The Clinicopathological Study of Benign Lesions of Vocal Cords

Accuracy of Diagnosis of Benign Vocal Fold Lesions among Ear, Nose, and Throat Residents

Introduction  Benign vocal fold lesions (BVFLs) disrupt the superficial lamina propria, impacting vocal fold pliability. Investigating the diagnostic competency of ear, nose, and throat (ENT) residents in identifying BVFLs, we hypothesize that factors such as residency year, subspecialty focus, and training center influence diagnostic accuracy. Objectives  To assess the accuracy of diagnosis of BVFLs among ENT residents and to correlate diagnostic accuracy with the year of residency. Methods  An observational cross-sectional study included all ENT residents in Saudi Arabia. It was performed in August and September 2021 using a self-administered online questionnaire that assessed demographic variables and included three images with open-ended questions on diagnosing vocal fold lesions. Results  A total of 61 ENT residents (62.3% male) were included in this study. The images of vocal fold cyst, vocal fold polyp, and vocal fold nodule were correctly diagnosed by 60.7%, 88.5%, and 91.8% of residents, respectively. There was a correlation between the year of residency and the accuracy of diagnosing a vocal fold cyst ( p  = 0.029). Residents interested in laryngology correctly diagnosed all three lesions more frequently than other residents. Conclusion  The ability of residents to diagnose vocal fold cysts was moderate. In particular, the senior residents were able to diagnose polyps and nodules with excellent accuracy.

Implementation of Eclectic Voice Therapy Program via Telepractice in Hyperfunctional Voice Disorders: A Preliminary Efficacy Study

PURPOSE

Hyperfunctional voice disorder (HFVD) has a multifaceted origin. Individuals with HFVD work in professions that demand high vocal usage and are bound to work for longer hours with very inflexible work schedules. In consequence, it can be speculated that an eclectic voice therapy program that uses combinatory approaches delivered via telepractice could bring about better efficiency of voice in these individuals. Nevertheless, very less attempts have been made in these lines. Therefore, the present study aims to implement eclectic voice therapy via telepractice and examine the efficacy of the same in HFVD.

METHOD

In total, 10 individuals with HFVD in the age range of 20-55years received Comprehensive Voice Habilitation Program (CVHP), an eclectic voice therapy approach via a videoconferencing platform, Zoom Video Communications, Inc. All the participants completed 15 sessions of voice therapy spread across 3weeks. Stroboscopy examination was performed at the baseline and post therapy to track the changes in laryngeal functions. Further, Consensus Auditory Perceptual Evaluation-Voice (CAPE-V), Acoustic Voice Quality Index (AVQI), and Voice Handicap Index in Kannada (VHI-K) were obtained at the baseline, post therapy, and two follow-ups to report the therapy outcomes. Related-sample Friedman's Two-way Analysis of Variance by Ranks and Wilcoxon Signed Rank Test were used to note the pre-post and follow-up changes in voice outcomes.

RESULTS

Significant improvement in movement patterns of the vocal folds and a reduction in ventricular hyperadduction were noted in stroboscopy. CAPE-V and AVQI scores decreased in post-therapy and follow-up evaluations indicating reduction in dysphonia severity over time. Also, decrease in VHI-K scores indicated improved psychosocial aspects and quality of life in HFVD.

CONCLUSION

The current study provided preliminary evidence on the possible benefits of telepractice in the delivery of CVHP in HFVD. Hence, telepractice could be recommended as an alternate treatment modality for patients with HFVD.

Injuries of Different Surgical Instruments on the Vocal Folds of Dogs

OBJECTIVE

This study aimed to compare the damage of vocal folds caused by four different surgical instruments: CO2 laser, electrosurgical knife, plasma radiofrequency ablation, and steel knife.

STUDY DESIGN

Randomized controlled study.

METHODS

The CO2 laser, electrosurgical knife, plasma radiofrequency ablation, steel knife, and other instruments were used to simulate the laryngeal microsurgery on experimental dogs. Both total vocal fold resection and punctate ablation were performed. On the day of surgery and 6 days later, the vocal fold tissue from the surgical site was removed for histological evaluation. The extent of vocal fold damage was assessed using the automatic digital pathological scanning system.

RESULTS

We detected varying degrees of damage to the laryngeal tissues. Only the steel knife caused epidermal defects on the vocal fold tissue, while other instruments produced thermal damage of different degrees. Furthermore, the steel knife also showed better and faster healing. The plasma radiofrequency ablation was found to cause more severe thermal burns to vocal folds than other surgical instruments (P < 0.05). Six days postsurgery the inflammatory reaction from the steel knife had basically subsided, with only hyperplasia and tissue repair visible microscopically, showing the best healing degree. On the other hand, the radiofrequency ablation group showed the heaviest inflammatory reaction, indicating relatively poor prognosis (P < 0.05).

