Sulcus vocalis: A new clinical paradigm based on a re‐evaluation of histology

Lee, Andrew; Sulica, Lucian; Aylward, Alana; Scognamiglio, Theresa

doi:10.1002/lary.25732

Cited by 27 publications

(32 citation statements)

References 16 publications

(56 reference statements)

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“…At present, no reports have precisely studied the relationship between LPR and the development of epidermoid cysts and sulci vocalis through an analysis of the microstructure of the vocal folds of patients with demonstrated LPR. Instead, the origins of epidermoid cyst and sulcus vocalis could be more complex and involve the interplay of phonotrauma, complex inflammatory reactions, congenital lesions, and possibly a genetic predisposition …”

Section: Discussionmentioning

confidence: 99%

Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review.

et al. 2019

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Objectives To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF). Methods PubMed, Cochrane Library, and Scopus were searched by three independent investigators for articles published between January 1990 and November 2018 providing substantial information about the role of LPR in the development of nodules, polyps, cysts, Reinke's edema, and sulcus vocalis. Inclusion, exclusion, diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses criteria. Results Of the 155 relevant publications, 42 studies were included. Thirty‐five were clinical studies and seven were experimental research studying the impact of reflux on vocal fold tissue. Only seven clinical studies utilized objective LPR diagnoses (pH monitoring), suggesting an association between LPR and the development of nodules, polyps, and Reinke's edema. These studies were characterized by a substantial heterogeneity due to discrepancies in inclusion/exclusion criteria, diagnostic methods, and clinical outcome evaluation. The few basic science studies on this topic support that LPR creates an environment that may predispose to BLVF through changes in defense mechanisms of the vocal folds, cell‐to‐cell dehiscence, inflammatory reaction of the vocal folds, and reaction to phonotrauma. Conclusions Caustic mucosal injury from LPR could cause increased susceptibility of the vocal fold mucosa to injury and subsequent formation of nodules, polyps, or Reinke's edema. However, the heterogeneity and the low number of high‐quality studies limit the ability to draw definitive conclusions. Future clinical and experimental studies are needed to better identify the role of reflux in development of BLVF. Laryngoscope, 129:E329–E341, 2019

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Section: Discussionmentioning

confidence: 99%

Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review.

et al. 2019

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“…Nakayama and colleagues found a high incidence (48%) of sulcus deformities in pathological examinations for laryngeal cancer, and suggested an acquired origin resulting from local trauma and/or chronic inflammation 7 . A mechanism similar to the development of middle ear cholesteatoma was considered by Lee et al 4 .…”

Section: Introductionmentioning

confidence: 95%

“…To date, there is no consensus regarding the aetiology of sulcus. Arguments for congenital origin link sulcus to epidermoid cyst and mucosal bridge of the vocal fold, representing the fourth and sixth branchial arch anomalies 1 , 4 . Keratin debris (fibrous mass) embedded deep within the sulcus or a concomitant scar are not unusual intraoperative findings 5 , 6 .…”

Section: Introductionmentioning

confidence: 99%

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

Miaśkiewicz

Panasiewicz

Gos

et al. 2020

Acta Otorhinolaryngol Ital

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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.

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“…Nakayama and colleagues found high incidence (48%) of sulcus deformities in pathological examinations for laryngeal cancer, and suggested an acquired origin resulted from local trauma and/or chronic inflammation [ 8 ]. A mechanism similar to the development of middle ear cholesteatoma was considered by Lee et al [ 9 ]. The heterogeneity in origin and clinical appearance makes the diagnostics and treatment of sulci a challenge [ 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Pathological sulcus vocalis: treatment approaches and voice outcomes in 36 patients

Miaśkiewicz

Szkiełkowska

Gos

et al. 2018

Eur Arch Otorhinolaryngol

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PurposeThis is a retrospective study to evaluate the results of surgical treatment of patients with pathological sulcus vocalis.MethodsThirty-six patients with pathological sulcus underwent surgery and in 33 cases were performed additional injection laryngoplasty. The pre- and postoperative evaluation of patients included the GRBAS scale, stroboscopic, and objective acoustic voice assessment. The Voice Handicap Index questionnaire (VHI-30) was also used and the scores were obtained from 33 patients.ResultsThe stroboscopic evaluation showed significant improvement of amplitude, mucosal wave, and glottal closure after treatment (p < 0.001). The VHI-30 scores decreased considerably indicating improvement due to the treatment for all aspects measured by VHI (p < 0.05, or p < 0.01). In all domains of GRBAS scale, the differences between preoperative and postoperative assessment were statistically significant (p < 0.001). We observed a significant change in Shim and APQ parameters (p < 0.05). Improvement was also observed in the sAPQ parameter, but it was not statistically significant (p = 0.051). For the remaining acoustic parameters, no changes were observed.ConclusionsThe surgical procedure with supplementary injection laryngoplasty of the vocal folds is a good treatment option for pathological sulcus vocalis. The post-treatment self-assessment indicates the significant improvement in VHI, just as perceptual–acoustic evaluation of voice does. Patients with pathological sulcus frequently present with amplitude disturbances, what explains their significant improvement after treatment.

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Sulcus vocalis: A new clinical paradigm based on a re‐evaluation of histology

Abstract: 4 Laryngoscope, 126:1397-1403, 2016.

Cited by 27 publications

References 16 publications

Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review.

Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review.

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

Pathological sulcus vocalis: treatment approaches and voice outcomes in 36 patients

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