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Pillai R, Sawaryn M, Ross T, Ahmed J. Unusual case of Reinke's oedema. BMJ Case Rep 2024; 17:e259492. [PMID: 38977316 DOI: 10.1136/bcr-2023-259492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
This case report describes a man in his mid 40s, with a history of chronic smoking, who presented with dysphonia. He underwent microlaryngoscopy and biopsy for a suspicious lesion on the anterior right vocal cord. Mask ventilation proved difficult on induction of general anaesthesia due to a solid lesion acting as a ball valve into the glottis. This mass was LASER debulked and sent for histopathology. This demonstrated a haematoma, likely traumatic in origin, with some polypoidal features, consistent with advanced Reinke's oedema. Reinke's oedema is a benign condition where chronic inflammation causes fluid accumulation within the vocal cords. Long-standing inflammation leads to disarrangement of the vocal cord lamina propria, causing fluid accumulation and thereby resulting oedema of the vocal cords. This process can subsequently lead to polyp formation and can cause gravelly voice. This case report describes the potential airway sequelae of this benign condition.
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Affiliation(s)
- Raji Pillai
- Department of Ear, Nose and Throat Surgery, The Royal London Hospital, Bart's NHS Trust, London, UK
| | - Michael Sawaryn
- Department of Anaesthesia, The Royal London Hospital, London, UK
| | - Talisa Ross
- Department of Ear, Nose and Throat Surgery, The Royal London Hospital, Bart's NHS Trust, London, UK
- UCL Ear Institute, University College London, London, UK
| | - Jahangir Ahmed
- Department of Ear, Nose and Throat Surgery, The Royal London Hospital, Bart's NHS Trust, London, UK
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Kang DW, Kim SI, Noh JK, Jeong SJ, Lee YC, Ko SG, Eun YG. Voice Outcome After Cold Knife Surgery According to the Characteristics of Vocal Fold Polyp. J Voice 2024; 38:780-787. [PMID: 34848104 DOI: 10.1016/j.jvoice.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Voice change is one of the major symptoms in patients with vocal fold polyp. As a result, phonomicrosurgery is commonly required in these patients. Since voice outcomes after polyp treatment can be variable according to polyp characteristics, we aimed to investigate the predicting factors of postoperative voice improvements in terms of polyp characteristics in patients with vocal fold polyp who underwent cold knife surgery. MATERIALS AND METHODS A total of 77 patients who were diagnosed with vocal fold polyp and underwent phonomicrosurgery with cold knife instruments. The polyp characteristics of color, size, shape, and location were evaluated at baseline. Acoustic and aerodynamic analyses, voice handicap index questionnaire and grade, roughness, breathiness, asthenia, strain scale were evaluated at baseline and 6 weeks after surgery. RESULTS All values of postoperative voice parameters improved after cold knife surgery. (P < 0.05) In patient with an organized vocal fold polyp, less improvement in postoperative values of maximum phonation time were observed. (P < 0.05) Likewise, less improvement of voice handicap index questionnaire score and grade, roughness, breathiness, asthenia, strain scale after surgery was shown in organized vocal fold polyp. (P < 0.05) CONCLUSIONS: Among the various polyp characteristics, the organized polyp was significantly related to relatively less improvement of objective and subjective voice parameters after surgery. These polyp characteristics would help to predict postoperative voice improvement and plan for personalized treatment in patients with vocal fold polyp.
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Affiliation(s)
- Dae Woong Kang
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea
| | - Su Il Kim
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea; Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Korea
| | - Joo Kyung Noh
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Korea
| | - Su Jin Jeong
- Statistics Support Part, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
| | - Young Chan Lee
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea
| | - Seong-Gyu Ko
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Young-Gyu Eun
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea; Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Korea.
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Hamdan AL, Hosri J, Feghali PAR, Abi Zeid Daou C, Ghanem A. Office-based Blue Laser Therapy of Vocal Fold Polyps: A Cohort of 18 Patients: Blue Laser Therapy of Vocal Fold Polyps. Laryngoscope 2023; 133:2712-2718. [PMID: 36752582 DOI: 10.1002/lary.30602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/21/2022] [Accepted: 01/22/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To investigate the effect of office-based blue laser therapy of vocal fold polyps on voice. METHODS The medical records and video recordings of patients who underwent office-based laser therapy in a tertiary referral center between February 2020 and May 2020, and May 2021 and October 2022 was conducted. Only patients with vocal fold polyps who had undergone office-based blue laser therapy were included. The voice was evaluated before and after surgery using the Voice Handicap Index-10 (VHI-10), GRB perceptual evaluation, acoustic analysis, and maximum phonation time. RESULTS A total of 18 patients were included. The mean age of the study group was 52.5 ± 11.94 years. The male-to-female ratio was 2:1. Ten patients of the total group (53.6%) had hemorrhagic polyps and the most common site was the mid-third of the vocal fold. All patients who presented for follow-up (n = 15) had partial or complete regression of the lesion (4 and 11, respectively). There was a significant decrease in the mean score of VHI-10 (17.6 ± 9.97 vs. 4.27 ± 5.76, p < 0.001) and in the means of grade of dysphonia (2.0 ± 0.73 to 0.5 ± 0.63, p < 0.001), roughness (1.88 ± 0.81 to 0.44 ± 0.51, p < 0.001) and breathiness (0.81 ± 0.75 to 0.13 ± 0.34 p < 0.001). There was also a marked decrease in the perturbation parameters (jitter and shimmer) and a significant increase in the MPT from 10.66 ± 4.22 s to 14.26 ± 6.26 s (p = 0.028). CONCLUSION Office-based blue laser therapy is an effective treatment modality in patients with vocal fold polyps. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2712-2718, 2023.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Jad Hosri
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Patrick Abou Raji Feghali
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Christophe Abi Zeid Daou
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Anthony Ghanem
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
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Adriaansen A, Van Lierde K, Meerschman I, Claeys S, D'haeseleer E. The Occurrence of Laryngeal Pathologies in a Treatment-Seeking Pediatric Population. J Voice 2023:S0892-1997(23)00210-2. [PMID: 37524580 DOI: 10.1016/j.jvoice.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES The purpose of this study was to 1) describe the age- and sex-specific occurrence of laryngeal pathologies in a treatment-seeking pediatric population in the voice unit of Ghent University Hospital, Belgium, and 2) describe this population in terms of vocal parameters, vocal complaints, influencing factors, and treatment history and recommendation. STUDY DESIGN Retrospective, observational study. METHODS All patient records were analyzed for children (0-18 years) who consulted the ear, nose, and throat department of Ghent University Hospital for the first time between July 2015 and June 2021 with complaints of dysphonia. In total, 103 children (66 males, 37 females) with a mean age of 10.01 years (SD: 3.4, range 3.93-17.96) were included in this study. Laryngeal pathology was diagnosed using a flexible videolaryngo(strobo)scopy. The influence of age and sex on laryngeal etiology (organic/functional voice disorder) was examined using a Welch-modified t test and a Fisher's exact test, respectively. RESULTS Organic lesions were observed in 77.7% of the participants, with vocal fold nodules (VFNs) being the most common diagnosis (66.0%). A functional voice disorder was diagnosed in 22.3% of the children. Children with a functional voice disorder are significantly older than children with an organic voice disorder. There was no statistically significant difference between males and females in laryngeal etiology. Mean dysphonia severity index was -2.7 (SD: 3.2, range -9.3 to +3.7), the mean acoustic voice quality index 4.70 (SD: 1.5, range 2.35-8.27), and the mean pediatric voice handicap index 29.8 (SD: 13.6, range 5-60). The occurrence of vocal misuse was mentioned in 80.6% of the patient records. CONCLUSION Organic voice disorders, especially VFNs, are predominant in treatment-seeking children with dysphonia. Functional voice disorders become more common with increasing age during childhood. A disordered vocal quality, reduced vocal capabilities and reduced voice-related quality of life were found.
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Affiliation(s)
- Anke Adriaansen
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Kristiane Van Lierde
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South-Africa.
| | - Iris Meerschman
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Sofie Claeys
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.
| | - Evelien D'haeseleer
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Royal Conservatory Brussels, Musical Department, Brussels, Belgium.
