Case Study

Benign vocal cord lesions

Nikhil Gupta , Deepanshu Gurnani2, Nehal Patel3, Toral Patel4, Pawan Sharma5, Sachin Jindal6,
1

Ambuj Pandey7, N. Modi8, D. A. Barot9, H. Maniyar10, V. Sinha11- Jamnagar (Gujarat)

Abstract
Objective: To study the incidence, age and sex ratio, common etiological factors, predisposing factors, various investigative
modalities, various modalities of treatment and preferred modality of treatment of benign vocal disorders. Methodology: This is a
prospective study of 50 patients, was conducted in ENT Department of M P Shah Govt. Medical College, Jamnagar, Gujarat,
between august 2010 to august 2012. Patient presenting with hoarseness of voice were subjected to further assessment.
Results: Maximum number of cases found were due to Vocal Nodules (48%,n=50) followed by Vocal cord Cysts (18%,n=50) and
Vocal cord Polyp (12%,n=50). Smoking was seen as a consistent aetiological factor with Reinke's edema and also in vocal cord
polyps. Diagnostic efficiency of Telescopy (by Hopkins's 70° and 90° scopes) was found to be better (90%, n=50) than that of
Indirect laryngoscopy (58%, n=50).
Conclusion: Voice disorders are prevalent in all age groups; usually occur in boys and woman as such persons are almost always
vocal over doers. Overall success rate of surgery is more than conservative treatment.
Keywords: Vocal cord nodules, Telescopy, Microlaryngeal surgery.

Introduction Study. Conservative treatment given in form of proper

Speech is one of the unique qualities that set human apart hydration, acid reflux management by antihistaminic &
from all other living organisms1. Human voice is proton pump blockers, voice rest, steroids were given. Speech
extraordinarily important not only for speech but also for therapy was given in a certain number of cases. Surgical
communication. Hoarseness of voice due to vocal lesions has treatment in form of microlaryngeal surgery with flap
deep impact on the emotional and occupational aspects of life. elevation & excision of vocal pathology was done. Surgical
As specialists in Ear Nose & Throat surgery, we are in best treatment was given only after minimum three months of
position to help these patients with voice disorders. With conservative therapy.
development of microscope, telescope & stroboscope, it has Observation
become easy to understand closely the act of phonation and This study was conducted on 50 cases presenting with
vocal cord abnormalities3. Thus, the nut shell of study is hoarseness of voice, out of 50, 64% patients were male and
directed towards the prevalence of vocal cord disorders, 36% patients were females. Majority of the patients were
associated etiology & treatment options and management between 20-60 years age group, which accounts for 84 %(
thereafter. n=50) of total patients studied. Maximum number of cases
Material & methods found were due to Vocal Nodules (48%, n=50) followed by
The Prospective study was carried out in ENT Department of Vocal cord Cysts (18%, n=50) and Vocal cord Polyp (12%,
M P Shah Govt. Medical College, Jamnagar, Gujarat between n=50).Vocal Nodules were found more common in females
August 2010 to August 2012 on 50 patients. Cases included in (54%, n=24) in all age groups but most frequent in 21-30year
the study were those who came to ENT OPD with chief age group(16.6%,n=24).Teachers were found to be most
complaints of change of voice, discomfort in speaking and commonly affected(29.1%,n=24) followed by housewives
voice fatigue. All the cases were subjected to detailed history, (25%, n=24) and professional voice users(25%,n=24).All
general examination and ENT examination. All the patients patients of vocal nodules2 were subjected to conservative
in this study group underwent the detailed laryngeal treatment, in which 14 patients were improved with
assessment by 70 degree & 90 degree telescope & conservative treatment only, rest of 10 patients were subjected
nasopharyngolaryngoscope (preoperatively & to surgery after not improving with conservative treatment, of
postoperatively for first & third month & also prior & post to which 8 patients improved by surgery & 2 cases recurred after
the conservative speech & medical therapy).Patients with surgery and failed to improve. In vocal cord cysts patient's
proven malignancy of the vocal tract were excluded from this male to female ratio was found to be 8:1 with

1
Senior Resident, 2-7 Resident,8,9,10Assistant Professor,11Dean & Prof, Department of Otolaryngology and
Head and Neck surgery, M.P. Shah Govt. Medical College Jamnagar (Gujarat)