CONCLUSION

Compared with the CO2 laser, the electrotome and steel knife showed less damage and better healing, while the plasma radiofrequency ablation showed the most obvious thermal burns to laryngeal and vocal tissues during surgery, with relatively poor healing.

Artificial intelligence for the recognition of benign lesions of vocal folds from audio recordings

Objective

The diagnosis of benign lesions of the vocal fold (BLVF) is still challenging. The analysis of the acoustic signals through the implementation of machine learning models can be a viable solution aimed at offering support for clinical diagnosis.

Materials and methods

In this study, a support vector machine was trained and cross-validated (10-fold cross-validation) using 138 features extracted from the acoustic signals of 418 patients with polyps, nodules, oedema, and cysts. The model's performance was presented as accuracy and average F1-score. The results were also analysed in male (M) and female (F) subgroups.

Results

The validation accuracy was 55%, 80%, and 54% on the overall cohort, and in M and F, respectively. Better performances were observed in the detection of cysts and nodules (58% and 62%, respectively) vs polyps and oedema (47% and 53%, respectively). The results on each lesion and the different patterns of the model on M and F are in line with clinical observations, obtaining better results on F and detection of sensitive polyps in M.

Conclusions

This study showed moderately accurate detection of four types of BLVF using acoustic signals. The analysis of the diagnostic results on gender subgroups highlights different behaviours of the diagnostic model.

Systematic Review of Recurrence Rates of Benign Vocal Fold Lesions Following Surgery

OBJECTIVES

Benign vocal fold lesions which include vocal fold nodules, polyps, cysts and other lesions often recur after surgery and require additional treatments. This systematic review of the current literature evaluated the effects of adjunctive therapies in addition to surgical resection on the recurrence rates of benign vocal fold lesions in adults.

STUDY DESIGN

Systematic review.

METHODS

A search using relevant keywords in electronic databases was conducted. Extracted data include author, year of publication, patient demographics, diagnostic approach, lesion type, surgical procedure, type of adjunctive therapy and the rates of recurrence. Descriptive statistics were performed on the collected data when appropriate.

RESULTS

Eleven articles were identified with a total of 1085 patients. The total 1101 lesions studied included 591 (53.7%) polyps, 125 (11.4%) nodules, 146 (13.3%) cysts, 184 (16.7%) pseudocysts, 19 (1.7%) midfold masses, 18 (1.6%) sulcus vocalis and 18 (1.6%) varices. Besides surgery, adjunctive therapies included voice therapy, steroid injection and reflux medication. There were 141 reported lesion recurrences, with an average recurrence rate of 13.0%. The recurrence rate in studies with adjunctive therapies was 7.14%, and in studies with no adjunctive therapies it was 24.44%.

CONCLUSIONS

Available evidence suggests that adjunctive therapies following surgery are associated with decreased lesion recurrence rates. However, due to differences in sample size, inconsistent reporting of lesion characteristics, heterogeneity of adjunctive therapies, variability in follow-up time across studies, and other factors, it is not possible to determine exactly which adjunctive therapies are of significant benefit and which lesion types may benefit the most.

Application of Transcutaneous Laryngeal Ultrasonography in the Diagnosis of Vocal Fold Polyps

The aim of this study was to explore the value of transcutaneous laryngeal ultrasonography in the diagnosis of vocal fold polyps. From December 2016 to June 2019, 87 patients with vocal fold polyps diagnosed pathologically in the Otolaryngology Head and Neck Surgery Department of the Second Affiliated Hospital of Xi'an Jiaotong University were enrolled and examined by electronic laryngoscopy and percutaneous laryngeal ultrasound on the same day before operation. To observe the effect of calcification length as a percentage of thyroid cartilage at the glottic level on vocal fold display, the characteristics of ultrasound images of vocal fold polyps and the value of transcutaneous laryngeal ultrasonography in the diagnosis of vocal fold polyps were assessed. Among 87 patients, the calcification rate of thyroid cartilage at the glottic level was 33.3%. The differences in calcification rate and percentage of calcification length between males and females were statistically significant. The rate of detection of vocal folds decreased gradually with an increase in calcification length percentage. Imaging features of vocal fold polyps were hypo-echoic with a clear boundary and regular shape. The detection rates for circular and non-circular polyps were 92.0% and 70.6%. Ultrasound was more likely to detect circular than non-circular polyps; however, the difference was not significant. Transcutaneous laryngeal ultrasonography can identify the morphology and location of vocal fold polyps and is non-invasive and highly accurate. Therefore, it has the potential to be an effective supplement to laryngoscopy for initial screening and post-operative review of vocal fold polyps.