Evaluation and management of voice disorders: Our experiences

Background: Change in voice is one of the most common complains among patients visiting to ENT outpatient. The causes are numerous and need to be evaluated before approaching to curative intent of treatment. Aims and Objectives: The current study was designed with an aim to analyze the spectrum of voice disorders and their management option. Materials and Methods: Prospective study conducted between June 25, 2020, and November 30, 2021. Clinical, demographic profiles were recorded. Fiber-optic laryngoscopy was performed in all the cases. Radiology examination computed tomography/magnetic resonance imaging was supplemented only in required cases. Treatment was executed based of etiological profile analysis. Minimum 3 months follow-up was collected post-therapy. Statistical analysis was performed using Statistical Package for the Social Sciences version 24. Pearson Chi-square test was used for see the association between parameters. P-value was considered significant while being <0.05. Results: Out of 218 patients, the most patients (approx. 70%) occupied in the age group of 30–50 years. There was male predominance (76.6%). Voice change secondary to laryngopharyngeal reflux was seen in 56.4% of cases. Benign vocal fold lesions (nodule/cyst/polyp) were noticed in 26.5% of cases. Malignant lesions were seen in 1.8% of cases. Benign vocal fold lesions (polyp and cyst) were treated by microlaryngeal surgery (MLS). Pre-malignant lesion (leukoplakia) was treated with MLS stripping. Out of four malignant lesions, one was in early stage and underwent supraglottic laryngectomy while others were in advanced stage (T4) and treated by total laryngectomy. Conclusions: Voice disorders comprise wide etiological profile from reflux to malignant lesion. Timely proper evaluation followed by definitive management achieves good treatment outcomes.

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Comparative study of benign vocal fold lesions in a tertiary health centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20150902 ◽

2015 ◽

Vol 1 (2) ◽

pp. 65 ◽

Cited By ~ 4

Author(s):

Geetha K. Siddapur ◽

Kishan R. Siddapur

Keyword(s):

Vocal Fold ◽

Early Stage ◽

Health Centre ◽

P Value ◽

Significance Level ◽

Vocal Nodule ◽

Predominant Symptom ◽

Benign Vocal Fold Lesions ◽

Operative Care ◽

History Of

Background: The present study was carried out to analyze the factors associated with different vocal fold lesions and to diagnose various benign vocal fold lesions at an early stage by their demographic profile and clinical presentations.Methods: Patients with history of hoarseness of voice as a predominant symptom, cough, pain, foreign body sensation, dryness of throat and with a dominant history of vocal abuse, smoking or alcoholism were included in the study. Patients with acute infections, carcinomas, vocal cord palsy or other neurological diseases were excluded from the study.Results: The males comprised 66.7% of patients in the study and the commonest age group involved was 30-40 years. Vocal abuse was the leading risk factor in 80% patients. Hoarseness of voice was the predominant symptom in 83% patients followed by vocal fatigue. Bilateral vocal fold involvement was seen in 50% of the cases. All vocal nodule cases had bilateral vocal fold involvement. The vocal nodules were the commonest lesion seen (35%). Intra-operative and post-operative use of intravenous steroids was also found beneficial. Statistical analysis was done using Chi-square test. Significance level was assessed with P value <0.05. The bilateral involvement in all the vocal nodule cases was found significant.Conclusions: Voice therapy and cessation of smoking and alcohol can significantly reduce the incidence of these benign vocal fold lesions. It’s not only surgery that’s important in managing vocal fold lesions, but the post-operative care equally plays a vital role.

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A Comparison of Vocal Function between Females with Benign Vocal Fold Lesions and Females with Normal Voices by Use of Electroglottograph

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.2020758 ◽

2020 ◽

Author(s):

Cholada Seepuaham ◽

Jeamjai Jeeraumporn ◽

Sumalee Dechongkit ◽

Montip Tiensuwan

Keyword(s):

Vocal Fold ◽

P Value ◽

Vocal Function ◽

Benign Vocal Fold Lesions ◽

Parameter Values ◽

Degree Of Severity

Objective: To compare vocal function between females with benign vocal fold lesions, and females with normal voices by use of electroglottograph (EGG), also in addition to determining which EGG parameters were significantly correlated with the perceptual degree of dysphonia. Material and Methods: EGG data were obtained from 32 females with benign vocal fold lesions and 32 females with normal voices. The EGG parameter values were analyzed from their productions of four sustained vowels (/a:/, /u:/, /i:/, and /æ:/). Results: The two perturbation measures of EGG signals, EGG-jitter and EGG-shimmer of females with benign vocal fold lesions were significantly higher than those of normal females at a p-value<0.01 for all four vowels. EGG-SDF0 of females with benign vocal fold lesions were significantly higher than those of normal females at a p-value<0.01 for /i:/, and /æ:/. EGG-F0 of females with benign vocal fold lesions were significantly lower than those of normal females at a p-value<0.01 for /u:/, /i:/, and /æ:/. The differences in contact quotient were non-significant on all four sustained vowels between the two groups. In addition, EGG-SDF0 was found to be significantly correlated with the perceptual degree of dysphonia for four sustained vowels. Conclusion: The results of this study showed the differences between vocal function of females with benign vocal lesions and females with normal voices, using EGG parameters. Furthermore, EGG-SDF0 could be used as an indicator for the degree of severity of dysphonia in females with benign vocal fold lesions.

