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.

Endolaryngeal surgery of benign vocal fold lesions with a 445 nm semiconductor laser: postoperative management

Introduction. Today the high prevalence of benign vocal fold lesions is shown (up to 55-70%). The possibilities of surgical management of this pathology are very extensive. Laser technologies are becoming more and more popular among high-tech treatment methods. However the comprehensive postoperative management of these patients is equally important.The aim of the study was to assess the features of the postoperative period in patients undergoing the endolaryngeal surgery using a semiconductor laser with a wavelength of 445 nm.Material and methods. On the basis of Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech from February to June 2021 20 patients with benign vocal fold lesions 6 women and 14 men from 24 to 67 years old were examined and treated. All the patients underwent endolaryngeal surgery with direct microlaryngoscopy using a new semiconductor 445 nm laser in an inert gas atmosphere (intraoperative helium supply). After surgical treatment, the patients observed vocal rest, received antiinflammatory, antibacterial therapy, inhalations, as well as the drug Homeovox® according to the standard scheme.Conclusion. Endolaryngeal surgery with the removing of benign vocal fold lesions using a semiconductor laser with a wavelength of 445 nm has been proven to be safe and effective. According to the results of video laryngostroboscopy, acoustic analysis of the voice (the questionnaire “Voice handicap index-30”) it was noted that the laryngeal functions were restored in a short time. The inclusion of Homeovox® in the complex postoperative treatment had a favorable effect on the restoration of the phonatory function.

Vocal outcomes after video assisted cold knife endolaryngeal phonosurgery of benign vocal fold lesions

<p class="abstract"><strong>Background:</strong> This study focuses on therapeutic possibilities in managing benign superficial vocal fold lesions with video assisted cold knife endolaryngeal phonosurgery.</p><p class="abstract"><strong>Methods: </strong>Fifty patients with benign vocal fold lesions presented to us between September 2013 and October 2015 who failed conservative therapy were subjected to video assisted cold knife endolaryngeal phonosurgery. The pre and postoperative results were evaluated based on voice rating by visual analogue scale and GRBAS scale.</p><p class="abstract"><strong>Results</strong>: Encouraging results were achieved with cold knife endolaryngeal surgery as 96.3% of patients were symptom free without any recurrence after single operation. Most of them have achieved &gt;90% of voice outcome by 1 month postoperatively based on voice assessment and laryngoscopic evaluation.</p><p class="abstract"><strong>Conclusions:</strong> Using a telescope with high definition video system for performing phonosurgery is economic, enables the surgeon to acquire static images and video sequences. Cold knife endoscopic laryngeal surgery is possibly a better option for addressing BVFLs.</p>

Use of Co2 Laser versus conventional microlaryngeal surgery in treatment of vocal fold benign lesions

Background Benign superficial lesions of vocal fold (nodule, polyp, cyst and Reinke's edema) arise from the epithelium and the lamina propria. Vocal abuse and misuse presumably lead to excessive mechanical stress and trauma in the membranous portion of vocal fold, resulting in wound formation. Wound healing leads to remodeling of the superficial layer of the lamina propria. This tissue remodeling leads to formation of benign vocal fold lesions. These lesions are classically treated by conventional microsurgery and recently by CO2 laser. The use of the CO2 laser for the surgical treatment of Minor Associated Pathological Lesions (MAPL's) is still controversial. Some preferred cold instruments, whereas others appreciate CO2 laser as a novel alternative to conventional microsurgery for benign vocal fold lesions. To summarize the reviewed literature the issue of CO2 laser versus cold instruments is still controversial and the stage is open for more studies. Aim The aim of this study is to investigate the effect of Co2 Laser versus cold instruments in the treatment of benign lesions of the vocal folds regarding voice outcome & vocal fold function. Methodology A meta-analysis study is done to assess the use of Co2 Laser versus conventional microlaryngeal surgery in treatment of vocal fold benign lesions. Results This study does not reveal any detectable differences in clinical outcomes in patients with nodules, polyps and cysts who underwent excision via CO2 laser or cold instruments. Conclusion There is no sufficient evidence to determine if conventional surgery or CO2 assisted surgery is better.

Behavioral Treatment for Benign Vocal Fold Lesions in Children: A Systematic Review

Purpose This systematic review aims to identify, classify, and evaluate existing information regarding treatment for benign vocal fold lesions in children and to identify gaps and limitations that may limit effective pediatric voice treatment. Method A literature search was performed using electronic databases (PubMed and Google Scholar) as well as reference lists from previous reviews, studies, and books. Included in the present review are studies that described behavioral treatment for children with benign vocal fold lesions presumed to be phonotraumatic (vocal fold nodules and edema). Results Twenty-one studies were eligible for inclusion in the review. Eight different research designs were used, and three intervention types were identified: direct voice intervention (voice training), indirect treatment (vocal hygiene or counseling), and comparative studies that contrasted different treatment methods. The most commonly used treatment method was eclectic direct intervention, which focused on vocal exercises or voicing patterns. Postintervention improvement was reported in all studies. In general, findings suggested an advantage of direct over indirect intervention and of longer treatment duration over short-term approaches. Conclusions The findings suggest that behavioral voice therapy may be generally effective in treating children with vocal fold nodules. Several limitations emerged in the corpus of studies reviewed including heterogeneity of research methods, missing information about outcome measures, and inappropriate statistical analyses. Thus, a need exists for further well-designed controlled studies to enhance the body of knowledge about developmental factors affecting vocal treatment outcomes, in particular, vocal fold structure as well as cognitive and linguistic development.