OBJECTIVE: To determine the prevalence of benign vocal cord lesions among Filipino patients in a tertiary institution and identify the demographic characteristics and possible risk factors found among these patients.
METHODS:
Design: Retrospective Case Series
Setting: Private Tertiary Hospital
Participants: Records of 2,375 patients who underwent laryngeal video endoscopy and stroboscopy from 2012-2014 were reviewed.
RESULTS: There were 632 records of patients with benign vocal fold lesions, of which nodules were most common (211, 33.38%) followed by Reinke's edema (165, 26.10%), cysts (122, 19.30%) and polyps (74, 11.70%) with hoarseness as the most common symptom (542, 85.76%). More than half (336, 53.16%) were aged 21-40 years and almost two-thirds (469, 74.21%) were female. The most common associated factors were caffeine intake (445, 70.41%) and inadequate water intake (370, 58.54%), followed by alcohol (253, 40.03%). Smoking was only present in 146 (23.19%).
CONCLUSIONS: Baseline evidence on the prevalence of benign vocal fold lesions in this institution as well as baseline data on the common characteristics and associated factors seen in the sample population may assist us in current practices and guide future studies directed toward treatment and prevention.

Human ; Male ; Female ; Stroboscopy ; Vocal Cords ; Hoarseness ; Caffeine ; Risk Factors ; Smoking ; Tertiary Care Centers ; Laryngeal Edema ; Polyps ; Larynx ; Cysts ; Alcohols ; Endoscopy ; Edema

BACKGROUND AND OBJECTIVES: Surgery is considered the primary treatment for intracordal cyst. However, patients who had undergone surgery are still subject to recurrence and continued voice changes. Intracordal cysts naturally disappear in some patient population. Cyst does not always recur in patients who had received partial surgical removal, too. Contradicting results raises a question whether complete surgical removal of intracordal cyst is necessary and demonstrate need for better treatment. Herein, the author proposes novel surgical method technique intralaryngeal needle technique (INT), a technique using surgical needle for not only injection but also for aspiration and excision of cyst. This study aims to examine the potential of intralaryngeal needle technique in treating intracordal cysts. MATERIALS AND METHODS: Surgical procedures were done on in-patients diagnosed with intracordal cyst. 23 patients received follow-up screening after the surgery for one year. Patients' subjective satisfaction levels, acoustic measures, aerodynamic measures, laryngeal stroboscopic results were compared before and after the treatment. RESULTS: Overall patients were satisfied with novel surgical excision method. In terms of aerodynamic measures, maximum phonation time, mean air flow rate improved after the surgery. In terms of acoustic measures, Jitter, Shimmer, NHR, and voice pitch changes after the treatment showed statistically significant differences. Laryngeal stroboscopy results showed significant decreases in cyst sizes. Post-surgery patients had improved mucosal waves and amplitudes values. CONCLUSION: The results show the validity of intralaryngeal needle technique in reducing intracordal cyst size by excision, aspiration, and injection. The author believes this novel technique can be used as an alternative surgical method for intracordal cysts.
Acoustics ; Follow-Up Studies ; Humans ; Mass Screening ; Methods ; Needles* ; Phonation ; Recurrence ; Stroboscopy ; Voice

After thyroid surgery, voice change occurs very frequently, in more than 30% of cases. In addition to injury to the recurrent laryngeal nerve (RLN) or the external branch of superior laryngeal nerve (EBSLN), vocal fold edema due to excessive tracheal traction or disrupted laryngeal venous drainage, and laryngotracheal fixation following injury to extralaryngeal musculature can cause post-thyroidectomy voice change. Although complete recovery can be expected mostly in 3 months, dysphonic patients should be evaluated pre and postoperatively by laryngoscopy or laryngeal stroboscopy. The present review discusses the evaluation of voice change, the anatomy of RLN and EBSLN and common cause of voice change after thyroid surgery. Furthermore, we represent how to preserve RLN, SLN including intraoperative nerve monitoring.
Drainage ; Edema ; Humans ; Laryngeal Nerves* ; Laryngoscopy ; Recurrent Laryngeal Nerve ; Stroboscopy ; Thyroid Gland ; Thyroidectomy ; Traction ; Vocal Cords ; Voice*

