• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.13 no.1
• /
• pp.33-39
• /
• 2002

Background and Objectives : The vocal fold nodules which were made by excessive contact or vibration of the vocal folds were classified to the soft nodule and the hard nodule in according to the hardness or the duration of nodule. Sometimes laryngologist saw the nodule to be located in different level. Authors thought that each nodule to be located in different level might have the different causes. Therefore we studied to know the relationship between the voicing technique and each vocal fold nodule to be located in different level. Materials and Methods : One-hundred forty nine patients who had the vocal fold nodule were evaluated. Sites and shapes of the vocal fold nodules were investigated using videostroboscopy. Videokymography was also used to scan the center of the vocal fold nodules during phonation and classified to several types. Same procedures were done on normal subject while he simulated the various types of voicing. And we compared the findings between both of them. Three different types of lesion can be distinguished. These are ML group that lesions were located from mid to low, MH group that lesions were located from mid to upper and HL group that lesions were located from lower to upper of the vocal folds. Results : The VKG findings of ML group and situation simulating with hard glottal attack and vocal fry were similar. MH group had a similar VKG findings with situation simulating with whispering or high pitch voicing. HL group had a similar VKG findings with situation simulating with loud voicing. Conclusions : Authors thought that each vocal fold nodule, which had different shapes and located in different level, related with the different types of voicing.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.2 no.1
• /
• pp.24-30
• /
• 1986

The vocal nodule is one of the major causes of hoarseness. The patholphysiologic mechanism of the vocal nodule is relatively well-known. Chronic mechanical stimuli, such as vocal abuse, causes vocal nodule by a tissue reaction of the vocal cords. Among the 841 patients, who visited the Vocal Dynamic Laboratory at Severance Hospital complaining of the dysphonia between the period of May 1981- May 1985, 169 patients were selected who were diagnosed as vocal nodule by indirect laryngoscopy and a series of phoniatric examination. (omitted)

• Proceedings of the KOR-BRONCHOESO Conference
• /
• 1983.05a
• /
• pp.6.2-6
• /
• 1983

The clinical study of 108 laryngeal mass was observed in our E.N.T. department, and classified clinically and pathologically as below. 1) Among total case of 108 Vocal nodule is 28 (26 %) Vocal polyp is 46 (42.5 %) Laryngeal papilloma is 6 (5.5 %) Laryngeal tuberculosis is 4 (4%) Laryngeal cancer is 24 (22%) 2) The sex ratio of male to female is 5 : 7 in vocal nodule 11 : 12 in vocal polyp 1 : 1 in laryngeal papilloma 3 : 1 in laryngeal tuberculosis 5 : 1 in laryngeal cancer 3) The age distribution is fourth, fifth decade in vocal nodule is fifth, fourth decade in vocal polyp is first decade in laryngeal papilloma is third and seventh decade in laryngeal tuberculosis is sixth and seventh decade in laryngeal cancer 4) The location of mass is between the anterior 1/3 and middle 1/3 of vocal cord in vocal nodule, polyp and papilloma middle 1/3 and posterior 1/3 in laryngeal tuberculosis and glottic (50%), supraglottic (42%), infraglottic (8%) in laryngeal cancer 5) The side of lesion is bilateral in vocal nodule and papilloma, the ratio of right to left is 2 : 3 in vocal polyp 6) The size is 1-2mm in vocal nodule and papilloma, 3-5mm in vocal polyp more than 10mm in laryngeal tuberculosis and laryngeal cancer 7) The duration of symptom is within 1 years in vocal nodule and vocal polyp and laryngeal papilloma, 1-several years in laryngeal tuberculosis and laryngeal cancer 8) The most frequent symptom was hoarseness 9) All laryngeal cancer was sguamous cell carcinoma

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.10 no.2
• /
• pp.135-139
• /
• 1999

Objectives : The purpose of this study was to systematically analyze and compare the acoustic characteristics of vocal major students with vocal nodule when singing. Materials and Methods : Ten sopranos with vocal nodule, who have never been treated due to voice problems, were the subject group. Twenty healthy sopranos major students were the control group for this study. The vocal nodule was confirmed by stroboscopy and the acoustic and electroglottographic analysis was conducted on be groups. Additionally, an inquiry on usual voice problems during speaking and singing were performed on each of the groups. Results : The vowel /a/ was spoken and sung by sopranos of each group. There were no significant differences in Fo, jitter, shimmer, NHR at speaking and singing in either group. We did not register any significant differences of closed quotient and speed quotient in electroglottography for both groups at singing, but speed quotient was increased in subject group at speaking(p＜0.05). And the sopranos with nodule demonstrated voice fatigue(70%), strained and tired voice after long period of performance and conversation(60%) on inquiry. Conclusions : Although they had a vocal nodule, this group, who had a long period of voice training, did not present any differences in acoustic and electroglottographic problems during short performance, but, the vocalists noticed delicate voice problems after a long performance. We conclude that the voice training teacher and laryngologist must initiate voice management and speech therapy for vocal nodule, even if there is no specific abnormality in acoustic analysis.