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Kenny HL, Friedman L, Blake Simpson C, McGarey PO. Vocal Fold Polyps: A Scoping Review. J Voice 2023:S0892-1997(23)00180-7. [PMID: 37433709 DOI: 10.1016/j.jvoice.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE This review aims to summarize the current understanding of vocal fold polyp etiology, pathophysiology, and prognosis, as well as recent developments in management. STUDY DESIGN Scoping literature review. REVIEW METHODS OVID Medline, PubMed, Google Scholar, Conference Papers Index, and Cochrane Library were searched for publications within the last 5 years using terms including "vocal," "cord," "fold," and "polyp." All abstracts were screened. Relevant studies pertaining to the etiology, pathophysiology, diagnosis, management, and prognosis of vocal fold polyps (VFPs) were included for review. RESULTS Eight-hundred and sixty-five citations resulted from database review. Seven-hundred and thirty citations remained after the exclusion of duplicates. One hundred and ninety-three papers underwent abstract review, with 73 citations undergoing full-text review. Fifty-nine papers were included in the review. CONCLUSIONS VFPs are one of the most common subtypes of benign vocal fold lesions. Phonotrauma contributes significantly to the development of these lesions, with laryngopharyngeal reflux and smoking also contributing. Correct diagnosis relies on a careful history, stroboscopy, response to voice therapy, and, in some cases, intraoperative findings. Phonosurgery is a definitive means of treatment, though more recently, in-office procedures have demonstrated efficacy and are potentially less costly and less invasive treatment options. Treatment modalities can be tailored based on the type and size of the lesion, the patient's vocal needs, medical comorbidities, and initial response to voice therapy. Voice specialists can anticipate greater emphasis placed on minimally invasive office-based procedures for the management of vocal pathology.
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Affiliation(s)
- Hannah L Kenny
- University of Virginia School of Medicine, Charlottesville, Virginia; Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Lisa Friedman
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
| | - C Blake Simpson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, Alabama
| | - Patrick O McGarey
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia.
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Yılmaz YZ, Uğurlar M, Yılmaz BB, Gülmez ZD, Özdoğan HA, Ataş A, Batıoğlu-Karaaltın A. The Comparison of Narrow Band Imaging, White Light Laryngoscopy and Videolaryngostroboscopy in the Evaluation of Benign Vocal Fold Lesions. J Voice 2023; 37:275-281. [PMID: 33483224 DOI: 10.1016/j.jvoice.2020.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aim of the study was comparing the diagnostic role of the white light (WL) endoscopy, video laryngostroboscopy (VLS), and narrow-band imaging (NBI) in the evaluation of the benign vocal fold lesions. MATERIAL AND METHODS From March 2018 to June 2019, a total of 118 cases were enrolled in this study. Ninety-eight patients were suspected with vocal fold nodules, cysts, polyps, and sulcus vocalis and 20 patients without a history of dysphonia. Each patient was examined by WL, VLS, and NBI endoscopy. Recorded images and videos were analyzed and scored by three otorhinolaryngologists who had at least 3 years of experience in phoniatrics field. The evaluation results were compared between the methods and the physicians. RESULTS A total of 118 cases were grouped by their confirmed diagnosis, vocal fold nodules (n = 28), vocal fold cyst (n = 24), vocal fold polyp (n = 9), and sulcus vocalis (n = 37). When the correct diagnosis rates of the physicians were compared, the statistical significance was found between the physicians in the WL and VLS method (P= 0.014, P= 0.027). No statistically significant difference was found among physicians in NBI method (P = 0.368). The difference between the diagnostic methods was found to be statistically significant in reaching the accurate diagnosis for benign vocal fold lesions (P< 0.001). While the difference between NBI-WL and VLS-WL was statistically significant (P< 0.001 and P< 0.001). The difference between NBI-VLS was not statistically significant while evaluating the vocal fold nodules, cysts, and sulcus vocalis separately (P= 0.102, P = 0.026, P = 0.157). Otherwise, it was statistically significant (P= 0.002) while evaluating total benign lesions in the study. The difference between NBI-VLS combination and VLS, NBI-VLS combination and VLS-WL combination were statistically significant (P< 0.001 and P= 0.001). CONCLUSION This study showed that NBI assessments have similar accuracy and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to VLS and have a higher value than WL endoscopy in reaching the diagnosis for benign vocal fold lesions. Therefore, NBI can be accepted as a promising approach to identify benign laryngeal lesions due to its optical properties.
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Affiliation(s)
- Yetkin Zeki Yılmaz
- Department of Otolaryngology Head and Neck Surgery, Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Müge Uğurlar
- Department of Otolaryngology Head and Neck Surgery, Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Begüm Bahar Yılmaz
- Department of Otolaryngology Head and Neck Surgery, Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Züleyha Dilek Gülmez
- Department of Audiology, Istanbul University-Cerrahpasa, Faculty of Health Sciences, Istanbul, Turkey
| | - Hasan Ahmet Özdoğan
- Department of Otolaryngology Head and Neck Surgery, Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Ahmet Ataş
- Department of Audiology, Istanbul University-Cerrahpasa, Faculty of Health Sciences, Istanbul, Turkey
| | - Ayşegül Batıoğlu-Karaaltın
- Department of Otolaryngology Head and Neck Surgery, Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey.
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Free N, Stemple JC, Smith JA, Phyland DJ. Variability in Voice Characteristics of Female Speakers With Phonotraumatic Vocal Fold Lesions. J Voice 2023:S0892-1997(23)00017-6. [PMID: 36813672 DOI: 10.1016/j.jvoice.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To examine the variability of lesion characteristics and vocal function in female speakers with phonotraumatic vocal fold lesions (PVFLs). STUDY DESIGN Prospective Cohort Study METHODS: Thirty adult female speakers with PVFL who were participating in voice therapy were recruited to complete a multidimensional voice analysis at four time points across 1 month. Analysis comprised self-ratings of effort and vocal function, expert ratings of videostroboscopy and audio recordings, and instrumental evaluation by selected aerodynamic and acoustic parameters. The degree of variability across time for each individual was assessed against a minimal clinically important difference threshold. RESULTS A high degree of variability across time was observed for participant self-ratings of perceived effort and vocal function, and for instrumental parameters. The greatest degree of variability was observed in aerodynamic measures of airflow and pressure, and the acoustic parameter semitone range. Comparatively less variability was observed in perceptual evaluation of speech, and lesion characteristics via stroboscopy still images. Findings suggest that individuals with all PVFL types and sizes present with variability in function across time, with the greatest degree of variability in function observed in participants with large lesions and vocal fold polyps. CONCLUSION Variability is observed in voice characteristics of female speakers with PVFLs across 1 month despite general stability in lesion presentation, suggesting vocal function can change despite the presence of laryngeal pathology. This study highlights the need to explore individual functional and lesion responses across time to determine potential for change and improvement in both aspects when selecting treatment options.
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Affiliation(s)
- Nicole Free
- Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
| | - Joseph C Stemple
- Department of Communication Sciences and Disorders, and Rehabilitation and Health Sciences PhD Program, University of Kentucky, Lexington, Kentucky
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Debra J Phyland
- Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Dewan K, Chhetri DK, Hoffman H. Reinke's edema management and voice outcomes. Laryngoscope Investig Otolaryngol 2022; 7:1042-1050. [PMID: 36000026 PMCID: PMC9392404 DOI: 10.1002/lio2.840] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Reinke's edema is a chronic disease of the respiratory tract that occurs in adults with a history of chronic smoke exposure. Also known as polypoid corditis, polypoid laryngitis, and polypoid degeneration of the vocal fold, it is strongly associated with smoking, frequently with vocal misuse/abuse, and occasionally with laryngopharyngeal reflux. Reinke's edema remains a cause of chronic dysphonia that is difficult to manage. This review provides perspectives on current and future management of Reinke's edema. Results Reinke's edema impacts <1% of the population. The excessive mass is seen in polypoid degeneration results in a loss of pitch control and a rough voice. Women are more likely to present for treatment as the characteristic lowering of vocal pitch is more noticeable in women than men. Multiple grading systems have been proposed within the literature. The current standard of care is surgical excision, after smoking cessation. The microflap technique remains the approach of choice for bulky lesions. Surgical management of Reinke's edema has evolved with the introduction of various lasers into otolaryngologic practice; some which can now be used in the office setting. While many management approaches have been described within the literature, there is a little direct comparison and no obvious superior method of Reinke's edema management. Conclusion To date, the biology of Reinke's edema is not well understood. Additional research is needed further elucidate the role of uncontrolled reflux in the development and recurrence of Reinke's edema.
