with vocal polyp and treated with surgical excision. Pathology report of the excised specimen was compatible with sarcomatoid carcinoma. Therefore, further surgical resection was performed to secure safety margins. We report a case of a sarcomatoid carcinoma patient who was clinically diagnosed as vocal polyp.

Huge Subglottic Polyp Treated with Tracheotomy and Laryngofissure

Vocal polyps are benign laryngeal lesions which arise from the Reinke's space abd hoarseness is the most common symptom. However, airway compromised is rarely presented in the vocal polyp. A rare case of large subglottic polyp causing dyspnea is reported. Tracheostomy was performed under local anesthesia and then the mass was resected under general anesthesia using a laryngofissure approach. The dyspnea and hoarseness disappeared after surgery immediately. The histopathological findings indicated a diagnosis of vocal cord polyp with chronic inflammatiuon. We consider that tracheostomy is the safest and most useful procedure to guarantee the upper airway in cases of large vocal polyp showing dyspnea. We hereby report a case of huge subglottic polyp in which a tracheostomy and laryngofissure was required for removing the subglottic mass successfully.

The Correlation between The Size and Location of Vocal Polyp and Voice Quality, Before and After Laryngeal Microsurgery

BACKGROUND AND OBJECTIVES: Vocal polyps are caused by inflammation induced by stress or irritation. Many patients with vocal polyps complain voice discomfort. For vocal polyps, surgery such as laryngeal microsurgery has been the mainstay of management. We analyzed the clinical features of vocal polyps, and how the size and location of vocal polyps affect the outcomes of surgery. METHODS: We retrospectively reviewed 42 patients from March 2014 to December 2015, who were diagnosed as unilateral single vocal polyp. When we operated on a vocal polyp with laryngeal microscopy, we measured their size and location. The quality of voice was evaluated by GRABS scale, jitter, shimmer, NHR (noise to harmonic ratio), MPT (maximum phonation time), and VHI (voice handicap index) before operation and 4 weeks after operation. RESULTS: When we divided the patients into large-sized vocal polyp group (the longest length >3 mm) and small-sized vocal polyp group (the longest length ≤3 mm), all parameter differences tend to be greater at large sized vocal polyp. However, these differences were not statistically significant (p>0.05). When we divided into two groups depending on the volume of vocal polyp, no distinct tendency was found. When we compared the location (anterior, mid and posterior) of vocal polyp with the improvement of voice quality, more change was found at mid portion vocal polyp, except the difference of VHI. However, these differences were also not statistically significant (p>0.05). CONCLUSION: All parameter differences tend to be greater at large vocal polyp and polyp of the mid location.

The Effects of Phonosurgery Combined with Voice Therapy for Vocal Polyps Accompanied with Muscle Tension Dysphonia / 听力学及言语疾病杂志

Objective To evaluate the effects of phonosurgery combined with voice therapy in patients with vocal polyps accompanied with muscle tension dysphonia (MTD) .Methods The study retrospectively enrolled 117 patients with a diagnosis of vocal polyps accompanied with MTD .All the patients were divided into two groups ac‐cording to the different remedies:the surgery group (n=57) ,and the combination group (n=60) .The Xion acous‐tic analysis was carried out on the two groups before and after therapy .We compared the results in each group ,the results of post-therapy between two groups ,and that of post-therapy with the control group(n=50) .The acous‐tic parameters were jitter percent (jitter) ,shimmer percent (shimmer) ,dysphonia severity index (DSI) .Results The results obtained in the study showed that all the voice analysis parameters were significantly improved after therapy in both the surgery group and combination group(P0 .05) .Conclusion As for vocal polyps accompanied with M TD ,successful phonosurgical treatment and voice therapy can improve patients’ voice quality .

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.

Effect of Vocal Hygiene Education in the Patients with Vocal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgical removal is generally known as the gold standard treatment of vocal polyp. However, the authors have not infrequently observed marked reduction or complete disappearance of the vocal polyps when vocal hygiene education was provided as a part of preoperative routine preparation. The aim of this study was to assess the effect of vocal hygiene education and to define the factors that can predict which patients with vocal polyp will get benefits from it. SUBJECTS AND METHOD: We reviewed the medical records of 190 patients with vocal polyp, and selected 88 patients who had received vocal hygiene education and completed a series of follow-up evaluation at 3 months later. According to the change of polyp size, patients were grouped into two: improvement and no improvement group. Eight factors (age, gender, duration of hoarseness, initial polyp size, hemorrhagic change of vocal polyp, degree of occupational voice abuse, smoking, and presence of reflux symptoms )were compared between the two groups. RESULTS: When given the vocal hygiene education, 19% of overall 190 patients and 41% of 88 patients who were followed up belonged to the improvement group. Univariate analyses showed that female patients, shorter duration of hoarseness, smaller polyp size, less occupational voice abuse, and no smoking are the meaningful favorable predictive factors. Multivariate analyses demonstrated that female patients with a small polyp and no symptoms of reflux have the largest possibility of getting improved. CONCLUSION: Vocal hygiene education should be provided as a first line of treatment for patients with vocal polyp, especially when a female patient without reflux symptom has a small polyp.

Electronic laryngoscopic diagnosis and therapy for laryngeal diseases / 第二军医大学学报

Objective: To study the diagnostic and therapeutic effects of electronic laryngoscope in treating laryngeal diseases and discuss some problems concerned. Methods: Follow up studies were conducted in 846 patients with laryngeal diseases who were treated electronic laryngoscopically in our department and sex, site of lesion and therapeutic effect were analyzed. Results: The incidence of vocal polyp and nodules in female was significantly higher than that in male, and vise versa in vocal cyst and leukoplakia. Vocal nodules could be located bilaterally, while vocal cyst unilaterally. The operative style applied showed good therapeutic effect. The effective rate for vocal polyp, nodule, and cyst was 99.84%~100%, and that for vocal leukoplakia, 66.67%. Conclusion: Operation under electronic laryngoscope has advantages of rapid performance, small dead angle, high accuracy, few complications, clear image, and little pain, and is beneficial to early diagnosis and treatment of laryngeal diseases. So it is worthy of wide application. [

Observation of Vocal Polyps Treated with CO_2 Laser and Laryngeal Microsurgery / 听力学及言语疾病杂志

Objective The present study aimed at the effect observation of vocal polyps treated with CO2 laser and laryngeal microsurgery. Methods The subjects were 60 patients, 30 were treated by CO2 laser and 30 by laryngeal microsurgery. A set of tests had been routinely used for vocal polyp patients in this study. The tests included(1) indirect laryngoscopic examination,(2)voice analysis: PPQ(pitch perturbation quotient), APQ(amplitude perturbation quotient), H/N(harmonics to noise ratio).(3)psychoacoustic evaluation: GRBAS method: Grade(G), Rough(R), Breathy(B), Asthenic(A), Strained(S). Results After operation, the recovery time of vocal cord for CO2 laser treated group was longer than that in the laryngeal microsurgery group. The acoustic parameters PPQ for CO2 laser group were larger than that in the laryngeal microsurgery group, moreover H/N values were smaller than that in laryngeal microsurgery group. The psychoacoustic evaluation for CO2 laser group was rough and strained, and for laryngeal microsurgery group was only rough. Conclusion The curative effect of laryngeal microsurgery is definite. Microsurgery is better than CO2 laser when recovery time and vocal function improvement are considered.

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.