BACKGROUND AND OBJECTIVES: The aim of this study was to verify that voice analysis could be an alternate tool for the evaluation of proton pump inhibitor treatment of laryngopharyngeal reflux (LPR). SUBJECTS AND METHOD: Twenty-two patients with LPR symptoms underwent laryngoscopy, stroboscopy and their reflux finding index (RFI) were evaluated. Subjective reflux symptom scores (RSS) and voice handicap index (VHI) were completed at the baseline. All patients underwent voice analysis. Thereafter, patients had short-term proton pump inhibitor therapy for 6 weeks. The RFI, RSS, VHI and voice analysis were repeated during the last week of the treatment. RESULTS: RFI was improved and both RSS and VHI were improved after the treatment. RSS and VHI were significantly correlated. In voice analysis, shimmer significantly improved and harmony to noise ratio (HNR) also improved. CONCLUSION: Voice analysis can be indicators of treatment results of laryngopharyngeal reflux disease.
Hoarseness ; Humans ; Laryngopharyngeal Reflux* ; Laryngoscopy ; Noise ; Proton Pumps* ; Stroboscopy ; Voice ; Voice Quality*

BACKGROUND AND OBJECTIVES: Vocal nodules are the most common voice disorder due to vocal misuses. Vocal nodules are primarily treated with voice therapy and are rarely removed through laryngomicrosurgery. Although the rate of recovery for individual patients may vary, 60-70% of them are fully treated. Because vocal nodules have many possible causes, 30-40% of patients remain untreated. Also, vocal nodules recurrence after the surgical treatment is sometimes observed. The author claims that incomplete contact between vocal cords during phonation is a major cause of the vocal nodules. Most vocal nodules do occur from incomplete contact between vocal cords during phonation, and various voice therapies are designed to improve habitual misuses of the vocal cords. However, vocal nodules tend to remain unhealed unless patients change their habitual misuses of the vocal cords. The cricothyroid muscle tension is known to hinder the contact between vocal cords. The author injected a restricted amount of botulinium toxin to the cricothyroid muscle to reduce the muscle tension and observed changes in vocal cords' movement. SUBJECTS AND METHOD: In this study, the author injected botulinium toxin to the cricothyroid muscle of 21 patients. For 2-4 weeks, we observed patients' responses to the treatment, by measuring changes in subglottal pressure, mean air flow rate, maximum phonation time, jitter, shimmer, noise-to-harmonic ration of patients and subjective evaluation of voice changes. In addition, the author conducted stroboscopy to evaluate the usefulness of the treatment. RESULTS: The improvement was in the subjective evaluation of voice changes and stroboscopic findings. CONCLUSION: The observation demonstrated a great improvement in vocal nodules after the injection of botulinium toxin into the cricothyroid muscle.
Humans ; Laryngeal Muscles ; Muscle Tonus ; Phonation ; Recurrence ; Stroboscopy ; Vocal Cords ; Voice ; Voice Disorders

BACKGROUND AND OBJECTIVES: Various phonation patterns yield various voice characteristics. Voice therapy using nasal stimulatory sounds seems to facilitate phonation in voice disodered patients. Under the hypothesis that nasalance may be influenced by the pattern of phonation, we studied the relationship between nasalance and voice disorders by observing abnormal supraglottic movements and vocol cord gaps in phonation. SUBJECTS AND METHOD: There were 143 patients who complained of voice problems and showed abnormal false vocal cord movements under stroboscopy. In addition to the four previously described types of MTD (muscle tension dysphonia), we described two more types of MTD (V: false vocal cord contracted posteriorly, VI: false vocal cord dilated laterally). We measured the vocal cord gaps in phonation and analyzed nasalance. RESULTS: Among those groups showing the pattern of false vocal cord (MTD 1, 2, 4), the vocal cord gaps in phonation were increased and nasalance was significantly decreased in MTD types, III and IV, and showed a tendency to decrease in MTD types, II and V, compared to the normal group. CONCLUSION: The supraglottis has a tendency to contract as the vocal cord gap in phonation increases, and this movement reduces nasalance.
Dysphonia ; Humans ; Phonation* ; Stroboscopy ; Vocal Cords ; Voice ; Voice Disorders

