The Application of I-Scan Imaging for Evaluating Benign Vocal Lesions.

Current standard methods for evaluating benign vocal lesions, including white light laryngoscopy and video laryngostroboscopy, may struggle to identify smaller lesions. While histopathological results obtained from laryngeal microsurgery provide definitive results, their invasiveness can lead to scarring and impaired phonological outcomes. Intralesional steroid injection has recently gained acceptance, but it lacks pathological diagnostic capabilities. Therefore, there is a growing need for a simple examination that can enhance the diagnosis of benign vocal lesions. NBI, from Olympus Corporation, has shown promising outcomes in detecting and characterizing laryngeal lesions. The i-scan technology by PENTAX, while providing the ability to improve visual clarity during endoscopic procedures, has been addressed less in this field. Our study aims to further investigate the application of i-scan imaging in benign vocal lesions, enrolling patients diagnosed with vocal cysts, polyps, and nodules. We conducted i-scan imaging prior to office-based intralesional steroid injection, assessing the possibility of its providing additional diagnostic information for benign vocal lesions without additional burden.

Laryngeal Cellular Myxoma Presenting as Vocal Polyp.

Laryngeal myxoma is an uncommon benign mesenchymal neoplasm. It usually presents as a laryngeal polyp with a history of progressive hoarseness. Although benign, they have a propensity for recurrence if not excised properly. The diagnosis of laryngeal myxoma can only be rendered after histopathological evaluation. The laryngeal myxoma can be further classified as cellular myxoma and angiomyxoma, depending on the stromal cellularity and stromal vascularity, respectively. Herein, we report a case of a 66-year-old lady who presented with a cellular myxoma of the larynx. We believe that this is the second case of laryngeal cellular myxoma. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03291-y.

Multiple vocal fold lesions in a single patient.

We report the case of a 48-year-old woman, a teacher, with recurrent severe dysphonia and multiple and different lesions at the same time in her vocal folds. The evolution of the lesions and the possible mechanism by which they have been associated in the same patient are commented.

Dysphonia: Epidemiology, Diagnosis and Risk Factors at Tertiary Health Care Center.

The physical, mental, financial, social and emotional constraints encountered by an individual having voice disorder can be easily anticipated as communication is the utmost need in day to day life and some professions. To study the clinical epidemiology of voice disorders in surrounding population and identify the risk factors. It also intended to make people aware of vocal hygiene programme. This observational, prospective, cross sectional study was conducted in Chirayu medical college and hospital, Bhopal from September 2016 to August 2017. All the patients were subjected to diagnostic flexible video laryngoscopy and stroboscopy and in some patients Chest X-ray PA view, USG Neck, Computerized tomography and Magnetic resonance imaging were advised for the confirmation. Amongst 45 patients who formed this study group, male preponderance was seen with male to female ratio of 2.2:1. Laryngeal malignancy (13 cases) was the commonest pathology, followed by vocal polyp (7 cases) and vocal cord palsy (6 cases). Rare cases of tubercular laryngitis and hemorrhage were also diagnosed. The largest group of patients belonged to labor/farming occupation suggesting the rural referral to this tertiary care center followed by housewives.

First-line treatment of exudative vocal fold-lesions by in-office local corticosteroid injection: A literature review.

OBJECTIVES: There are emerging reports of the effectiveness of in-office awake vocal-fold corticosteroid injection in the treatment of exudative vocal-fold lesions. The aim of this study was to review this therapy and specify indications, practical modalities and outcomes. STUDY DESIGN: Systematic review of the literature without meta-analysis. METHODS: A systematic review by PubMed search for the period January 2000 to December 2018 was carried out. RESULTS: Nine articles were included, for a total of 502 lesions: nodules (46.4%), polyps (31.7%), and Reinke's edema (21.9%). Submucosal injection of low-dose triamcinolone acetonide (0.1 to 0.3mL) was transoral, transcutaneous or transnasal via flexible endoscope with operating channel. Lesion volume was significantly reduced in more than 90% of cases, with significant vocal improvement in all studies. Relapse rates ranged between 4% and 31%, with time to relapse of 1 to 40 months. CONCLUSIONS: First-line treatment of exudative glottic lesions by submucosal corticosteroid injection provides at least transient significant reduction in lesion volume and vocal improvement. It is consensually reserved to moderate-sized mainly exudative lesions without fibrosis. In-office injection provides an immediate therapeutic response in case of vocal impairment, enabling surgery under general anesthesia to be postponed.

Recurrence of benign phonotraumatic vocal fold lesions after microlaryngoscopy.