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Affiliation(s)
- Karuna Dewan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Dinesh K. Chhetri
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los AngelesLos AngelesCaliforniaUSA
| | - Henry Hoffman
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
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Hirosaki M, Kanazawa T, Komazawa D, Konomi U, Sakaguchi Y, Katori Y, Watanabe Y. Predominant Vertical Location of Benign Vocal Fold Lesions by Sex and Music Genre: Implication for Pathogenesis. Laryngoscope 2021; 131:E2284-E2291. [PMID: 33421134 DOI: 10.1002/lary.29378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/04/2020] [Accepted: 12/24/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vertical locations of vocal fold mucosal lesions (VFMLs) vary along the free edge. As the vertical contact area of vocal folds (VFs) depends on the vocal register, lesions may occur in the contact area of more frequently used vocal registers. This study investigated the cause of location variations by comparing the vertical sites of VFMLs in singers of both sexes with different music genres. STUDY DESIGN Retrospective review. METHODS Sixty professional classical and rock singers (11 male classical [M-classical], 22 male rock [M-rock], 13 female classical [F-classical], and 14 female rock [F-rock] singers) who underwent microlaryngeal surgery for VF polyps and nodules and their 108 lesions were enrolled. The VF free edge was vertically divided into three equal parts and classified into the following four lesion sites: upper, middle, lower, and multiple sites. RESULTS Upper lesions were most common among F-classical singers (73.9%), whereas lower lesions were most common among M-classical (90.0%) and M-rock (60.6%) singers. Among lesions localized to a single site, lower lesions were most common among F-rock singers (37.0%). F-classical singers had significantly more upper lesions than the other groups (P < .001). M-classical singers had significantly more lower lesions than female singers of any genre (P < .001). CONCLUSION Upper lesions were most common among F-classical singers who mostly used the head voice. Lower lesions were most common among singers who mainly used the modal voice. This study suggests that sex, the dominant vocal register used for singing, and mechanical stress on VFs influence the vertical site of VFMLs. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2284-E2291, 2021.
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Affiliation(s)
- Mayu Hirosaki
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Takeharu Kanazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, Tochigi, Japan
| | - Daigo Komazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,AKASAKA Voice Health Center, Tokyo, Japan
| | - Ujimoto Konomi
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Voice and Dizziness Clinic Futakotamagawa Otolaryngology, Tokyo, Japan
| | - Yu Sakaguchi
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yusuke Watanabe
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
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10
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Lee M, Sulica L. Recurrence of benign phonotraumatic vocal fold lesions after microlaryngoscopy. Laryngoscope 2019; 130:1989-1995. [DOI: 10.1002/lary.28349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/19/2019] [Accepted: 09/19/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Mark Lee
- Weill Cornell Medical College New York New York U.S.A
| | - Lucian Sulica
- The Sean Parker Institute for the Voice, Department of Otolaryngology–Head & Neck Surgery Weill Cornell Medical College New York New York U.S.A
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11
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Meehan-Atrash J, Korzun T, Ziegler A. Cannabis Inhalation and Voice Disorders. JAMA Otolaryngol Head Neck Surg 2019; 145:956-964. [DOI: 10.1001/jamaoto.2019.1986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - Tetiana Korzun
- Department of Otolaryngology, Oregon Health & Science University, Portland
| | - Aaron Ziegler
- School of Medicine, Department of Otolaryngology–Head & Neck Surgery, Oregon Health & Science University, Portland
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12
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Vasconcelos DD, Gomes ADOC, Araújo CMTD. Vocal Fold Polyps: Literature Review. Int Arch Otorhinolaryngol 2019; 23:116-124. [PMID: 30647795 PMCID: PMC6331298 DOI: 10.1055/s-0038-1675391] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/02/2018] [Indexed: 10/27/2022] Open
Abstract
Introduction Vocal fold polyps are one of the most frequent benign laryngeal lesions, impacting the quality of life of those affected by them, primarily the vocal production. Despite being a well-established therapy in conjunction with surgery, speech therapy alone may also be effective in treating these lesions. As such, otolaryngologists and speech therapists need updated bibliographic knowledge on the issue. Objective To describe the literature findings on vocal fold polyps that discuss prevalence, etiology, histology, physiopathology, vocal characteristics or treatment. Data Synthesis The present study is a review article based on a bibliographic search using platforms, databases and search engines, with no restrictions on means of publication, methodological quality or language. All the articles on vocal fold polyps pertaining to the object of study published in the past 15 years were included. Among the characteristics investigated, the most discussed were prevalence of men, smoking as an etiological cofactor, the possibility of histological differentiation from vocal nodules, the relationship with cover minor structural alterations, and the indication and effectiveness of different treatment options. Conclusion Despite the discrepancies found in the present literature review on vocal fold polyps, there has been a notable scientific progress in the otolaryngologic techniques and in the effectiveness of speech therapy as initial treatment, with direct and indirect techniques, corroborating the need for scientific investigation of the issue.
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Affiliation(s)
- Daniela de Vasconcelos
- Speech Therapy Service, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, PE, Brazil
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13
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Ropero Rendón MDM, Ermakova T, Freymann ML, Ruschin A, Nawka T, Caffier PP. Efficacy of Phonosurgery, Logopedic Voice Treatment and Vocal Pedagogy in Common Voice Problems of Singers. Adv Ther 2018; 35:1069-1086. [PMID: 29949040 PMCID: PMC11343907 DOI: 10.1007/s12325-018-0725-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Functional and organic impairments of the singing voice are common career-threatening problems of singers presenting in phoniatric and laryngological departments. The objective was to evaluate the efficacy of phonosurgery, logopedic voice treatment and vocal pedagogy in common organic and functional voice problems of singers, including investigation of the recently introduced parameter vocal extent measure (VEM). METHODS In a prospective clinical study, the analysis of treatment outcome in 76 singers [57 female, 19 male; 38 ± 11 years (mean ± SD)] was based on pre- and post-therapeutic voice function diagnostics and videolaryngostroboscopy. Examination instruments included auditory-perceptual voice assessment, voice range profile (VRP), the VEM calculated from area and shape of the VRP, acoustic-aerodynamic analysis, and patients' self-assessment (e.g., Singing Voice Handicap Index). RESULTS While 28% of all singers (21/76) presented with functional dysphonia, 72% (55/76) were diagnosed with organic vocal fold changes, of which marginal edema (n = 25), nodules (n = 9), and polyps (n = 8) were the most common pathologic changes. Of the 76 singers, 57% (43) received phonosurgery, 43% (33) had conservative pedagogic (14) and logopedic (19) treatment. Three months post-therapeutically, most parameters had significantly improved. The dysphonia severity index (DSI) increased on average from 6.1 ± 2.0 to 7.4 ± 1.8 (p < 0.001), and the VEM from 113 ± 20 to 124 ± 14 (p < 0.001). Both parameters correlated significantly with each other (rs = 0.41). Phonosurgery had the largest impact on the improvement of vocal function. Conservative therapies provided smaller quantitative enhancements but also qualitative vocal restoration with recovered artistic capabilities. CONCLUSIONS Depending on individual medical indication, phonosurgery, logopedic treatment and voice teaching are all effective, objectively and subjectively satisfactory therapies to improve the impaired singing voice. The use of VEM in singers with functional and organic dysphonia objectifies and quantifies their vocal capacity as documented in the VRP. Complementing the established DSI, VEM introduction into practical objective voice diagnostics is appropriate and desirable especially for the treatment of singers.
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Affiliation(s)
- Maria Del Mar Ropero Rendón
- Department of Audiology and Phoniatrics, Charité, University Medicine Berlin, Campus Charité Mitte, Berlin, Germany
| | - Tatiana Ermakova
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Marie-Louise Freymann
- Department of Audiology and Phoniatrics, Charité, University Medicine Berlin, Campus Charité Mitte, Berlin, Germany
| | - Alina Ruschin
- Department of Audiology and Phoniatrics, Charité, University Medicine Berlin, Campus Charité Mitte, Berlin, Germany
| | - Tadeus Nawka
- Department of Audiology and Phoniatrics, Charité, University Medicine Berlin, Campus Charité Mitte, Berlin, Germany
| | - Philipp P Caffier
- Department of Audiology and Phoniatrics, Charité, University Medicine Berlin, Campus Charité Mitte, Berlin, Germany.