BACKGROUND AND OBJECTIVES: The size of nodule is generally known as a main criterion for the evaluation of voice improvement in the patients with vocal nodules. However, the patients who are receiving voice therapy for their vocal nodules frequently report variable degree of improvement in their voice quality even though the size of nodules remain unchanged during the stroboscopic evaluation. We aimed to define valuable parameters of laryngeal stroboscopy in evaluating the efficacy of voice therapy for vocal nodules. SUBJECTS AND METHOD: We reviewed the medical records of twenty adult women with bilateral vocal nodules. They received 4 to 8 sessions of voice therapy and reported variable degree of their voice improvement. Laryngeal stroboscopy (nodule size, glottal closure, vocal fold vibration, laryngeal tension), acoustic analysis (jitter, shimmer), perceptual parameters (GRBAS) were evaluated before and after voice therapy. Laryngeal stroboscopic gradings and GRBAS gradings were matched and analyzed for their correlation. RESULTS: There were significant correlations between R and vocal fold vibration; between B and nodule size and glottal closure; between S and laryngeal tension; between G and glottal closure, vocal fold vibration and laryngeal tension. CONCLUSION: Among laryngeal stroboscopic findings, improved glottal closure, vocal fold vibration and decreased laryngeal tension as well as decreased nodule size are proved to be useful parameters to evaluate the effectiveness of voice therapy in the patients with vocal nodules.
Acoustics ; Adult ; Female ; Humans ; Medical Records ; Stroboscopy ; Vibration ; Vocal Cords ; Voice Disorders ; Voice Quality ; Voice* ; Weights and Measures*

BACKGROUND AND OBJECTIVES: The aims of this study are to introduce Artecoll and Restaylane, that have been available for facial augmentation, as new materials for injection laryngoplasty, to investigate the mucosal wave of true vocal folds after the injection of these two materials into the true vocal fold, and to assess its biocompatibility and durability. SUBJECTS AND METHOD: After complete paralysisof the right recurrent laryngeal nerve of 6 Beagle dogs, the dogs were divided into the Artecoll injection group and the Restylane injection group, and Artecoll or Restylane was injected into vocalis muscle and vocal ligament. The recurrent laryngeal nerve of the opposite side was stimulated, the posterior commissure was sutured, and the mucosal wave of true vocal folds was examined by stroboscopy in in vivo canine study 1, 3, and 6 months after the injection. And, histopathological change of the injected materials after total laryngectomy was examined by hematoxylin and eosin (H & E) staining and masson trichrome staining. RESULTS: In both the Artecoll injection and the Restylane injection groups, the mucosal wave of true vocal folds was detected by stroboscopic examination until 6 months after the injection, and the difference of the mucosal wave of true vocal folds between these two groups was difficult to detect. Histological studies revealed that the injected materials remained in the vocal ligament and vocalis muscle and theses two materials were resorbed with time, Artecoll showing less resorption. These two materials were biocompatible and, particularly, Restylane showed less foreign body reaction. CONCLUSION: Since both Artecoll and Restylane are biocompatible and durable, they areconsidered as the suitable material for injection larygoplasty, and additional long-term studies are required.
Animals ; Dogs ; Eosine Yellowish-(YS) ; Foreign-Body Reaction ; Hematoxylin ; Laryngeal Muscles ; Laryngectomy ; Laryngoplasty ; Recurrent Laryngeal Nerve ; Stroboscopy ; Vocal Cords*