OBJECTIVES: To determine recurrence rates for benign phonotraumatic vocal fold lesions after microlaryngoscopic surgery. STUDY DESIGN: Retrospective review. METHODS: Records of adults who underwent microlaryngoscopy between 2006 and 2017 for vocal fold cysts, midfold masses, polyps, pseudocysts, sulcus vocalis (Ford type 3), and varices were reviewed for demographics, medical history, treatment, and lesion recurrence. Patients operated for nonphonotraumatic lesions (e.g., granuloma, keratosis/leukoplakia, papilloma) were excluded. Stroboscopic examinations were re-reviewed to confirm diagnosis and outcome. RESULTS: Five hundred ten adults (223 male:287 female; mean age 40.3 ± 14.9 years) were included. Overall, 62 of 510 (12.2%) recurred (median time to recurrence: 70.0 months). Of these, 44 (71.0%) recurred to the same lesion type and 49 (79.0%) to the same side. Recurrence rates by initial lesion type were as follows: cysts, two of 92 (2.2%); midfold masses, four of 18 (22.2%); polyps, 25 of 235 (10.6%); pseudocysts, 30 of 145 (20.7%); sulcus vocalis, one of 18 (5.6%); and varices, zero of two (0%) (χ 2 = 28.7, degrees of freedom [df] = 5, P < 0.001). No significant difference in recurrence existed between males (21 of 223, 9.4%) and females (41 of 287, 14.3%). However, young adults (17 of 86, 19.8%) had significantly higher recurrence rates compared to middle-aged (12 of 155, 7.7%) and older adults (3/60, 5.0%) (χ 2 = 9.5, df = 3, P = 0.023). Of 62 recurrences, 18 were re-operated and four re-recurred. CONCLUSION: Benign phonotraumatic vocal fold lesions recur at variable rates. This variation suggests pathophysiologic differences between categories that may not be entirely explained by behavioral factors. LEVEL OF EVIDENCE: 4 Laryngoscope, 130: 1989-1995, 2020.

The association of sulcus vocalis and benign vocal cord lesions: intraoperative findings.

OBJECTIVE: To investigate the presence of sulcus vocalis in patients who underwent phonomicrosurgery due to benign vocal cord lesions. METHODS: Between January 2013 and June 2018, the records of 133 patients who underwent operations for benign vocal fold pathology were retrospectively reviewed. Intraoperative findings of the patients were noted. Patients were divided into two groups: patients with only benign vocal fold lesions (BVFL) and patients with benign vocal fold lesions and accompanying sulcus vocalis (SV + BVFL). RESULTS: In total, 67 patients (50.4%; 38 females, 29 males) had BVFL and 66 (49.6%; 37 females, 29 males) had SV + BVFL. The patients in the SV + BVFL group were significantly younger than those in the BVFL group (p = 0.039). The sulcus was unilateral in 60.6% of the patients. The presence of sulcus vocalis was 49% and 47.6% in patients with a diagnosis of polyps (n = 51) and cysts (n = 42), respectively. A total of 12 of 13 patients with multiple benign vocal fold lesions had accompanying sulcus vocalis. CONCLUSION: Approximately half of the patients who underwent operations for benign vocal fold lesions had accompanying sulcus vocalis. More than half of the sulcus associated with benign lesions was unilateral.

Efficacy of Intralesional Steroid Injection in Small Benign Vocal Fold Lesions.

OBJECTIVES: The present study was conducted to study the efficacy of intralesional steroid (ILS) injection in small benign vocal fold lesions and compare the outcomes with microlaryngeal surgery in terms of improvement in symptoms and reduction in lesion size. METHODS: The current randomized control trial was conducted in the Department of Otolaryngology at the Postgraduate Institute of Medical Education and Research in Chandigarh between 2014 and 2015. The clinical diagnosis was based on appearance of the lesion during endoscopy and the mucosal vibration pattern. Subjects with lesions of size less than or equal to 5 mm were included. RESULTS: A total of 29 subjects were included in the study and 15 (nine men and six women) of them were randomized to receive ILS injection. Fourteen (13 men and one woman) were randomized to the second group to receive initial microlaryngeal surgery. We noted significant reduction in the size of the lesion among subjects undergoing ILS injection at 12 weeks (1.11 + 1.45 mm) as compared to baseline (2.63 + 1.28 mm) with no recurrence. CONCLUSIONS: ILSs are effective in reducing size of lesion and also improve acoustic parameters, perceptual analysis, and grade of dysphonia in patients presenting with small benign vocal cord lesions.

Clinical Significance of Contralateral Reactive Lesion in Vocal Fold Polyp and Cyst.

