Voice aspects in sulcus coexisting with benign lesions of the vocal folds.

ACTA OTORHINOLARYNGOLOGICA ITALICA 2020;40:262-269; doi: 10.14639/0392-100X-N0555 Laryngology Voice aspects in sulcus coexisting with benign lesions of the vocal folds Caratteristiche della voce in pazienti con sulcus e lesioni benigne delle corde vocali Beata Miaśkiewicz1, Aleksandra Panasiewicz1, Elżbieta Gos2, Agata Szkiełkowska1, Piotr H. Skarżyński2, Elżbieta Włodarczyk2 Audiology and Phoniatrics Clinic, Institute of Physiology and Pathology of Hearing, Kajetany, Warsaw, Poland; 2 Teleaudiology and Screening Department, Institute of Physiology and Pathology of Hearing, Kajetany, Warsaw, Poland 1 SUMMARY The purpose of this study was to measure the clinical profile of patients with sulcus who had concomitant benign lesions such as polyp, oedema, cyst, nodules, or fibrous mass of the vocal fold. We reviewed the medical charts of 38 patients who had a diagnosis of sulcus type 2 or 3 (according to Ford). The patients were classified into two groups. The study group consisted of 16 subjects who had sulcus and associated benign lesion; 22 patients diagnosed with sulcus alone were enrolled in a control group. We analysed psychosocial (Voice Handicap Index-30), auditory-perceptual (GRBAS), acoustic measures and videostroboscopic images. In the study group, the mean VHI-30 scores of all subscales ranged from moderate to severe handicap. The difference between groups was significant on the emotional (p = 0.004) and physical (p = 0.007) subscales. On GRBAS scale, the majority of patients from both groups exhibited mild hoarseness, breathiness, asthenic or strained voice, although roughness was more frequently rated moderate; the differences between groups were not statistically significant. The most abnormally increased values were achieved for amplitude values of acoustic parameters, but significant difference between groups was found in Soft Phonation Index only (p = 0.049). Concerning glottal closure, the most frequent finding was irregular chink in the study group, and spindle glottic chink in controls; we found significant differences between groups (p = 0.004). In both series of patients, the most frequent abnormal findings were moderately diminished amplitude and moderately restricted mucosal wave, with no significant difference between groups. Patients with sulcus and coexisting benign lesions were more handicapped on the emotional and physical subscales of VHI-30. The most characteristic shape of the glottal gap was irregular chink in the study group, and spindle chink in the control group. Acoustic evaluation of voice showed that the most severe disturbances affected amplitude parameters. The clinical characteristics indicated that the presence of sulcus primarily determines the quality of voice, and that additional benign pathologies do not drastically affect further voice deterioration. The coexistence of secondary benign vocal fold lesions aggravates the difficulties in making a preoperative diagnosis of sulcus. It is important to clinically suspect the possibility of coexistent sulcus to plan the correct treatment and obtain better voice outcomes. KEY WORDS: larynx, laryngoscopy, polyps, vocal folds, hoarseness RIASSUNTO Lo scopo di questo lavoro è valutare il profilo clinico dei pazienti con sulcus ed affetti contestualmente da lesioni benigne come polipi, edema, cisti, noduli o fibromi delle corde vocali. Abbiamo analizzato le cartelle cliniche di 38 pazienti con diagnosi di sulcus di tipo 2 o 3 (secondo FORD). I pazienti sono stati suddivisi in due gruppi. Il gruppo di studio è composto da 16 pazienti con sulcus e lesioni benigne cordali; il gruppo di controllo è costituito da 22 pazienti con diagnosi di sulcus senza altre lesioni cordali associate. Abbiamo valutato il Voice Handicap Index-30, GRBAS, misurazione acustica ed immagini videostroboscopiche. Nel gruppo di studio i punteggi medi del VHI-30 sono compresi in un range di handicap dal moderato al severo. Sono emerse delle differenze statisticamente significative nei due gruppi nelle valutazioni emozionali e fisiche (rispettivamente p = 0,004 e p = 0,007). Sulla scala GRBAS, la maggior parte dei pazienti di entrambi i gruppi ha mostrato raucedine di grado lieve, respiro affannoso, voce astenica o tesa, sebbene l’irregolarità fosse risultata più frequentemente di grado moderato, con differenze statisticamente non significative nei due 262 Received: November 21, 2019 Accepted: March 22, 2020 Correspondence Beata Miaśkiewicz Audiology and Phoniatrics Clinic, Institute of Physiology and Pathology of Hearing, Mokra 17 Str., Kajetany, 05-830 Nadarzyn, Warsaw, Poland Tel. +48 22 356 03 51. Fax +48 22 356 03 86 E-mail: Funding The work was done in the Audiology and Phoniatrics Clinic and Otorhinolaryngology Surgery Clinic of the Institute of Physiology and Pathology of Hearing, Warsaw, Poland. The Institute of Physiology and Pathology of Hearing covered all expenses incurred during the study. Conflict of interest The Authors declare no conflict of interest. How to cite this article: Miaśkiewicz B, Panasiewicz A, Gos E, et al. Voice aspects in sulcus coexisting with benign lesions of the vocal folds. Acta Otorhinolaryngol Ital 2020;40:262-269. https://doi. org/10.14639/0392-100X-N0555 © Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale OPEN ACCESS This is an open access article distributed in accordance with the CC-BY-NC-ND (Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International) license. The article can be used by giving appropriate credit and mentioning the license, but only for non-commercial purposes and only in the original version. For further information: https:// creativecommons.org/licenses/by-nc-nd/4.0/deed.en Sulcus with coexisting benign lesions gruppi. L’alterazione più evidente dei valori è risultata essere quella a carico dell’ampiezza dei parametric acustici, tuttavia l’unica differenza statisticamente significativa è risultata a carico del Soft Phonation Index (p = 0,049). Per quanto concerne la chiusura glottica, l’alterazione più frequente nel gruppo di studio è stata una rima glottica irregolare mentre nel gruppo dei controlli, una rima glottica fusiforme, (p = 0,004). In entrambe le serie di pazienti le alterazioni più frequenti sono state l’ampiezza moderatamente ridotta e l’onda della mucosa moderatamente limitata, ma non abbiamo riscontrato differenze significative tra i due gruppi. Le caratteristiche cliniche indicano che la presenza di solco influisce in manieradeterminante sulla qualità della voce mentre le ulteriori patologie benigne associate al sulcus influiscono solo parzialmente sulla disfonia. La coesistenza di lesioni secondarie benigne delle corde vocali rende più difficile formulare una diagnosi preoperatoria di sulcus. È importante sospettare clinicamente la possibilità di un sulcus coesistente per pianificare il giusto trattamento al fine di ottenere un migliore risultato vocale. PAROLE CHIAVE: laringe, laringoscopia, polip (...truncated)