A nomenclature paradigm for benign midmembranous vocal fold lesions

Rosen, Clark A.; Gartner‐Schmidt, Jackie; Hathaway, Bridget; Simpson, C. Blake; Postma, Gregory N.; Courey, Mark S.; Sataloff, Robert T.

doi:10.1002/lary.22421

Cited by 110 publications

(97 citation statements)

References 8 publications

(8 reference statements)

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“…Clinical diagnoses were based on the appearance of the vocal fold edge and the vibratory property of the mucosa revealed by videolaryngostroboscopy (VLS), based on the published nomenclature and diagnostic paradigm. 1 Vocal nodules were classified as (1) soft (ie, mid-membranous thickening without fibrotic change of the epithelium or limitation of the mucosal wave) or (2) hard (ie, hyperkeratosis of the epithelium, fibrotic appearance with some limitation of mucosal wave propagation). Vocal polyps were classified as hemorrhagic (vascular), fusiform (wide-based), pedunculated, and fibrous.…”

Section: Study Subjectsmentioning

confidence: 99%

“…1 Common clinical presentations of these lesions include dysphonia, voice fatigue, dryness or tightness of voice, narrowed vocal range, and deteriorated voice quality (husky or breathy character). Because most of these patients have an occupational dependence on their voices, noisy working environments, or inappropriate phonation habits; in most circumstances, behavioral modification remains the first-line management, followed by phonomicrosurgery.…”

Section: Introductionmentioning

confidence: 99%

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Comprehensive Outcome Researches of Intralesional Steroid Injection on Benign Vocal Fold Lesions

2015

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Section: Study Subjectsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comprehensive Outcome Researches of Intralesional Steroid Injection on Benign Vocal Fold Lesions

2015

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“…Additionally, this study sought to find diagnostic concordance for conditions such as benign vocal fold lesions in which there is much disagreement regarding the basic diagnostic criteria. 14,15 For instance, it is unclear whether the diagnostic variability in the present study with vocal fold nodules represents limitations of the imaging modality or the agreement as to the physical appearance of those nodules. Finally, the wide range of diagnostic possibilities engaged multiple levels of variability, which ultimately limits the statistical power of the findings.…”

Section: Discussionmentioning

confidence: 84%

The Diagnostic Role of High-Speed Vocal Fold Vibratory Imaging

Mendelsohn

Remacle²,

Courey

et al. 2013

Journal of Voice

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Summary: Objective. Although high-speed imaging (HSI) has been identified as a valuable tool in phonatory biomechanics research, to date, there have only been a selected number of reports investigating the clinical utility of HSI. We aim to elucidate the role of HSI in the diagnosis of the dysphonic patient. Methods. The video files from 28 consecutive dysphonic patients with concurrently acquired videostroboscopy and HSI were retrospectively collected. Stroboscopy video files were edited to include vibratory motion only. Videos were then anonymously and randomly presented to four academic laryngologists. Experts were asked to assign a single best diagnosis for each video file. Assigned diagnoses were then compared with treatment diagnoses conferred based on medical history, phonatory evaluation, laryngeal examination, and response to treatment. Results. Interrater analysis for the four laryngologists demonstrated significant and meaningful correlations for the diagnoses of polyps, cysts, nodules, and normal examination using stroboscopy (kappa > 0.40, P < 0.001). The experts demonstrated significant and meaningful correlations for the diagnoses of polyps, presbyphonia, and normal examination using HSI (kappa > 0.40, P < 0.001). Combined intrarater analysis performed by comparing single rater's diagnosis for single patient across both modalities resulted in poor correlation without statistical significance (kappa ¼ 0.30, P ¼ 0.07). Both stroboscopy-and HSI-assigned diagnoses matched the treatment diagnoses at equal predicted frequencies (32.3%), as demonstrated through multivariate logistic regression analysis (P < 0.001). Conclusion. Overall, HSI did not improve the diagnostic accuracy above stroboscopy alone. Although specific laryngeal states such as presbyphonia may be better diagnosed with HSI, further studies are required to define HSI's precise role in the clinical setting.