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An observational study of benign oral lesions in central India

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20173201 ◽

2017 ◽

Vol 3 (4) ◽

pp. 816

Author(s):

Prashant N. Keche ◽

Nishikant P. Gadpayle ◽

Surendra H. Gawarle ◽

Gaurav A. Chamania

Keyword(s):

Oral Cavity ◽

Malignant Tumors ◽

Early Stage ◽

Minor Salivary Gland ◽

Salivary Gland Tumor ◽

Oral Lesions ◽

Age Group ◽

Cross Sectional ◽

Male Predominance ◽

Malignant Lesions

Background: The oral mucosa serves as a protective barrier against trauma, pathogens and carcinogenic agents. It can be affected by a wide variety of lesions and conditions, some of which are harmless while others may have serious complications. The appearance of benign oral soft tissue masses can occasionally resemble malignant tumors. Methods: Present study is an observational and cross sectional study under taken in the Department of ENT in Shri Vasant Rao Naik Government Medical College, Yavatmal. All cases of benign oral lesions were included in the study and following cases were excluded: malignant oral lesions, immunocompromised state and benign Oral lesions due to systemic diseases. Results: Present study included 235 lesions of oral cavity which were clinically or histo-pathologically found to be benign in nature. Benign oral lesions were more commonly found in males with (70.2%) than females (29.8%), and M:F ratio was 2.3:1. most common benign oral lesions were found to be Oral Sub Mucus Fibrosis (26.8%) followed by Apthous ulcers (20.4%), Leukoplakia (18.3%) and Mucocele (17.1%). Least common benign oral lesions were found to be Minor Salivary Gland Tumor (MSGT) (1.7%) followed by Squamous Papilloma (2.1%), Ranula (2.1%) and Hemangioma (2.1). There was a male predominance in oral sub mucus fibrosis with M:F ratio of 9.5:1 followed by Leukoplakia with M:F ratio of 4.4:1. OSMF was found most commonly in 21-30 years age group with (57.1%). Followed by 11-20 years with (20.6%). No cases were found in ≤10 years, 51-60 and >60 years age group. Conclusions: Most of the benign oral lesions have a predilection to transform into malignant lesions therefore imperative to diagnose the pre malignant lesions of oral cavity in an early stage where appropriate treatment can be given.

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Role of magnetic resonance spectroscopy in brain space occupying lesions for detection of malignancy and grading of malignant lesions

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20205309 ◽

2020 ◽

Vol 8 (12) ◽

pp. 4378

Author(s):

Rajsekar Chandrasekharan ◽

Ramaiah Rajesh Khanna ◽

Chinmay Kulkarni ◽

Srikanth Moorthy

Keyword(s):

Magnetic Resonance ◽

Sample Size ◽

Mr Spectroscopy ◽

Spectroscopic Data ◽

Malignant Lesion ◽

Invasive Technique ◽

P Value ◽

Resonance Spectroscopy ◽

Malignant Lesions

Background: Magnetic resonance (MR) spectroscopy is a non-invasive technique that enables tissue characterization on a biochemical level using radio frequency signals emitted by the nuclei in the tissue. Primary aim is at determining the utility of MR spectroscopy to differentiate malignant from benign lesions and to assess its role in grading of gliomas as secondary objectives.Methods: MR system with proton spectroscopic capability using standard head coils and quantum gradients used in a sample size of 50 patients with intracranial space occupying lesions in conventional MRI. The diagnostic accuracy of the spectroscopic data based on the Cho/Naa ratios was used to detect the malignant lesions and distinguish them from the benign lesions.Results: The lesion characterization using the MR spectroscopic data in distinguishing malignant lesions from benign was statistically compared with the histopathological data using chi square tests proved to be significant with p value of less than 0.05. Grading of the malignant space occupying lesion with the available spectroscopic data was done with the corresponding histopathology that proved statistically not significant.Conclusions: Statistical data proves utility of MR spectroscopic data in differentiating malignant occupying lesions from benign. Role of spectroscopic data in grading the malignant lesion to differentiate to low and high grade could not be determined statistically which may be attributed to low sample size in the secondary objective.