OBJECTIVE: We investigated the clinical significance of contralateral reactive lesions in patients undergoing laryngeal microsurgery for benign vocal fold lesions such as vocal polyps and cysts. STUDY DESIGN: This was a retrospective, single institution cohort study. METHODS: Patient medical records were reviewed for demographic characteristics; acoustic, aerodynamic, and perceptual analyses; and Voice Handicap Index score before and after laryngeal microsurgery. Definitive diagnoses were made via intraoperative microlaryngoscopic evaluations. Clinical parameters were assessed to identify risk factors for contralateral reactive lesions. We evaluated surgical outcome using voice analysis. RESULTS: We enrolled 268 patients (109 men and 159 women) with benign vocal fold lesions. A total of 195 (72.8%) had a contralateral reactive vocal fold lesion. A multivariable analysis revealed that being a never smoker and having a hoarseness duration ≥6 months, vocal polyps, and small primary lesions were independent risk factors for contralateral reactive lesions (P <0.05). The preoperative perceptual evaluation and maximum phonation time were significantly worse in patients with a contralateral reactive lesion than in those without one (P = 0.014, P = 0.004, respectively). The voice parameters in patients who underwent excision of the contralateral reactive lesion were generally better than those who received conservative treatment, particularly the noise-to-harmonic ratio (P = 0.004). CONCLUSIONS: Contralateral reactive vocal fold lesions are frequently detected in patients with vocal polyp and cyst. The reactive lesions had an adverse effect on voice quality. Simultaneous excision of primary and contralateral reactive lesions may be an alternative treatment for better voice outcome.

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.

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.

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.

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.

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.

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.

Comparison of vocal outcomes after angiolytic laser surgery and microflap surgery for vocal polyps.

OBJECTIVE: The microflap technique is a standard procedure for the treatment of vocal fold polyps. Angiolytic laser surgery carried out under topical anesthesia is an alternative method for vocal polyp removal. However, it is not clear whether angiolytic laser surgery has the same effects on vocal outcomes as the microflap technique because of a lack of studies comparing both procedures. In the current study, vocal outcomes after both procedures were compared to clarify the effects of angiolytic laser surgery for vocal polyp removal. METHODS: Vocal outcomes were reviewed for patients who underwent angiolytic laser surgery (n=20, laser group) or microflap surgery (n=34, microflap group) for vocal polyp removal. The data analyzed included patient and lesion characteristics, number of surgeries required for complete resolution, and aerodynamic and acoustic examinations before and after surgery. RESULTS: In the laser surgery group, complete resolution of the lesion was achieved with a single procedure in 17 cases (85%) and with two procedures in 3 cases (15%). Postoperative aerodynamic and acoustic parameters demonstrated significant improvement compared to preoperative parameters in both the laser surgery group and the microflap surgery group. There were no significant differences in any postoperative aerodynamic and acoustic parameters between the two groups. CONCLUSION: The current retrospective study demonstrated that angiolytic laser surgery achieved complete resolution of vocal polyps within two procedures. Postoperative effects on aerodynamic and acoustic functions were similar to those after microflap surgery.

Quantum molecular resonance-assisted phonomicrosurgery: preliminary experience.

The objective of this study was to evaluate the use of quantum molecular resonance (QMR) energy in phonomicrosurgery. Quantum molecular resonance energy (QMRE) is an innovative technology that provides low temperature cutting and coagulation of tissues and causes minimal tissue damage during the procedure. Because of these features, this technology may offer new possibilities in phonomicrosurgery. Twelve patients with vocal fold polyps underwent QMR-assisted phonomicrosurgery. The patients were evaluated before and after surgery at 1 and 3 months postoperatively by using the voice handicap index, laryngeal stroboscopy rating, acoustic voice analysis, and perceptual voice evaluation. The subjects were also evaluated by a patient self-assessment questionnaire at 3 months postoperatively. All parameters significantly improved after QMR-assisted phonomicrosurgery (P < .05). All of the patients also subjectively improved by self-rating. These results suggest that QMRE is a safe and potentially promising treatment in phonomicrosurgery. Yet, further studies should be conducted to confirm these results.

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 .

Comparison of effects on voice of diode laser and cold knife microlaryngology techniques for vocal fold polyps.

AIM: To compare the effects on voice of endolaryngeal microsurgery (EMS) with cold instruments and a new method, "diode laser," for vocal fold polyps. PATIENTS AND METHODS: Fifty-one patients with vocal fold polyps suffering from dysphonia who were treated in the Erciyes University Department of Otolaryngology were included in the study. Voice analysis was performed in a soundproof room, holding the microphone 15 cm away from the patients' mouth and by recording a sustained [a] vowel for at least 10 seconds. Fundamental frequency (F0), Jitter, Shimmer, and noise-to-harmonic ratio (NHR) parameters were evaluated in terms of vocal analysis. All patients were asked for to fill in a questionnaire, after being informed about the voice handicap index (VHI). EMS was performed with a diode laser and cold knife on 26 and 25 patients, respectively. Patient follow-up was performed 8 weeks after surgery. Changes in F0, Jitter, Shimmer, and NHR values were measured and recorded. VHI was also completed and reassessed. RESULTS: There was a significant difference in each technique's VHI score between the preoperative and postoperative questionnaire (P < 0.001). Postoperatively, there was no significant difference in VHI scores between two groups (P > 0.05). There was a significant difference in voice analysis values measured preoperatively and at the postoperative controls for both groups (P < 0.05). Postoperatively, there was no significant difference in voice analysis values between two groups (P > 0.05). CONCLUSION: In the treatment of vocal polyps, EMS with both diode laser and traditional cold knife is effective.