A follow-up study of surgically managed benign vocal cord lesions using vocal handicap index - 10 score.

Background and Objectives: Benign lesions of the vocal cords not only impair the patient's ability to communicate due to poor pronunciation and voice capabilities, but they also cause a variety of psychological and social problems, worsening their quality of life. To assess voice handicap, Voice Handicap Index (VHI)-10 is an easy-to-administer, valid and reliable tool. The present study was conducted to compare the pre-operative and post-operative well-being of patients with benign vocal cord lesions using VHI-10 among patients attending our Outpatient department. Materials and Methods: The study was a hospital based observational study with prospective study design, conducted over a period of 17 months (August 2019 to December 2020) on 53 patients who were clinically diagnosed to have benign vocal cord lesion and underwent micro laryngeal surgery followed by histopathological confirmation. Follow-up of the participants was done on 4th and 8th week post-operatively. Visualization of the condition of the laryngeal structures using laryngoscope assessment of VHI-10 score was done at each follow-up visit. Results: In our study, out of 53 study participants, approximately one-third of the cases were seen in the 5th decade, that is, 40-49 years. The mean (±SD) age of the study participants was 43.2 (±12.1) years. There was male predominance (73.6%) with male to female ratio of 2.78:1. Majority of the patients had voice-demanding profession with history of vocal abuse. In cases of non-professional voice users, the highest incidence was noted in homemakers (11.4%). Smoking was noted in nine male patients while all the female patients were non-smokers. Habit of alcohol consumption was seen in 15.1% patients and 7.5% patients had habit of other substance abuse such as tobacco chewing, betel nut chewing, etc. Vocal polyps were the most common benign lesions found in 43.3% of the patients. Preoperatively mean (± SD) VHI-10 score was 20.7 (±3.5) which significantly decreased to 12.6 (±2.5) at 4th week post-operatively and 8.5 (±2.3) at 8th week post-operatively. Mean differences between pre-operative and post-operative scores were statistically significant (P < 0.01), depicting that there was improvement in the voice of the patients post-operatively. Conclusion: The VHI-10 scale is shown to be a good and convenient tool for assessing patient voice handicap and determining improvement post-operatively. Wider studies with larger sample size in different parts of the country may be recommended to validate the findings of the study. In addition to surgical excision of lesion, speech therapy, and patient counselling are indubitably essential measures that should be undertaken for each patient so as to alleviate the handicapping effect of voice disorder and improve the overall quality of life of the individuals.

Correlating laryngoscopic appearance of laryngeal lesions with histopathology.

OBJECTIVES/HYPOTHESIS: Meticulous scrutiny of laryngeal lesions with laryngoscopes and microscopes often identify angiogenic activity, one of the hallmarks of neoplastic and preneoplastic lesions. The aim of this study was to determine if there is an association between laryngoscopic appearance and histopathology of laryngeal lesions based on operative biopsies. STUDY DESIGN: Retrospective case-control study. METHODS: One hundred forty-four laryngeal biopsies from 92 patients between 2015 and 2017 met inclusion criteria. Cases were patients who had biopsy-proven laryngeal dysplasia or malignancy. Controls were patients who had benign laryngeal pathology. All of the laryngeal lesions had either keratosis or vascular stippling, an indication of angiogenic activity. Medical records, videostroboscopies and operative findings of these patients were reviewed. Multivariable logistic regression was used to examine the correlation between laryngoscopic appearance of laryngeal lesions and presence or absence of dysplasia and invasive carcinoma. RESULTS: Fifty percent of the 144 laryngeal lesions were classified either as dysplastic or malignant by histopathology. Vascular stippling was present in 31% of all laryngeal lesions. On logistic regression, vascular stippling was significantly associated with dysplastic and malignant lesions (P = .0018). Overall sensitivity and specificity of vascular stippling and the presence of dysplasia and malignancy were 51% and 89%, respectively. CONCLUSIONS: Laryngoscopic and microscopic appearance of vascular stippling could inform clinicians on diagnostic sampling of suspicious laryngeal lesions that reduces delay in diagnosis. The low sensitivity of vascular stippling underlies the importance of maintaining high clinical suspicion and proceeding to the operating theater for adequate tissue sampling. LEVEL OF EVIDENCE: 3 Laryngoscope, 129:1308-1312, 2019.