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Aerodynamic measurement-Maximum Phonation Time in young patients with benign vocal fold lesions and with normal voice: a comparative analysis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192907 ◽

2019 ◽

Vol 7 (7) ◽

pp. 2725

Author(s):

Nisar Hussain Dar ◽

Mukhtar Ahmad ◽

Zubair A. Lone ◽

Suhail Amin Patigaroo

Keyword(s):

Young Adults ◽

Vocal Fold ◽

Young Patients ◽

Neck Surgery ◽

Control Group ◽

P Value ◽

Maximum Phonation Time ◽

Benign Vocal Fold Lesions ◽

Males And Females ◽

Age And Sex

Background: Clinicians use Maximum Phonatory Time (MPT) as one of tool to verify the glottic efficiency objectively. Impairment of vocal fold mucosa integrity due to lesions results in alteration in MPT. The aim of current study was to compare MPT in young adults with vocal fold lesions and age and sex matched normal subjects.Methods: This study was conducted in the Department of ENT & Head and Neck surgery of Government Medical College Srinagar on 41 adult patients with benign vocal fold lesions and 41 healthy subjects matched for age and sex for a period of 2 years from April 2017- April 2019. The aerodynamic measure was measured as maximum phonation time in seconds and the results were analysed statistically. Both patients and controls were explained the procedure. Results: Mean MPT in seconds in males with vocal fold lesion was 14.42 seconds with SD of 5.62 seconds and in females was 10.81 seconds with SD of 3.44 seconds. Coefficients of variation (CV) was 0.35 and 0.21 respectively. In control group it was 18.15 seconds with SD of 5.88 in males and in females it was 15.72 seconds with a SD of 6.21. Mean difference between patients and controls in males and females was 3.8 and 4.9 respectively. P-Value in males and females was 0.053 and 0.003 respectively.Conclusion: Vocal cord lesions decrease MPT in both sexes even in young adults.

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The importance of the occupational vocal load for the occurence and treatment of organic voice disorders

Slovenian Journal of Public Health ◽

10.1515/sjph-2018-0003 ◽

2018 ◽

Vol 57 (1) ◽

Author(s):

Miha Zabret ◽

Irena Hočevar Boltežar ◽

Maja Šereg Bahar

Keyword(s):

Vocal Fold ◽

Voice Disorders ◽

Speaking Rate ◽

Work Related ◽

Tertiary Centre ◽

Benign Vocal Fold Lesions ◽

Professional Voice Users ◽

Clinical Records ◽

The Voice ◽

Professional Voice

AbstractIntroductionThe voice represents a basic working tool for carrying out certain occupations. Hoarseness, as a consequence of vocal fold lesions, presents an important cause of work-related absences for voice professionals.MethodsOur study was designed as a retrospective cohort one. Data on gender, workplace, vocal load and exposure to risk factors for voice disorders of the patients who had surgery in the 2014-2015 period at the tertiary centre due to benign vocal fold lesions were collected from their clinical records. We compared professional voice users (PVU) to subjects with no vocal load at work (NPVU). The SPSS programme, version 22.0, was used for statistical analysis.ResultsFrom 2014 to 2015, 103 PVU and 132 NPVU were surgically treated for benign vocal fold lesions. In comparison to the second group, loud speech use was reported significantly more often by PVU (40.8% vs. 14.4%), as was a fast speaking rate (22.3% vs. 9.8%) and additional vocal load outside of the workplace (23.3% vs. 12.9%). The time that had passed between the occurrence of the hoarseness and the surgical treatment did not differ between the groups. The majority of patients were satisfied with the outcome of the operation.ConclusionsNearly a half of the operated patients had a considerable vocal load at work. An ENT assessment prior to starting a job as well as priority phoniatric treatment of voice disorders for PVU would significantly reduce the costs of work absences and contribute to a speedier recovery and return to the workplace.

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Does laryngopharyngeal reflux affect voice quality? a cross-sectional study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212126 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1021

Author(s):

Almas J. Vakil ◽

Pratibha Vyas ◽

Shreya Prasad ◽

Praveen Singh

Keyword(s):