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Cohen SM, Garrett CG. Utility of Voice Therapy in the Management of Vocal Fold Polyps and Cysts. Otolaryngol Head Neck Surg 2016; 136:742-6. [PMID: 17478208 DOI: 10.1016/j.otohns.2006.12.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Accepted: 12/06/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To evaluate the efficacy of voice therapy in the management of vocal fold polyps and cysts. STUDY DESIGN AND SETTING: Retrospective review of vocal fold cysts and polyps undergoing voice therapy in a tertiary care center. Symptom resolution or persistence resulting in surgical intervention was the main outcome measure. RESULTS: Fifty-seven patients were identified, of which 49.1% achieved symptom resolution with voice therapy alone. Patients with complete glottal closure and muscle tension dysphonia did not have a better response than those with incomplete glottal closure and without muscle tension dysphonia ( P = 0.1, χ 2 , respectively). Patients with translucent polyps more commonly responded to voice therapy than fibrotic, hyaline, or hemorrhagic polyps, 81.8% versus 15.4% and 25.0% response rate, respectively ( P = 0.002, χ 2 ). CONCLUSIONS: Voice therapy is an effective treatment modality for vocal fold polyps and cysts. SIGNIFICANCE: A multidisciplinary approach including a trial of voice therapy is warranted.
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Affiliation(s)
- Seth M Cohen
- Duke Voice Care Center, Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, NC 27710, USA.
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Vasconcelos DD, Gomes AODC, Araújo CMTD. Efetividade da fonoterapia no tratamento do pólipo em pregas vocais. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201517614215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO: O objetivo dessa revisão de literatura foi verificar a efetividade da fonoterapia no tratamento do pólipo em pregas vocais, a partir de levantamento bibliográfico. Foi realizada pesquisa bibliográfica na plataforma PublicMedline e nas bases de dados Scopus, Science Direct, Cumulative Index to Nursing and Allied Health Literature e Web of Science, seguindo etapas de seleção e análise crítica dos artigos. Foram incluídos artigos originais que utilizaram a fonoterapia como tratamento para o pólipo vocal, sem restrições de data de publicação ou língua. Foram excluídos artigos que abordassem exclusivamente outros tratamentos para pólipo vocal e os que utilizaram a fonoterapia somente após a cirurgia laríngea. Foram encontrados inicialmente 905 artigos. Após as etapas de seleção, restaram nove artigos na composição final da amostra. Foram então analisados na íntegra, cadastrados por meio de protocolo previamente elaborado que contemplou autor, ano, local, tipo de estudo, amostra, classificação do pólipo, tipo de intervenção e principais resultados. Os artigos analisados apresentaram fragilidade metodológica e ausência de padronização quanto aos protocolos e procedimentos fonoaudiológicos utilizados. Foram constituídos em sua maioria por série de casos retrospectiva. A amostra dos estudos variou em relação à quantidade de participantes, tipo de lesão e tipo de pólipo. A fonoterapia para o tratamento do pólipo em pregas vocais demonstrou efetividade entre 38% e 100% nos estudos analisados, com melhores resultados em lesões pequenas e recentes.
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Il'yinskaya EV, Stepanova YE, Koren' EE, Kosenko VA. [The electron microscopic study of tumour-like structures on the vocal cords]. Vestn Otorinolaringol 2015:44-47. [PMID: 25909674 DOI: 10.17116/otorino201580144-47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We have undertaken the electron microscopic investigation into peculiarities of six tumour-like structures on the vocal cords. The study has demonstrated changes in the number and distribution patterns of intercellular junctions, keratin and tonofilament contents in epithelial cells, basal membrane structure, and composition of the basic substance in lamina propria. All the examined tumour-like structures contained bacteria an two of them had viral particles in vacuoles of fibroblasts. Moreover, the bacteria were found on the surface of epithelium, between epithelial cells and in the basic substance in lamina propria. Cytoplasm of epithelial cells and fibroblasts not infrequently contained bacteria in the phase of division.
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Affiliation(s)
- E V Il'yinskaya
- Saint-Petersburg Institute of Ear, Throat, Nose, and Speech, Russian Ministry of Health, St.Petersburg, Russia, 190013; Saint-Petersburg Research Institute of Influenza, St. Petersburg, Russia, 197376
| | - Yu E Stepanova
- Saint-Petersburg Institute of Ear, Throat, Nose, and Speech, Russian Ministry of Health, St.Petersburg, Russia, 190013
| | - E E Koren'
- Saint-Petersburg Institute of Ear, Throat, Nose, and Speech, Russian Ministry of Health, St.Petersburg, Russia, 190013
| | - V A Kosenko
- Saint-Petersburg Institute of Ear, Throat, Nose, and Speech, Russian Ministry of Health, St.Petersburg, Russia, 190013
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Filho JMI, Carvalho B, Mizoguchi FM, Catani GSDA, Filho EDDM, Malafaia O, Stahlke HJ. Characteristics of polypoid lesions in patients undergoing microsurgery of the larynx. Int Arch Otorhinolaryngol 2015; 17:279-84. [PMID: 25992024 PMCID: PMC4399699 DOI: 10.7162/s1809-97772013000300008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 03/09/2013] [Indexed: 11/21/2022] Open
Abstract
Introduction: Dysphonia is the main symptom of lesions that affect the vocal tract. Many of those lesions may require surgical treatment. Polyps are one of the most common forms of vocal cord lesions and the most prevalent indication for laryngeal microsurgery. There are different types of polyps, and their different characteristics can indicate different prognosis and treatments. Aim: To conduct a comparative study of polypoid lesions (angiomatous and gelatinous) in patients undergoing laryngeal microsurgery via an electronic protocol. Method: We prospectively evaluated 93 patients diagnosed with vocal fold polyps; the polyps were classified as angiomatous or gelatinous. Results: In total, 93 patients undergoing laryngeal microsurgery were diagnosed with vocal fold polyps. Of these, 63 (64.74%) had angiomatous and 30 (32.26%) gelatinous polyps. Most patients with angiomatous polyps were men; their polyps were frequently of medium size, positioned in the middle third of the vocal fold, and accompanied by minimal structural alterations (MSA). In contrast, the majority of patients with gelatinous polyps were women; their polyps were smaller, positioned in the middle and posterior third of the vocal fold, and were not accompanied by MSA. Both types of polyps were more frequently located on the right vocal fold. Conclusion: Angiomatous polyps were more frequently encountered than gelatinous polyps. In addition, correlations between polyp type and sex, polyp size, position, location, and the presence of MSA were observed. Different surgical techniques were used, but the postoperative results were similar and satisfactory after speech therapy.
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Affiliation(s)
| | | | | | | | | | - Osvaldo Malafaia
- PhD in Medical Anatomy (1976). Professor associated with the postgraduate program in Surgical Principles at the Faculdade Evangelica do Parana
| | - Henrique Jorge Stahlke
- PhD in Clinical Surgery in the postgraduate program at UFPR (2002). Professor and Coordinator of Vascular Surgery at HC/UFPR
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18
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Vocal fold paresis accompanying vocal fold polyps. Eur Arch Otorhinolaryngol 2014; 272:149-57. [DOI: 10.1007/s00405-014-3227-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 07/29/2014] [Indexed: 11/26/2022]
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Hanshew AS, Jetté ME, Thibeault SL. Characterization and comparison of bacterial communities in benign vocal fold lesions. MICROBIOME 2014; 2:43. [PMID: 25671105 PMCID: PMC4323261 DOI: 10.1186/2049-2618-2-43] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/20/2014] [Indexed: 05/11/2023]
Abstract
BACKGROUND Benign vocal fold lesions, including cysts, nodules, polyps, and Reinke's edema, are common causes of hoarseness and subsequent voice disorders. Given the prevalence of these lesions, disease etiology and pathophysiology remain unclear and their microbiota has not been studied to date secondary to the paucity of available biopsies for investigation. We sought to characterize and compare the bacterial communities in biopsies of cysts, nodules, polyps, and Reinke's edema collected from patients in Germany and Wisconsin. These samples were then compared to the communities found in healthy saliva and throat samples from the Human Microbiome Project (HMP). RESULTS 454 pyrosequencing of the V3-V5 regions of the 16S rRNA gene revealed five phyla that explained most of the bacterial diversity, including Firmicutes (73.8%), Proteobacteria (12.7%), Bacteroidetes (9.2%), Actinobacteria (2.1%), and Fusobacteria (1.9%). Every lesion sample, regardless of diagnosis, had operational taxonomic units (OTUs) identified as Streptococcus, with a mean abundance of 68.7%. Most of the lesions, 31 out of 44, were indistinguishable in a principal coordinates analysis (PCoA) due to dominance by OTUs phylogenetically similar to Streptococcus pseudopneumoniae. Thirteen lesions not dominated by S. pseudopneumoniae were more similar to HMP throat and saliva samples, though 12 of them contained Pseudomonas, which was not present in any of the HMP samples. Community structure and abundance could not be correlated with lesion diagnosis or any other documented patient factor, including age, sex, or country of origin. CONCLUSIONS Dominance by S. pseudopneumoniae could be a factor in disease etiology, as could the presence of Pseudomonas in some samples. Likewise, decreased diversity, as compared to healthy saliva and throat samples, may be associated with disease, similar to disease models in other mucosal sites.