19 National Journal of Otorhinolaryngology and Head & Neck Surgery, Vol. 1(10) No. 2, August 2013
 maximum incidence in 41-50 year age group. All 9 patients of Conclusion
Vocal cord Cysts were subjected to Microlaryngoscopy and Voice disorders are prevalent in all age groups usually occur
postoperative speech therapy was taken by 6 patients. in boys and women as such persons are almost always vocal
Maximum numbers of patients of Reinke's edema2 were over doers. With the development of Microscope and advance
found in the age group of 51-60 years in which 75% (n=4) endoscopes, it has become possible to easily diagnose &
patients were smokers. Vocal cord polyps were equally perform microsurgery on the larynx with great precision thus
distributed in all age groups. Males (75%, n=6) were more reducing the burden of the disease to great extent.
commonly affected than females. Smoking could be Conservative treatment should be the frontline in all the new
suggested as a predominant causative factor in development cases. Predisposed individuals should give rest between
of polyps (more than 50%, n=6) followed by vocal abuse period of excessive loudness and they should take proper
(33.33%, n=6). Regarding occupation in all cases most hydration. As patient compliance is a matter of prime
patients were laborers' (34%, n=50) followed by housewives importance for the success of conservative line of treatment,
(20%, n=50), teachers (18%, n=50) and students (8%, n=50). proper counseling and education to predisposed individuals is
Diagnostic efficiency of Telescopy (by Hopkins's 70° and 90° a must. All the patients with voice disorders should undergo
scopes) was found to be better (90%, n=50) than that of thorough ENT examination and evaluation by speech
Indirect laryngoscopy (58%,n=50).According to this study therapist. Speech therapy is an important part of conservative
the success in those subjected to surgical modality was treatment modality. Advance diagnostic modalities like
83.33% (n=30).The success of those subjected to stroboscopy, high speed digital imaging & narrow band
Conservative modality was 64.28% (n=28) . imaging have made diagnosing the pathologies fluidic and
Discussion swift as compared to older times. Surgery although is better
The male to female ratio for all vocal pathologies included in option as compared to conventional conservative
our study was found to be 1.78: 1, & the most of the patients lie management but it should be reserved as the last resort. Newer
within the age group of 20 to 60 years. Vocal Nodules were advances in surgical line of management like lasers have
found more common in females (54.17%, n=24) in all age eased the procedure to a day care surgery thus minimizing
groups but most frequent in 21-30 year age group (16.6%, patient trauma and ameliorated the results.
n=24).Vocal cord nodules occur mostly in case of chronic References
voice use/ misuse, e.g.: in case of teachers (29.1% n=24), 1. Benign vocal fold mucosal disorders : Cummings
singer and housewives (25%, n=24) as seen in this study. otolaryngology Head Neck Surgery ,Volume 1 , 5th
More association of housewives with voice disorders can be edition,No 859 – 882
related to their vocal abuse in excessive voice use with taking 2. Sinha V. Examination of Larynx, Practical E.N.T. 2nd
care of children at home. Professional voice users, stage show edition; 2011, 68-82
players and hawkers who are more prone to vocal abuse 3. Julian McGlashan: Disorders of Voice; Scott Brown's
because of lack of training and poor vocal hygiene form a Otorhinolaryngology, Head and Neck Surgery, 7th edition,
substantial part of our study. As seen in the present study Vol 2, 2190-2205.
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which is similar to A White,D W Sim series(84%)5 . Males are Otology. April,1991 Vol 105, 291-292.
more commonly affected than females in our study(75%), 6. Vinko Kambic, Zora Radsel et al: The Journal of
which is similar to the Kleinssaser series(73%)4. Smoking Laryngology and Otology,June 1981, Vol.95, 606-618.
could be suggested as a predominant causative factor in 7. Oscar Kleinssaser: Restoration of Voice in benign lesions
development of polyps (more than 50%) followed by vocal of vocal folds by endolaryngeal microsurgery. Journal of
abuse (33.33%) in our study, which issimilar to Vinko, Zora Voice 1991; 5: 257-263
Series6. Vocal cord Cysts patients improved with surgery Address of correspondence:
irrespective of post operative speech therapy taken or not. Dr. Nikhil Gupta,
Success rate of microsurgery of our study 83.33% (n=30) is Senior Resident, ENT Department,
comparable to Kleinssaser 7 study (79%, n=104) M. P. Shah Govt. Medical College, Jamnagar, Gujarat,
Cell +91 9727751329, E-mail : [email protected]

20 National Journal of Otorhinolaryngology and Head & Neck Surgery, Vol. 1(10) No. 2, August 2013