[Clinical observation of traumatic granuloma after CO2 laser cordectomy and laryngopharyngeal reflux].

OBJECTIVE: Through clinical observation of granuloma after CO2 laser cordectomy under suspensive laryngoscope to discuss the effects of laryngopharyngeal reflux(LPR) to traumatic granuloma. METHODS: According to the classification of depth and range of CO2 laser cordectomy, 111 cases were divided into 5 groups, and the incidence of postoperative granuloma of each group was observed. The largest number of the 5 groups was 49 cases of type III CO2 laser cordectomy which was subdivided into 4 groups according to whether or not laryngopharyngeal reflux and whether or not proton pump inhibitor (PPI) treatment. RESULTS: In 111 cases, 56 cases (50.5%) developed granuloma after CO2 laser cordectomy. The incidence of traumatic granuloma after surgery was 10% (1/10), 26.1% (6/23), 53.1% (26/49), 78.6% (11/14), 80.0% (12/15) in I, II, III, IV, V type, respectively. It had statistical significance in chi-square test between 5 kinds of operative classification and the incidences of postoperative granuloma (χ² = 20.32, P < 0.01) and Spearman correlation analysis showed positive correlation between classification of operation and incidences of granuloma (r = 0.44, P < 0.01). According to LPR (-), LPR (+)and PPI (+), PPI (-), the incidence of granuloma had statistical significance in these 4 group patients of 49 type III cases (χ²= 5.83, P < 0.05). The incidence of granuloma after surgery was the lowest in LPR (-) PPI (+) group (30%) and the highest in LPR (+) PPI (-) group (80%), and it showed significant difference (χ² = 6.25, P < 0.05). CONCLUSIONS: With the increase of removal depth and the range after CO2 laser cordectomy, it appears rising trend in incidence of granuloma. Laryngopharyngeal reflux and PPI therapy on the incidence of traumatic granuloma has certain influence.

[Investigation of dependability of laryngopharyngeal reflux and disorders of phonation].

OBJECTIVE: To investigate the voice features of laryngopharyngeal reflux (LPR), and analyze the effects of LPR to the life qualities of patients. To analyze the dependability between objective and subjective ways. METHOD: One hundred and ninety-six of the patients who were suspected of LPR were received the surveys of general state, electronic nasopharyngolaryngoscope, evaluation of the reflux symptom index (RSI) and the reflux finding score (RFS). One hundred of patients whose RSI>13, RFS>7 were diagnosed as LPR and were received evaluation of voice handicap index (VHI), analysis of vocal acoustics and examination of glottogram. RESULT: The funda mental frequency included male and female depressed,the perturbation of fundamental frequency, the perturbation of amplitude and normalization noise energy increased. Differences were statistically significant (P<0.01) compa ring with the normal control. The contiguity rate depressed, maximum phonation time shorten, the differences in which were statistically significant (P<0.01) comparing with the normal control. In the evaluation of VHI, the score of physiology was the highest, the function was second and the emotion was the lowest. The RSI and VHI had correlations (P<0.05), while RFS, RSI and VHI had not (P>0.05). Physiology, function and emotion had correlations in LPR. CONCLUSION: From the analysis of vocal acoustics and examination of glottogram,we knew that vocal function was effected because the vocal cord was injured by LPR. The fundamental frequency depressed and the vibrations of vocal cords were not instability, glottis wasn't closed up well and contact time was depressed. Patients who had the reflux symptoms uncertainty had the reflux findings.