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Affiliation(s)
- Alissa S Hanshew
- Department of Surgery, University of Wisconsin, 1111 Highland Avenue, Madison, 53705 Wisconsin USA
| | - Marie E Jetté
- Department of Surgery, University of Wisconsin, 1111 Highland Avenue, Madison, 53705 Wisconsin USA
| | - Susan L Thibeault
- Department of Surgery, University of Wisconsin, 1111 Highland Avenue, Madison, 53705 Wisconsin USA
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Bohlender J. Diagnostic and therapeutic pitfalls in benign vocal fold diseases. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc01. [PMID: 24403969 PMCID: PMC3884536 DOI: 10.3205/cto000093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis.
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Affiliation(s)
- Jörg Bohlender
- Phoniatrics and Logopedics, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
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Effect of voice therapy after phonomicrosurgery for vocal polyps: a prospective, historically controlled, clinical study. The Journal of Laryngology & Otology 2013; 127:1134-8. [DOI: 10.1017/s0022215113002454] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:This study aimed to evaluate the efficacy of post-operative voice therapy after phonomicrosurgery for vocal polyp removal.Methods:The study retrospectively enrolled 55 consecutive patients who had undergone voice therapy after phonomicrosurgery for vocal polyp removal occurring between June 2010 and June 2011. A historical group of 63 similar patients not receiving voice therapy was used as an external control. We compared voice analysis parameters and Voice Handicap Index scores for the two groups.Results:Most objective and subjective voice outcome parameters were significantly improved after surgical treatment. Although the study and control groups showed no significant difference regarding objective parameters (using acoustic and aerodynamic analysis) or the subjective parameters assessed using the grade-roughness-breathiness-asthenia-strain scale, the study group had significantly better final Voice Handicap Index scores.Conclusion:Following surgery for vocal polyps, post-operative voice therapy can improve patients' vocal discomfort, emotional responses and everyday self-perception.
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Pizolato RA, Mialhe FL, Cortellazzi KL, Ambrosano GMB, CornacchioniRehder MIB, Pereira AC. Avaliação dos fatores de risco para distúrbios de voz em professores e análise acústica vocal como instrumento de avaliação epidemiológica. REVISTA CEFAC 2013. [DOI: 10.1590/s1516-18462013000400025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
OBJETIVO: avaliar fatores de risco para disfonia em professores e associá-los compresença de alteração vocal. MÉTODO: 102 professores(81 mulheres e 21 homens) selecionados aleatoriamente de 11 escolas do município de Piracicaba/SP, com média de idade de 42,48 anos. Um questionário sobre aspectos do ambiente e organização do trabalho, comportamento vocal, estilo de vida e sinais e sintomas de alterações vocais foi aplicado.Uma análise acústica da voz foi realizada e as variáveis avaliadas dependentes foram Frequência Fundamental e a Intensidade média vocal. Foram realizadas associações entre as variáveis do questionário com a frequência fundamental e a intensidade média e utilizaram-se os testes estatísticos: Qui-quadrado, Exato de Fisher e cálculo do OddsRatio e este é um estudo clínico prospectivo. RESULTADOS: os indivíduos do sexo masculino tiveram menos chance de apresentarem frequência fundamental da voz alterada do que o gênero feminino (p<0,0001). As professoras que lecionavam para o ensino fundamental II e médio tiveram menos chance de apresentar alteração da frequência fundamental da voz do que aquelas que lecionavam para o ensino fundamental (p=0,04). O ruído ambiente teve associação significante com a alteração da intensidade média da voz (p=0,02). CONCLUSÃO: fatores como o sexo feminino lecionar para o ensino primário e estar exposto ao ruído do ambiente de trabalho foram considerados indicadores de risco para distúrbios da voz em professores.
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Li NYK, Dailey S, Thibeault SL. Assessment of fine needle aspiration feasibility and specimen adequacy for molecular diagnostics of benign vocal fold lesions. Laryngoscope 2013; 123:960-5. [PMID: 23404571 DOI: 10.1002/lary.23703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/ HYPOTHESIS The use of molecular testing is becoming more significant for the diagnosis and classification of disease. The application of fine-needle aspiration (FNA) biopsy as the means of sampling lesions in union with molecular testing could be a powerful combination in laryngology. The objectives of this study were to investigate 1) if FNA was feasible to sample benign vocal fold lesions; 2) if FNA samples provided sufficient RNA quality for molecular analysis; and 3) if gene expression of FNA samples matched paired surgical excised specimens. STUDY DESIGN Prospective cross-sectional. METHODS Fifteen vocal fold specimens were obtained from adult patients undergoing routine surgical removal for benign vocal fold lesions using FNA and surgical excision. Comparisons were made between FNA and excision biopsies for RNA quality. Correlative analysis was completed for RNA expression of nine genes, including decorin (DCN), connective tissue growth factor (CTGF), vascular endothelial growth factor (VEGF), collagen type VI alpha 3 (COL6A3), superoxide dismutase 1 (SOD1), glutathione S-transferase (GST2), collagen type I alpha 2 (COL1A2), ATP binding cassette (ABC), and procollagen I alpha 1 (COL1A1). RESULTS FNA and excision samples demonstrated similar RNA quality (P > 0.05). Per gene expression, four out of nine genes were moderately correlated between the paired samples (P < 0.05). CONCLUSIONS FNA of the vocal fold lamina propria is technically feasible to perform. Further improvement in the FNA technology is desirable to optimize RNA quality for reliable gene expression analysis.
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Affiliation(s)
- Nicole Y K Li
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin 53705-2275, USA
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Cielo CA, Finger LS, Rosa JDC, Brancalioni AR. Lesões organofuncionais do tipo nódulos, pólipos e edema de Reinke. REVISTA CEFAC 2011. [DOI: 10.1590/s1516-18462011005000018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
TEMA: lesões organofuncionais são formações benignas decorrentes de comportamento vocal alterado e inadequado, sendo as mais comuns: nódulos, pólipos vocais e edema de Reinke. OBJETIVO: realizar um estudo comparativo dos dados descritos na literatura sobre prega vocal normal e afecções organofuncionais do tipo nódulos, pólipos e edema de Reinke. O estudo foi realizado por meio de um levantamento bibliográfico em periódicos indexados no Science Direct, periódicos Capes, LILACS, SciELO, MedLine e Scopus e livros, no período de 1999 a 2010. CONCLUSÃO: a distribuição dos constituintes da matriz extracelular da lâmina própria lw32da mucosa, fibras elásticas, colágenas, ácido hialurônico e fibronectina, encontra-se alterada nas três afecções. Ocorre modificação das características vibratórias de amplitude, propagação da onda de mucosa e simetria do padrão vibratório devido à presença do aumento de massa nas pregas vocais, ao contrário do que se observa nas pregas vocais sem afecção. O sinal perceptivo-auditivo da qualidade vocal encontrado nas três lesões é a rouquidão, seguida da soprosidade e da aspereza (exceção do edema de Reinke), sinalizando a presença de ruído acústico à emissão, estando presente também, no edema de Reinke, o agravamento considerável da frequência fundamental. Quanto à etiologia observou-se a predominância dos usos incorretos, e quanto à incidência, nódulos e edema de Reinke predominam no sexo feminino e pólipos no sexo masculino.