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

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

Comparison of the Results of Voice Handicap Index and Computer-Assisted Voice Analysis in Patients with Benign Vocal Cord Lesions before and after Microlaryngeal Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Voice Handicap Index (VHI) subjectively evaluates the severity of voice disorders. On the other hand, computer-assisted voice analysis objectively evaluates the severity of voice disorders. The purpose of this study was to compare the results of these two different tests in patients with benign vocal cord lesions and to measure the correlation between parameters of these two tests. MATERIALS AND METHODS: From January 2002 to December 2003, 76 patients who underwent microlaryngeal surgery for benign vocal cord lesions in the Asan Medical Center were included in this study. They all filled out the VHI questionnaires, which were composed of 30 questions about before and after surgery. For 32 out of 76 patients, we also performed preoperative and postoperative acoustic analysis (jitter, shimmer, noise to harmonic ratio) and aerodynamic analysis (maximum phonation time, mean flow rate, mean subglottic pressure). All VHI and voice analysis parameters were entered into a statistical program and analyzed using a Pearson correlation. RESULTS: All the parameters of VHI showed significant improvement after surgery. The values of jitter, shimmer, noise to harmonic ratio, and maximal phonation time showed a significant change after surgery, but the mean flow rate and the mean subglottic pressure didn't. Each VHI parameter provided a significant level of reliability (p0.05) after surgery. CONCLUSION: The VHI provides a measure of self-perception on the severity of the voice disorders that cannot be assessed through objective acoustic and aerodynamic measures. No objective parameters show strong correlation with VHI parameters when compared across other testing methods after surgery. This discrepancy indicates that no objective parameters can yet be regarded as a prognostic factor to evaluate subjective perception.

Vocal Dynamic Studies before and after Laryngeal Microsurgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Perceptual acoustic measures are most often used to judge the outcomes and the objective analysis of phonosurgical results before and after the microlaryngeal surgery. However, they have rarely been reported in this country. The purpose of this study is to analyze aerodynamic and acoustic results before and after microlaryngeal surgery and to analyze the differences of the prognosis of various benign vocal cord lesions. MATERIALS AND METHODS: At Inha University Hospital, from June 1996 to August 1998, 245 microlaryngeal surgeries were done. Malignant lesions were excluded. And 118 (54 females and 64 males) out of 245 patients were followed up after the surgery: the acoustic and the aerodynamic studies before and 8 weeks after microlaryngeal surgery for benign lesions: vocal polyp, vocal nodule, Reinke's edema, intracordal cyst and hyperkeratosis. Seven measurements were performed: fundamental frequency, jitter, shimmer, noise to harmonic ratio as the acoustic analysis, maximal phonation time, mean flow rate and subglottal pressure as the aerodynamic analyses. RESULTS: Postoperative acoustic and aerodynamic data of vocal polyp, vocal nodule, Reinke's edema and intracordal cyst were improved, but those of hyperkeratosis were not improved. CONCLUSION: By comparing the acoustic and aerodynamic data before and after the microlaryngeal surgery, postoperative vocal function was defined more accurately and objectively. Jitter, shimmer, and MFR might be meaningful parameters accessing the quantitative changes in vocal quality before and after the microlaryngeal surgery.

Acoustic Analysis of Benign Vocal Cord Lesions: Before and after Microlaryngeal Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign vocal cord lesions that are not responsive to medical and/or speech therapy are often treated by microlaryngeal surgery. The purpose of this study is to measure selected acoustic parameters to document quantitative changes in vocal quality before and after microlaryngeal surgery and to analyze differences of prognosis for various benign vocal cord lesions, such as vocal cord polyp, vocal cord nodule, and Reinke's edema. MATERIALS AND METHODS: The authors used a computerized acoustic analysis program (CSL-MDVP) to measure mean fundamental frequency (Fo), jitter, shimmer, and noise to harmonics ratio (NHR) from voice samples of selected patients who had benign vocal cord lesions before and after at least 10 weeks of surgery. RESULTS: The values of Fo and NHR showed no significant difference in all three groups. There was significant improvement in nodule regarding jitter. Also, there was significant improvement in the vocal cord polyp regarding jitter and shimmer. CONCLUSION: Jitter and shimmer will be effective acoustic parameters in documenting the quantitative changes in vocal quality before and after microlaryngeal surgery.