BACKGROUND AND OBJECTIVES: Decrease in mucosal waves and diplophonia are known as main diagnostic criteria of vocal cysts. However, preoperative differential diagnosis of intracordal retention cyst (IRC) over vocal polyp and/or edema is not infrequently challenging even with those criteria. Authors aimed to evaluate the efficacy of laryngeal stroboscopy and acoustic analyses for the proper diagnosis of IRC. MATERIALS AND METHOD: We reviewed medical records of 30 patients who were initially diagnosed as having IRC either through laryngeal endoscopy or stroboscopy. Endoscopic and/or stroboscopic findings, acoustic and perceptual parameters were analyzed in comparison to the final pathologic diagnosis. RESULTS: Only 70% of the subjects were correctly diagnosed with laryngeal stroboscopy, which suggested the need of reconsideration of current diagnostic criteria. Decrease in mucosal waves was a frequently observable but not a specific finding confined to IRC. Diplophonia was neither a common nor a specific finding of IRC. Acoustic evaluation was not helpful for the differential diagnosis of IRC over vocal polyp. Hemorrhagic changes around the lesion were observed in some of vocal polyps but not in any of IRC. CONCLUSION: Decreased or absent mucosal wave is one of the characteristics of IRC, but is a not absolute criterion for the differential diagnosis between IRC and vocal polyp. Diplophonia and other acoustic parameters are not helpful for the differential diagnosis of those lesions. A careful endoscopic or stroboscopic evaluation of general contour, mucosal change and any surrounding hemorrhage will help in the proper differential diagnosis of IRC over vocal polyp. Decrease in mucosal waves will also help the diagnosis of IRC but not when it is overemphasized as an absolute criterion.
Acoustics* ; Diagnosis* ; Diagnosis, Differential ; Edema ; Endoscopy ; Hemorrhage ; Humans ; Medical Records ; Polyps ; Stroboscopy* ; Vocal Cords

BACKGROUND AND OBJECTIVES: Mitomycin-C is an antibiotic, antineoplastic agent that inhibits DNA and protein synthesis, and fibroblast proliferation. It has been successfully used in adjunction to glaucoma surgery, dacryocystorhinostomy, pterygium surgery, and middle meatal antrostomy. The purpose of this study is to evaluate the efficacy and safety of intraoperative Mitomycin-C application as an adjunct therapy in the endoscopic treatment of laryngeal stenosis and granulation. MATERIALS AND METHOD: A total 13 subjects, of whom 2 had anterior glottic web, 4 posterior laryngeal stenosis, and 7 laryngeal granuloma were included. All underwent stroboscopy and were treated with endoscopic laryngomicrosurgery with CO2 laser. Then, 1 cc of 0.4 mg/mL Mitomycin-C was directly applied for 4 minutes on the surgical site. The patients' symptoms were assessed, and the size of the airway was graded on a scale of I (< or =50%) to IV (total occlusion) after a mean follow-up period of 5 months. The recurrence of the laryngeal granuloma was checked. RESULTS: There was a significant improvement in postoperative symptoms in the group of posterior laryngeal stenosis. Two with tracheotomy underwent decannulation. The postoperative size of airway was markedly increased and restenosis was not noted. There was only one case of recurrence in the granuloma group. CONCLUSION: According to these preliminary results, it is suggested that application of Mitomycin-C can be used as a beneficial adjunct therapy in the endoscopic COc laser excision for laryngeal stenosis and granuloma.
Dacryocystorhinostomy ; DNA ; Fibroblasts ; Follow-Up Studies ; Glaucoma ; Granuloma* ; Granuloma, Laryngeal ; Laryngostenosis* ; Lasers, Gas ; Mitomycin* ; Pterygium ; Recurrence ; Stroboscopy ; Tracheotomy