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Analysis of factors influencing voice quality and therapeutic approaches in vocal polyp patients. Eur Arch Otorhinolaryngol 2011; 268:1321-7. [DOI: 10.1007/s00405-011-1618-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 04/19/2011] [Indexed: 10/18/2022]
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Stepp CE, Heaton JT, Stadelman-Cohen TK, Braden MN, Jetté ME, Hillman RE. Characteristics of phonatory function in singers and nonsingers with vocal fold nodules. J Voice 2011; 25:714-24. [PMID: 21216129 DOI: 10.1016/j.jvoice.2010.06.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 06/09/2010] [Indexed: 12/01/2022]
Abstract
PURPOSE The goals of this study were to determine if there were significant differences between singers and nonsingers in the morphology of vocal nodules and the associated impact on vocal function. METHOD Participants were 10 professionally trained singers with nodules, eight nonsingers with nodules, and 10 individuals with healthy normal voice (controls). Surface electromyography (sEMG) from three anterior neck locations and acoustic rise times for vowels /a/ and /i/ were measured in all the participants. In individuals with nodules, dB SPL/cm H(2)O, glottal airflow, and nodule location and size were also measured. RESULTS There were no significant differences between singers and nonsingers with nodules in terms of airflow, dB SPL/cm H(2)O, nodule size, or nodule location. In nonsingers with nodules, airflow and nodule size were significantly correlated, but were not significantly correlated in singers. Vowel rise times and sEMG during vocal tasks did not differentiate among nodule and control groups. Sternocleidomastoid sEMG during initiation of the vowel /a/ was statistically significantly stronger in nonsingers with nodules relative to singers with nodules and controls. CONCLUSIONS Nodule morphology did not differ between singers and nonsingers, although some behavioral aspects of phonation differed between the groups.
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Affiliation(s)
- Cara E Stepp
- Harvard-MIT Division of Health Science & Technology, Cambridge, Massachusetts, USA.
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Artico M, Bronzetti E, Ionta B, Bruno M, Greco A, Ruoppolo G, De Virgilio A, Longo L, De Vincentiis M. Reinke's edema: investigations on the role of MIB-1 and hepatocyte growth factor. Eur J Histochem 2010; 54:e30. [PMID: 20819770 PMCID: PMC3167312 DOI: 10.4081/ejh.2010.e30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/17/2010] [Accepted: 04/30/2010] [Indexed: 11/26/2022] Open
Abstract
Reinke's edema is a benign disease of the human vocal fold, which mainly affects the sub-epithelial layer of the vocal fold. Microscopic observations show a strongly oedematous epithelium with loosened intercellular junctions, a disruption of the extracellular connections between mucosal epithelium and connective tissue, closely adherent to the thyroarytenoid muscle. Thickening of the basal layer of epithelium, known as Reinke's space, high deposition of fibronectin and chronic inflammatory infiltration it is also visible. We analyzed, together with the hepatocyte growth factor (HGF), the expression level of MIB-1 in samples harvested from patients affected by Reinke's edema, in order to define its biological role and consider it as a possible prognostic factor in the follow-up after surgical treatment. We observed a moderate expression of HGF in the lamina propria of the human vocal fold and in the basal membrane of the mucosal epithelium. Our finding suggests that this growth factor acts as an anti - fibrotic agent in Reinke's space and affects the fibronectin deposition in the lamina propria. MIB-1, on the contrary, showed a weak expression in the basement membrane of the mucosal epithelium and a total absence in the lamina propria deep layer, thus suggesting that only the superficial layer is actively involved in the reparatory process with a high regenerative capacity, together with a high deposition of fibronectin. The latter is necessary for the cellular connections reconstruction, after the inflammatory infiltration.
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Affiliation(s)
- M Artico
- Department of Otorhinolaringology,Audiology and Phoniatry G. Ferreri, University of Rome La Sapienza, piazzale Aldo Moro 5, Rome, Italy.
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Stepp CE, Hillman RE, Heaton JT. A virtual trajectory model predicts differences in vocal fold kinematics in individuals with vocal hyperfunction. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2010; 127:3166-76. [PMID: 21117765 PMCID: PMC2882670 DOI: 10.1121/1.3365257] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
A simple, one degree of freedom virtual trajectory model of vocal fold kinematics was developed to investigate whether kinematic features of vocal fold movement confirm increased muscle stiffness. Model simulations verified that increases in stiffness were associated with changes in kinematic parameters, suggesting that increases in gesture rate would affect kinematic features to a lesser degree in vocal hyperfunction patients given the increased levels of muscle tension they typically employ to phonate. This hypothesis was tested experimentally in individuals with muscle tension dysphonia (MTD; N = 10) and vocal nodules (N = 10) relative to controls with healthy normal voice (N = 10) who were examined with trans-nasal endoscopy during a simple vocal fold abductory-adductory task. Kinematic measures in MTD patients were less affected by increased gesture rate, consistent with the hypothesis that these individuals have elevated typical laryngeal muscle tension. Group comparisons of the difference between medium and fast gesture rates (Mann-Whitney, one-tailed) showed statistically significant differences between the control and MTD individuals on the two kinematic features examined (p<0.05). Results in nodules participants were mixed and are discussed independently. The findings support the potential use of vocal fold kinematics as an objective clinical assay of vocal hyperfunction.
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Affiliation(s)
- Cara E Stepp
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts 02139, USA.
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[Phoniatricians aspect of international statistical classification of diseases and related health problems]. ACTA ACUST UNITED AC 2010; 56:65-9. [PMID: 20218105 DOI: 10.2298/aci0903065v] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In everyday phoniatrician practice there are problems in finding adequate coding in current version of International Classification of Diseases. There is grey area for additional explanation under the official diagnosis and its code in Computer program window, but that has bad consequences on efficacy in writing the final medical report. OBJECTIVE Suggestions for solving this problem that can contribute in next Revision are presented. METHOD The comparation between diagnoses in 7 years period of Phoniatric Department everyday practice and given diagnoses in current version of International Classification of Diseases. RESULTS Certain percent of diagnoses that are overviewed during last 7 years in our Phoniatric Department has no adequate expression in given diagnoses in Tenth Revision. One can say that there is some kind of communication disorder. CONCLUSION This is the moment for Communication Disorders Care Center experts to participate in constitution of widespread acceptable nomenclature. The role of phoniatrician is necessary and logical in this system. The phoniatrician aspect of contribution in next Revision, is presented.
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Martins RHG, Defaveri J, Domingues MAC, de Albuquerque e Silva R. Vocal polyps: clinical, morphological, and immunohistochemical aspects. J Voice 2010; 25:98-106. [PMID: 20097524 DOI: 10.1016/j.jvoice.2009.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 05/05/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To study the clinical, morphological, and immunohistochemical characteristics of vocal polyps. STUDY DESIGN Prospective and retrospective. METHODS Clinical study: 76 medical charts from patients with polyps were reviewed. Histology study: in 42 slides from surgical specimens, the following were analyzed: epithelium, basal membrane, and lamina propria. In the transmission and scanning electron microscopy (TEM and SEM) studies, eight new cases of polyps were included. An immunohistochemical study was carried out in the 42 specimens, using antibody antifibronectin, antilaminin, and anticollagen IV. RESULTS Genders--43% males and 57% females; age range--between 21 and 40 years (36.85%); and between 41 and 60 years of age (51.31%); smoking and drinking-reported by 39 and 15 patients, respectively; associated symptoms-vocal abuse (61%), gastroesophageal (47%), and nasosinusal symptoms (32%); occupation--teachers (24.0%) and maids (18.0%). Histology--epithelial hyperplasia (31.71%), hyperkeratosis, (14.28%), edema (100%), vessel proliferation (92.86%), and congestion (83.33%). SEM--reduction in mucous lacing and increase in desquamating cells. TEM--hyperplastic epithelium, enlargement of the intercellular junctions, dense subepithelial network of collagen and basal membrane with adhesion loss. Immunohistochemistry--greater immunoexpression of fibronectin, laminin, and collagen IV around the vessels. CONCLUSIONS In vocal polyps, the morphological analyses show lamina propria with edema, vessel proliferation and inflammation, basement membrane with adhesion loss in some areas and dense network of subepithelial collagen. Immunohistochemistry techniques identify pigmentation of the antibodies anti-fibronectin, anti-laminin, and anti-collagen IV in the endothelium of blood vessels.
