Benign Laryngeal Lesions

Benign laryngeal lesions represent a diverse set of pathologies whose clinical presentation may range from no symptoms to dyspnea and/or dysphonia. Flexible fiberoptic laryngoscopy and videolaryngostroboscopy are important in distinguishingdifferent types of lesions, and management and treatment are dependent on the identification of these lesions, as they have different etiologies. Some lesions such as vocal fold nodules and polyps are primarily phonotraumatic and may benefit fromspeech therapy and vocal hygiene as initial approaches. Vocal fold cysts and benign tumors may benefit from microlaryngeal approaches, while capillary ectasias, polypoid corditis, laryngoceles, saccular cysts, and papilloma may benefit from laser therapy. Vocal fold granulomas may arise from various etiologies such as intubation, traumatic behaviors, or reflux. Polypoid corditis arises from smoking. This review is intended to provide an overview of the variety of lesions that encompass non-malignant laryngeal lesions that is both suitable for junior and senior residents. This review contains 12 figures, 5 tables, and 64 references Keywords: Benign laryngeal lesions, Laryngocele, Polyp, Cyst, Polypoid Corditis, Papilloma

Personality in Children With Vocal Fold Nodules: A Multitrait Analysis

Purpose Vocal fold nodules (VNs) are bilateral, symmetrical, callous-like lesions secondary to phonotrauma and possibly related to specific personality traits. This case–control study examined the relation between personality and VNs in children within the context of the Trait Theory of VNs. Method Parents of children with VNs ( N = 39, M = 7.43, SD = 2.01 years) and two medical control groups (i.e., voice disordered controls, but not VNs [VDCs; N = 40, M = 7.09, SD = 2.01 years] and vocally normal controls [VNCs; N = 40, M = 7.6, SD = 1.54 years]) completed the Inventory of Child Individual Differences, a personality instrument that describes the Big Five superfactors as well as 15 lower order personality traits. Results Children with VNs, as compared with VNCs, were (a) emotionally reactive (i.e., higher N—Neuroticism, p < .005, Cohen's d = 0.53), (b) Antagonistic, Strong-Willed, and less Compliant (i.e., lower A—Agreeableness, p < .014, Cohen's d = 0.59), and (c) Distractible and Disorganized (i.e., lower C—Conscientiousness, p < .009, Cohen's d = 0.62). Both voice disordered groups displayed elevated scores on the personality superfactor of Neuroticism (N; and the “Negative Emotions” lower order trait). Conclusions The combination of personality traits identified in this study (i.e., high N, low A and C) may play a central role in VNs development and possibly attenuate voice therapy success. Children with VNs displayed a similar personality typology as women with VNs, with the exception of elevated Extraversion (E), thereby providing support for the relevance of the Trait Theory of VNs in both children and adults. Clinicians treating children with voice disorders, including VNs, should consider their underlying personality traits in assessment and management.

Glycyrrhiza Glabra and Platycodon Grandiflorus are Alternative Treatment Options for Vocal Fold Nodules

Background: Vocal fold nodules (VFN) are one of the main causes of hoarseness. In this study, we try to figure out an alternative treatment from our clinical experience summary.Methods: We retrospectively reviewed VFN patients who received traditional Chinese medicine (TCM) treatments from July 2018 to August 2020 and traced their Chinese Voice Handicap Index-10 (VHI-C10) and multidimensional voice program (MDVP) analysis results. Also, we induce inflammatory response of porcine vocal fold epithelial (PVFE) cells with 50 ng/mL TNF-alpha. The inflamed PVFE cells were separately cultured in the aqueous extract of Glycyrrhiza glabra and Platycodon grandiflorus. Results: For these patients (n = 22), the average VHI-C10 score decreased from 17.6 to 6.6 (p < 0.001). MDVP analysis revealed improvements in jitter, shimmer, noise–harmonic ratio, and GRBAS scoring system. Analysis of prescription patterns revealed that the most commonly used herbs were Licorice and Platycodon grandiflorus. In the MTT assay of PVFE cells, no adverse effects of our extracts were observed at doses of 1­–200 ug/mL. Western blot analysis revealed downregulation of p65 and mitogen-activated protein kinase pathway proteins.Conclusions: The results from both the clinical and in vitro aspects of this study revealed that the herbs G. glabra and P. grandiflorus may offer beneficial outcomes as alternative treatments for VFNs.

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.

The Effect of the Mother’s Participation in Therapy on Children with Vocal Fold Nodules

Objectives: Vocal fold nodules (VFN) are a bilateral epithelial thickening of the membranous vocal folds. In this study, children with VFN and their mothers took part in voice therapy. We then compared acoustic analyzes and subjective evaluations to those in previous literature to determine whether voice therapy is more effective for children with VFN when their mothers also take part in therapy. Methods: Children aged eight to 12 years who were diagnosed with bilateral VFN between January 2018 and January 2020 were included in this study. Participating children diagnosed with bilateral VFN were divided into two groups based on the wishes and cooperation of their families. Group 1 consisted of 16 patients; Group 2 included 17 patients. The children in Group 1 received voice therapy alone; children in Group 2 took part in therapy with their mothers. For all participants, the average fundemental frequency (F0), jitter percentages, shimmer percentages, maximum phonation time (MPT) and s/z ratios were measured. Pediatric voice handicap index (p-VHI) values were calculated as well. Results: The two groups’ measures pre-treatment and post-treatment were compared. Except for p-VHI, no significant difference was observed between the two groups. However, p-VHI post-treatment was significantly lower in Group 2 than in Group 1. Conclusions: Involving the families and even teachers of children with VFN in voice therapy can increase the effectiveness of therapy. The family’s involvement increases the child’s motivation in therapy. The mother’s presence during therapy, supporting the child or even doing the work with the child, can be a very important source of motivation for the child, who may already be tired from school and other activities. Thus, the mother’s involvement increases the child’s compliance with and interest in therapy.