Laryngopharyngeal Reflux ◽

Voice Quality ◽

Voice Disorders ◽

Empirical Therapy ◽

Cross Sectional Study ◽

Sectional Study ◽

Reflux Symptom Index ◽

Voice Change ◽

Symptom Index ◽

Cross Sectional

Background: Laryngopharyngeal reﬂux (LPR) is a rising disease that leads to voice changes. This study aimed to assess the potential association between the symptoms of laryngopharyngeal reflux (LPR) and voice disorders using the Reflux symptom index (RSI) and the Voice handicap index (VHI-10) scales, respectively.Methods: This cross-sectional study was conducted in the Department of Otorhinolaryngology at Mahatma Gandhi Medical College and Hospital, Jaipur, India, from June 2019 to November 2019, on a sample size of 144 patients having complaints related to voice change and laryngopharyngeal reflux. The participants filled the RSI and the VHI-10 questionnaires. RSI scores of >13 and VHI-10 scores of >11 indicated LPR-related symptoms and voice disorders, respectively.Results: The study included 70 (48.61%) patients who were males and 74 (51.38%) patients who were females. The mean age was 33.5 years. Overall, 89(61.80%) patients had RSI scores of >13 while 102 (70.83%) patients had VHI-10 scores of >11. A significant association was found between positive RSI and VHI-10 scores (p<0.001).Conclusions: A significant association between RSI and VHI-10 scores reflects an association of laryngopharyngeal reflux with long-standing voice change. RSI and VHI-10 may constitute valuable tools in diagnosing suspected patients with voice change and direct early start of empirical therapy with PPI.

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Occult Laryngeal Pathology in a Community-Based Cohort

Otolaryngology ◽

10.1067/mhn.2001.114256 ◽

2001 ◽

Vol 124 (4) ◽

pp. 448-450 ◽

Cited By ~ 72

Author(s):

Todd R. Reulbach ◽

Peter C. Belafsky ◽

P. David Blalock ◽

James A. Koufman ◽

Gregory N. Postma

Keyword(s):

Head And Neck ◽

Vocal Fold ◽

Laryngopharyngeal Reflux ◽

Voice Disorders ◽

Community Based ◽

Laryngeal Pathology ◽

History Of ◽

The Mean ◽

Over 40 Years ◽

Laryngeal Examination

BACKGROUND: Little information is available regarding the prevalence of laryngeal pathology in adults. PURPOSE: To estimate the prevalence of occult laryngeal pathology in a community-based cohort of adults over 40 years of age. METHODS: One hundred consecutive volunteers over age 40 with no history of voice disorders were enrolled. All completed a self-administered laryngeal symptom questionnaire and underwent a comprehensive head and neck examination including transnasal fiberoptic laryngoscopy. RESULTS: The mean age of the cohort was 61 years. Vocal fold bowing (presbylaryngis) was present in 72% of the patients, and findings of laryngopharyngeal reflux were present in 64% of the cohort. In addition, other laryngeal pathology were identified in 21%. Only 12% had a completely normal laryngeal examination. CONCLUSIONS: Occult laryngeal pathology is very common in persons over 40. Findings suggestive of laryngopharyngeal reflux are present in 64%, and vocal fold bowing is present in 72% of persons over 40.

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Benign and malignant lesions of the breast: clinico-pathological perspective from a government teaching hospital in West Bengal, India

International Surgery Journal ◽

10.18203/2349-2902.isj20184609 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3460 ◽

Cited By ~ 1

Author(s):

Saurav Sarkar ◽

Arista Lahiri ◽

Soumyajyoti Bandyopadhyay ◽

Snehasish Das ◽

Tamal Chakraborty

Keyword(s):

Ductal Carcinoma ◽

Benign Lesion ◽

Malignant Lesion ◽

Benign Disease ◽

Breast Diseases ◽

P Value ◽

Histopathological Diagnosis ◽

Age Group ◽

Peau D’Orange ◽

Malignant Lesions

Background: While breast cancer is one of the most commonly diagnosed cancer more than half of the women develop some benign disease of breast in their lifetime. The current study was conducted to describe the clinico-pathological findings associated with breast diseases and study their relationship.Methods: A record-based cross-sectional study was conducted on the samples of breast tissue obtained by fine needle aspiration cytology (FNAC) examination. The clinical variables like age, sex, presenting complaint, involved side (right/left/both) etc. were taken from the clinical notes sent, and nature of the aspirate, histopathological diagnosis, nature of the diagnosed disease (benign/malignant), and axillary metastasis were taken as variables from pathological examination.Results: The mean age of the patients was 33.49 years (±13.24 years) with majority belonging to 20-40 years. Among the 184 specimens examined, 94.57% belonged to female patients. The most frequent presentation was with lump (95.11%). Complaint arising out of right breast (47.83%) were higher compared to left breast (40.76%). Involvement of the supero-lateral quadrant was seen in 75.54%. In 30.44% of the cases the material was bloody or blood-mixed. Majority of the patients (86.41%) were diagnosed with benign disease commonest being fibroadenoma. Ductal carcinoma was the commonest malignant lesion. Younger age group, absence of bloody discharge and absence of peau d’orange were associated with benign lesion in a statistically significant way (p-value <0.001).Conclusions: In consonance with published literature the findings suggest association of older age group with malignant lesions. Blood-mixed aspirate, peau d’orange appear to be danger signs.

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