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Affiliation(s)
- Regina Helena Garcia Martins
- Department of Otorhinolaryngology, Ophthalmology and Head and Neck Surgery, School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil.
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Stepp CE, Hillman RE, Heaton JT. Use of neck strap muscle intermuscular coherence as an indicator of vocal hyperfunction. IEEE Trans Neural Syst Rehabil Eng 2010; 18:329-35. [PMID: 20083462 DOI: 10.1109/tnsre.2009.2039605] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intermuscular coherence in the beta band was explored as a possible indicator of vocal hyperfunction, a common condition associated with many voice disorders. Surface electromyography (sEMG) was measured from two electrodes on the anterior neck surface of 18 individuals with vocal nodules and 18 individuals with healthy normal voice. Coherence was calculated from sEMG activity gathered while participants produced both read and spontaneous speech. There was no significant effect of speech type on average coherence. Individuals with vocal nodules showed significantly lower mean coherence in the beta band (15-35 Hz) when compared to controls. Results suggest that bilateral EMG-EMG beta coherence in neck strap muscle during speech production shows promise as an indicator of vocal hyperfunction.
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Affiliation(s)
- Cara E Stepp
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA.
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Martins RHG, Fabro AT, Domingues MAC, Chi AP, Gregório EA. Is Reinke's Edema a Precancerous Lesion? Histological and Electron Microscopic Aspects. J Voice 2009; 23:721-5. [DOI: 10.1016/j.jvoice.2008.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 03/03/2008] [Indexed: 11/28/2022]
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Martins RHG, Defaveri J, Custódio Domingues MA, de Albuquerque E Silva R, Fabro A. Vocal fold nodules: morphological and immunohistochemical investigations. J Voice 2009; 24:531-9. [PMID: 19853410 DOI: 10.1016/j.jvoice.2009.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 01/06/2009] [Indexed: 11/18/2022]
Abstract
The objective of this study was to investigate the morphological and immunohistochemical characteristics of vocal fold nodules. The study design was prospective and retrospective. For the histological study, we reviewed 15 slides from the surgical cases of vocal fold nodules, in which we analyzed epithelium, basal membrane (bm), and lamina propria. For the transmission and scanning electron microscopy (TEM, SEM) studies, five new cases on vocal fold nodules were included. Immunohistochemistry study was carried out in the 15 specimens, using antifibronectin, antilaminin, and anticollagen IV antibodies. The main histological alterations were epithelial hyperplasia (73.33%), basement membrane thickening (86.66%), edema, and fibrosis (93.33%). SEM--reduction in mucous lacing and increase in the desquamating cells, without epithelial erosion. TEM--hyperplasia of the epithelium, enlargement of the intercellular junctions, which was filled by fluid, subepithelial thickening of the lamina reticularis, and break points in the basal membrane. Immunohistochemistry--we identified greater immunoexpression of fibronectin on the basal membrane, on the lamina propria, and around the vessels. Antilaminin and anticollagen IV antibodies showed higher pigmentation on the endothelium of the vessels than that on the basal membrane. In vocal fold nodules, combined assessment using light microscopy, electron microscopy, and immunohistochemistry can reveal important morphological details useful in characterizing these lesions.
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Affiliation(s)
- Regina Helena Garcia Martins
- Department of Otorhinolaryngology, Ophthalmology and Head and Neck Surgery, School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil.
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Chung JH, Tae K, Lee YS, Jeong JH, Cho SH, Kim KR, Park CW, Han DS. The Significance of Laryngopharyngeal Reflux in Benign Vocal Mucosal Lesions. Otolaryngol Head Neck Surg 2009; 141:369-73. [DOI: 10.1016/j.otohns.2009.05.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 05/18/2009] [Accepted: 05/29/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE: To determine the significance of laryngopharyngeal reflux (LPR) in benign vocal mucosal lesions. STUDY DESIGN AND SETTING: A case-control study at the tertiary referral medical center. SUBJECTS AND METHODS: From April 2003 to December 2006, we studied 110 patients with benign vocal mucosal lesions who had undergone 24-hour ambulatory double pH monitoring. The control group included 200 patients who had undergone ambulatory 24-hour double-probe pH monitoring due to laryngopharyngeal reflux-related symptoms without specific findings of benign vocal mucosal lesions. Reflux symptom index and reflux finding score were measured. We compared the prevalence of pathologic laryngopharyngeal reflux and various parameters of the pH monitoring such as total reflux number, fraction time of pH below 4 in various positions, and DeMeester scores. RESULTS: The prevalence of pathologic laryngopharyngeal reflux was 65 percent in the control group, 66 percent in vocal nodule group, 75 percent in the vocal polyp group, and 90 percent in the Reinke's edema group. Patients with Reinke's edema had a significantly higher prevalence of pathologic laryngopharyngeal reflux than controls ( P = 0.016). LPR was associated with a significantly increased risk of Reinke's edema (odds ratio: 4.846, 95% confidence interval 1.093∼21.492). Total reflux number and DeMeester scores in the Reinke's edema group and fraction time of pH below 4 in the supine position in the vocal polyp group were significantly higher than those in the control group. CONCLUSION: Laryngopharyngeal reflux might play a role as an etiologic factor in Reinke's edema and vocal polyps.
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Affiliation(s)
- Jae Ho Chung
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyung Tae
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Yong Seop Lee
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Jin Hyeok Jeong
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Seok Hyun Cho
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyung Rae Kim
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Chul Won Park
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Dong Soo Han
- Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
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Liquid accumulation in vibrating vocal fold tissue: a simplified model based on a fluid-saturated porous solid theory. J Voice 2009; 24:260-9. [PMID: 19660905 DOI: 10.1016/j.jvoice.2008.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 09/22/2008] [Indexed: 11/20/2022]
Abstract
The human vocal fold is treated as a continuous, transversally isotropic, porous solid saturated with liquid. A set of mathematical equations, based on the theory of fluid-saturated porous solids, is developed to formulate the vibration of the vocal fold tissue. As the fluid-saturated porous tissue model degenerates to the continuous elastic tissue model when the relative movement of liquid in the porous tissue is ignored, it can be considered a more general description of vocal fold tissue than the continuous, elastic model. Using the fluid-saturated porous tissue model, the vibration of a bunch of one-dimensional fibers in the vocal fold is analytically solved based on the small-amplitude assumption. It is found that the vibration of the tissue will lead to the accumulation of excess liquid in the midmembranous vocal fold. The degree of liquid accumulation is positively proportional to the vibratory amplitude and frequency. The correspondence between the liquid distribution predicted by the porous tissue theory and the location of vocal nodules observed in clinical practice, provides theoretical evidence for the liquid accumulation hypothesis of vocal nodule formation (Jiang, Ph.D., dissertation, 1991, University of Iowa).
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Eckley CA, Swensson J, Duprat ADC, Donati F, Costa HO. [Incidence of structural vocal fold abnormalities associated with vocal fold polyps. Braz J Otorhinolaryngol 2009; 74:508-11. [PMID: 18852975 PMCID: PMC9442099 DOI: 10.1016/s1808-8694(15)30596-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 03/05/2007] [Indexed: 11/16/2022] Open
Abstract
Phonotrauma is considered the main cause of vocal fold polyps (VFP). However, the authors believe that an underlying anatomical deviation could render the vocal folds more susceptible to such trauma. Aim To prove this hypothesis a retrospective chart review was carried out to correlate the surgical findings of patients with VFP. Material and Methods The charts of thirty-three patients who underwent surgery for excision of VFP were reviewed: 21 had right VFP, 10 had left VFP and 2 had bilateral lesions. Results Associated lesions were reported in 27 patients (14 lesions on the opposite VF and 13 on the ipsilateral VF): 10 opposite nodules, 12 sulcus vocalis, 3 cysts, and 2 capillary engorgement. Discussion and Conclusions The high incidence of associated anatomical lesions to the VF (63%) suggests that patients with these minor underlying anatomical deviations are more vulnerable to vocal abuse, probably because they present abnormal glottic closure and an irregular vibratory margin.
