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Abstract
The present study was conducted on twenty patients, complaining of change of voice quality with duration ranged from 1 month to 51 months with a mean value of 14.5 months. Suspected vocal fold polyps were present in 17 out of 20 patients while suspected vocal fold nodules were present in 3 out of 20 patients.
The aim of the present work was to evaluate histopathological and electron microscopic findings of these vocal fold lesions as well as pre and postoperative study of acoustic analysis aerodynamic parameters, APA, VPSS and DSI).
All patients were subjected to the following:
Elementary diagnostic aids including ( patient ’s interview, VPSS and APA ) , clinical diagnostic aids including ( indirect laryngoscopy , stroboscopic examination and voice recording ), additional diagnostic measures including (acoustic analysis , electroglottography , aerodynamic measures as well as calculation of DSI based on results from acoustic measures) , surgical intervention ( cold knife microlaryngosurgery for excision of vocal fold polyps and nodules ) , histopathological and electron microscopic examination of excised vocal fold polyps and nodules . Voice therapy was done for all patients pre and postoperative according to the program of voice therapy. Postoperative recording of elementary, clinical and additional diagnostic aids were done for all patients.
Statistical analysis of the present data revealed that:
- Fourteen patients were males (70%) and six patients were females (30%), their ages ranged from 18 to 59 years with a mean value of 35.65 years.
- Etiological factors were present in various proportions : voice abuse & misuse (90%) , smoking (50% ) , smoking and chronic cough (30%) , exposure to chemical vapors (5%) , vocal demand ( grade I (15%) , grade II (50%) & grade III (35%) ) And hyperacidity (50%).
- Vocal fold polyps and nodules were excised safely using cold knife microlaryngosurgery with smooth recovery from general anesthesia without recording any intra & postoperative complications.
- Histopathological examination was unable to differentiation between vocal fold polyps and nodules and the final diagnosis based on ultra structural findings obtained from electron microscopic study.
By Electron microscopic examination of vocal fold polyps show stromal changes in the form of abundant vascularity, hyaline degeneration, sub-epithelial oedema, sparce collagen fibers,and epithelial changes in the form of intercellular junctions between the polyhedral cells (disruption with gapping). Disruption of basal lamina were present in few cases in mild degree,while in vocal fold nodules show stromal changes as sparse vascularization , abundant collagen, fibers active fibroblasts and epithelial changes in the form of intercellular junctions between the polyhedral cells ( disruption with gapping). Disruption of basal lamina were present in most cases in sever degree.
- There were highly significant statistical difference between pre & postoperative finding as regard parameters of (VPSS).
- There were highly significant statistical difference between pre & post operative finding as regard general grade, strained & roughness while there was significant difference between pre & post operative finding as regard leaky & breathy parameters.
- There were significant statistical different between pre & post operative findings as regard most of MDVP parameters.
- As regard results of aerodynamic study, there were postoperative statistically significant difference as regard peak air pressure, mean resistance & maximum flow rate when compared to preoperative results. While there were no significant difference between pre & post operative finding as regard other aerodynamic measures.
- There were non-significant statistical differences between pre & post operative findings obtained from patients as regard EGG parameters: duration & pitch as well as contact & open.
- There were highly statistically significant differences between pre & postoperative results as regard max. phonatory time, Jitter % , highest F.F. , Lowest intensity & DSI .
- There were no significant difference between pathological finding (vocal fold polyps and nodules) as regard general grade, straining, leaky, and breathy and roughness.