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“…The lesions often or typically interfere with the vibratory behaviour of the vocal folds, creating increased aperiodicity which results in symptoms of mild to moderate dysphonia characterised by hoarseness, breathiness, low pitch, and laryngeal hyperfunction; with hoarseness being the most common symptom (Pannbacker, 1999;Verdolini et al, 2006). It has been reported that a key stroboscopic diagnostic feature for vocal fold nodules is normal or minimal impairment of the vibratory properties of the mucosa (Rosen et al, 2012). Also, vocal fold nodules respond favorably to voice therapy and reduced voice demands with either complete resolution or substantive diminution of the size of the lesions.…”

Section: Chapter One 1 Introductionmentioning

confidence: 99%

“…Also, vocal fold nodules respond favorably to voice therapy and reduced voice demands with either complete resolution or substantive diminution of the size of the lesions. Thus, any lesions that do not respond to voice therapy, cannot be vocal fold nodules (Rosen et al, 2012). Vocal fold nodules cause voice difficulties that often lead to lost time at work, reduced productivity and impaired quality of life (Kunduk & McWhorter, 2009).…”

Section: Chapter One 1 Introductionmentioning

confidence: 99%

Efficacy of intensive voice therapy for patients with vocal fold nodules

Fu¹

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The primary aetiologic factor for vocal fold nodules has been proposed to be cumulative perpendicular impact stress between the vocal folds over time, which increases with voice use (Titze, 1994). Many people with vocal fold nodules work in high vocal demand occupations, therefore, it is essential that they recover vocal function so that their ability to perform their jobs is not compromised (Karkos & McCormick, 2009). A number of studies have reported positive improvements in vocal fold nodules following various types of behavioural voice therapy, and as such, voice therapy is recommended as a first-line treatment .The majority of the intervention studies for patients with vocal fold nodules have examined treatment outcomes following traditional voice therapy models, typically delivered once a week over a period of multiple weeks. To date, no studies have systematically examined the impact of using an intensive, massed practice therapy approach. In that the rehabilitation process for vocal fold nodules requires the learning, maintenance and transfer of new behaviours, it is possible that a more condensed voice therapy protocol may yield equal or even greater benefit. Therefore, the primary aim of this thesis was to explore the efficacy of intensive voice therapy (eight sessions within 3 weeks) as compared with traditional voice therapy (one session per week for 8 weeks).Both the short and long term effects of the different treatments on perceptual, acoustic, and physiological outcomes were examined.Although it has been established that voice therapy is often effective, in many caseloads, rates of therapy completion are poor and this creates a challenge for clinicians (Portone-Maira, Wise, Johns, & Hapner, 2011). Traditional, face-to-face (FTF) voice therapy has shown dropout rates as high as 65% (Hapner, Portone-Maira, & Johns, 2009). Various factors contributing to nonattendance include travel time, inflexible work conditions, and inability to access due to physical barriers. Non-attendance not only affects treatment success, but also results in unnecessary extensions to treatment, and repeated examinations without sufficient behavioural change to effect improvement. Ultimately, there may be a loss of revenue or even employment if patients are unable to meet the vocal requirements of their occupations (Portone, et al., 2008;Portone-Maira et al., 2011). Consequently, there is a need to explore ways to help maximise attendance and ultimately enhance outcomes for people with vocal fold nodules. To this end, the secondary aim of this thesis iii was to examine the feasibility and outcomes of delivering intensive voice therapy via telepractice, as an alternative service delivery model for patients with vocal fold nodules.To address aim one, 53 female patients (56% professional voice users) with bilateral vocal fold nodules were recruited. Participants were matched in pairs according to their age, occupation, and severity of dysphonia and assigned to either of two treatment groups: traditional therapy of eigh...

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A nomenclature paradigm for benign midmembranous vocal fold lesions

Cited by 110 publications

References 8 publications

Comprehensive Outcome Researches of Intralesional Steroid Injection on Benign Vocal Fold Lesions

Comprehensive Outcome Researches of Intralesional Steroid Injection on Benign Vocal Fold Lesions

The Diagnostic Role of High-Speed Vocal Fold Vibratory Imaging

Efficacy of intensive voice therapy for patients with vocal fold nodules

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