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Spontaneous Resolution of Hemorrhagic Polyps of the True Vocal Fold. J Voice 2009; 23:132-5. [DOI: 10.1016/j.jvoice.2007.07.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 07/06/2007] [Indexed: 11/23/2022]
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Exudative lesions of Reinke’s space: a terminology proposal. Eur Arch Otorhinolaryngol 2008; 266:869-78. [DOI: 10.1007/s00405-008-0863-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 10/20/2008] [Indexed: 11/25/2022]
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Eckley CA, Swensson J, Duprat ADC, Donati F, Costa HO. Incidência de alterações estruturais das pregas vocais associadas ao pólipo de prega vocal. ACTA ACUST UNITED AC 2008. [DOI: 10.1590/s0034-72992008000400005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A etiologia mais aceita para pólipos de pregas vocais é o fonotrauma. Imaginamos que possa existir alguma alteração anatômica prévia nas pregas vocais que predisponha indivíduos a apresentarem lesões fonotraumáticas. OBJETIVO: O presente estudo retrospectivo procura encontrar correlação entre os pólipos de prega vocal e alterações estruturais da prega vocais. MATERIAL E MÉTODO: Foi realizado trabalho retrospectivo a partir da descrição cirúrgica de 33 pacientes submetidos a exérese de pólipo de prega vocal no período de três anos em hospital universitário. RESULTADOS: Trinta e um pacientes apresentaram pólipos unilaterais e 2 bilaterais. Foram encontradas 27 lesões associadas: 10 lesões reacionais, 12 sulcos, 3 cistos e 2 ectasia capilars. Foram 14 lesões contralaterais e 13 ipsilaterais. DISCUSSÃO E CONCLUSÕES: Encontrou-se uma forte correlação entre a presença de uma lesão de base influindo como co-fator de fragilização da prega vocal ao fonotrauma, pois das 27 lesões encontradas 17 foram consideradas pré-existentes (63%). As lesões poderiam interferir na coaptação das pregas vocais, gerando uma onda mucosa irregular durante a fonação, expondo o espaço de Reinke a uma agressão estrutural. Apesar do caráter preliminar do trabalho os achados sugerem íntima correlação entre o pólipo e lesões estruturais mínimas das pregas vocais.
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Ruiz DMCF, Pontes P, Behlau M, Richieri-Costa A. Laryngeal Microweb and Vocal Nodules. Folia Phoniatr Logop 2006; 58:392-9. [PMID: 17108697 DOI: 10.1159/000095000] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The etiology and pathogenesis of laryngeal microwebs are heterogeneous, and in most cases they are an incidental finding. It has also been suggested that microwebs could be a familial trait, representing a postblastogenic embryonic vestigial structure that might alter the biomechanical and vibratory properties of the vocal fold. Vocal nodules are small benign swellings along the margins of the vocal cords, with preferential location at the junction of the anterior and middle thirds, and usually resulting from mechanical trauma. The authors studied a sample of 107 patients with vocal nodules, looking for a possible correlation with microwebs due to the predicted involvement in the vibration of vocal cord margins. Glottic proportion, type of glottic closure, nodule location and the main complaints in patients with microwebs were compared with those in a sample of patients without microwebs. In the present study, microwebs were found in 9.4% of the patients, who showed much smaller glottic proportion than patients with micronodules only. Furthermore, vocal nodule location was not related to the presence and/or absence of laryngeal microwebs.
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Affiliation(s)
- Daniela Maria Cury Ferreira Ruiz
- Departamento de Genética Clínica, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brazil.
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Duflo SM, Thibeault SL, Li W, Smith ME, Schade G, Hess MM. Differential gene expression profiling of vocal fold polyps and Reinke's edema by complementary DNA microarray. Ann Otol Rhinol Laryngol 2006; 115:703-14. [PMID: 17044544 DOI: 10.1177/000348940611500910] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Our purpose was to determine whether complementary DNA (cDNA) microarray analysis (MA) can establish distinct gene expression profiles for 2 phenotypically similar vocal fold lesions: Reinke's edema (RE) and polyps. Established transcript profiles can provide insight into the molecular and cellular processes involved in these diseases. METHODS Eleven RE specimens and 17 polyps were analyzed with MA for 8,745 genes. Further MA profiling was attempted within each lesion group to identify molecular markers for reflux exposure and smoking. Prediction analysis was used to predict lesion classification for 2 unclassified samples. A real-time polymerase chain reaction was performed to corroborate MA transcript levels for selected significant genes. RESULTS Sixty-five genes were found to differentiate RE and polyps (p = .0088). For RE, 19 genes were differentiated for reflux exposure (p = .016). No genes were found to differentiate smokers from nonsmokers. For polyps, no genes were found to differentiate for reflux (p = .16) and smoking (p = .565). Categorization of unclassified lesions was possible with a minimum of 13 genes. CONCLUSIONS We demonstrate the feasibility of benign lesion classification based on MA. Microarray analysis is useful not only for improving diagnosis and classification of such lesions, but also for potentially generating prognostic indicators and targets for therapy.
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Affiliation(s)
- Suzy M Duflo
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine, The University of Utah, Salt Lake City, Utah, USA
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Jovanović MB, Perović JV, Milenković S. [Rigid telescopy and contact endoscopy in the diagnosis and surgery of Reinke's oedema--clinical and histological assessment]. SRP ARK CELOK LEK 2006; 133:469-75. [PMID: 16758845 DOI: 10.2298/sarh0512469j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We focussed our attention on the use of both rigid telescopy and contact endoscopy in order to assess their effectiveness in the diagnosis and surgery of Reinke's oedema. Changes were observed in a sample of 40 patients, suffering from different stages of Reinke's oedema, who had undergone microlaryngoscopies. For the first time during our laryngological praxis, we discussed a number of parameters that appeared to be significant in the monitoring and detailed evaluation of this vocal fold disease. With contact endoscopy, during the early stages of the disease, the cells and nuclei of normal squamous layered epithelium continued to display uniform morphological features. The appearance of epithelial changes helps to distinguish between different stages of Reinke's oedema, which can be associated with severe inflammation or keratinisation. With latter-stage oedemas, the following was observed: various changes in the blood vessels of the glottis, which when viewed through the endoscope have an unusual "loop-like" or "branching" appearance, as well as elongated and varicose blood vessels, and the build-up of erythrocytes inside atypical capillaries. Both endoscope techniques are non-invasive and very appropriate for precisely diagnosing Reinke's oedema within a relatively short period of time. Rigid telescopy has the advantage of enabling the systematic observation of many details in the large area of both vocal fold mucosae, particularly when access to the larynx is difficult. This enables dynamic monitoring and immediate pathology consultations inside the operating theatre. The special contribution of contact endoscopy is that, both in vivo and in situ, it allows a detailed scanning and mapping to be performed of all cell changes and ofvascularisation throughout the entire mucosa surface. Video-assisted telescopy does not permit a completely first-rate surgical resection of Reinke's oedema, because of unsatisfactory control or insufficient stability of the instrument during the operation using the one-handed method.
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Moorthy SS, Gupta S, Pfefferkorn T. Anesthetic implications of Reinke’s edema of vocal cords. Can J Anaesth 2005; 52:775-6. [PMID: 16103399 DOI: 10.1007/bf03016575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Johns MM. Update on the etiology, diagnosis, and treatment of vocal fold nodules, polyps, and cysts. Curr Opin Otolaryngol Head Neck Surg 2003; 11:456-61. [PMID: 14631179 DOI: 10.1097/00020840-200312000-00009] [Citation(s) in RCA: 170] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Innovative otolaryngologists, speech language pathologists, and voice scientists have continued to advance our understanding of the etiology, diagnosis, and treatment of vocal fold nodules, polyps, and cysts. This article reviews the recent publications over the past 3 years with respect to these advances. RECENT FINDINGS Support for the notion that benign vocal fold lesions arise from phonatory trauma and vocal misuse continues to become evident. Changes in the molecular characteristics of the lamina propria in these lesions are beginning to be understood. For diagnostic purposes, the use of innovative technology such as ultrasonography and virtual laryngoscopy is being explored. Continued support for behavior modification as a primary treatment modality for benign vocal fold lesions has been published, and refinements in technical aspects of laryngeal microsurgery persist. Finally, outcomes studies have demonstrated improvements in vocal disability with both behavioral and surgical interventions. SUMMARY Clinical and basic research has furthered our understanding of benign vocal fold lesions and has expanded our diagnostic and therapeutic armamentarium for patients with dysphonia arising from these lesions.
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Affiliation(s)
- Michael M Johns
- Department of Otolaryngology--Head and Neck Surgery, Emory University, Atlanta, Georgia 30308, USA.
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