• Speech Sciences
• /
• v.8 no.4
• /
• pp.87-98
• /
• 2001

Vocal nodule is one of the representative chronic diseases of vocal folds, and it can be cured by surgical removal or voice therapy. The aim of this study is to evaluate the effect of the accent method, one of the popular effective voice therapy, in the patients with vocal nodule. Authors executed the accent method in 17 patients with vocal nodule who visited the Voice & Speech Therapy Clinic, Pusan National University Hospital analysed the voice before and after treatment using the local findings, acoustic analysis and aerodynamic analysis MPT. The voice was analysed with MDVP of CSL and MPT was checked using stop watch. The parameters included Fo, Jitter, Shimmer and noise to harmonic ratio(NHR) as acoustic analysis. The results were obtained as follows. In the evaluation by the local findings, it was improved to 77% in the patients of vocal nodule. Jitter and Shimmer were shown to be improved significantly. In particular, it was shown to be improved significantly in patients with vocal nodule. As the result of this study, the improvement of aerodynamic aspect was more statistically significant than that of acoustic parameters. When I generalized the above mentioned results, we suggest that it is a useful voice therapy which can be helpful to the improvement of voice, applying the accent method to the vocal nodule patients, and there are currently many methods to be used in the voice therapy, but it is thought which the accent method is the good treatment as the alternatives of keeping the continuous medical treatment.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.18 no.2
• /
• pp.122-128
• /
• 2007

This study aims to analyze the voices of the patients with voice disorders including vocal fold paralysis, vocal fold cyst and vocal nodule/polyp in the aspect of acoustic phonetics. This study intends to collect subsidiary acoustic data in order to make a speech treatment and an standardization of vocal disorders. Subjects and Methods: The subjects of this study were 64 adult patients who underwent indirect laryngoscopy and laryngostroboscopy, and were diagnosed as vocal fold paralysis, vocal fold cyst or vocal nodule/polyp. Experimental group consisted of 20 patients who were diagnosed as vocal fold paralysis, 21 patients who were diagnosed as vocal fold cyst and had the average age of 42.0 $({\pm}10.03)$ ; and 23 patients who were diagnosed as vocal nodule/polyp and had the average age of 40.9 $({\pm}13.75)$. For the methodology of this study, the patients listed above were asked to sit in a comfortable position at intervals of 10cm apart from the patient's mouth and a microphone, and subsequently to phonate a vowel sound /e/ for the maximum phonation time with natural tone and vocal volume then the sound was directly inputted on a computer. During recording, sampling rate was set to 44,100Hz and the 1-second area corresponding to stable zone except the first and the last stage of waveform of the vowel sound /e/ vocalized by the individual patients was analyzed. Results: First, there was no statistically significant difference in jitter and shimmer between vocal fold paralysis and vocal fold cyst, while there was highly statistically significant difference in them between vocal fold paralysis and vocal nodule/polyp. Second, looking into the mean values obtained from NNE, HNR and SNR results associated with noise ratio, the disease showing the most abnormal characteristics was vocal fold paralysis, followed by cyst and nodule/polyp in order. For NNE, there was statistically significant difference between vocal nodule/polyp, and cyst or paralysis. In other words, it was found that the NNE of vocal nodule/polyp was weaker than that of cyst or paralysis. Similarly, HNR and SNR also showed the same characteristics; there was statistically significant difference between vocal fold paralysis and vocal fold cyst or nodule/polyp, and HNR and SNR values of vocal fold paralysis were lower than those of vocal fold cyst or nodule/polyp. Conclusion: For vocal fold paralysis, the abnormal values of acoustic parameters associated with frequency, amplitude and noise ratio were statistically significantly higher than those of vocal fold cyst and nodule/polyp. This finding suggests that the voices of the patients with vocal fold paralysis are the most severely injured due to less stability of vocal fold movement, asymmetry and incomplete glottic closure. In addition, there was no statistically significant difference in the acoustic parameters of tremor among vocal fold paralysis, vocal fold cyst and vocal nodule/polyp. Further studies need to ascertain reasonable acoustic parameters with various vocal disorders as well as to clarify the correlation between acoustics-based objective tools and subjective evaluations.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.12 no.2
• /
• pp.145-151
• /
• 2001

Background and Objectives : A voice therapy can be used the basic method for the voice improvement of patients with the voice disorders. However, according to each voice disorders, various results of treatments have been reported. The purpose of this study was to evaluate the clinical features of the patients who did not improved after the voice therapy and to explore factors that could affect the results of the voice therapy. Material and Method : There are patients (n=49) diagnosed as the vocal nodule and patients (n=13) diagnosed as the vocal polyp. They received the voice therapy more than 6 times from September, 2000 to August, 2001. Clinical features, stroboscopic findings, esophagographic findings and PNS x-ray findings were compared between the improved and the nonimproved groups. Results : Before the voice therapy, PNS x-ray found two of all patients had the paranasal sinusitis. 14 of the vocal nodule patients (28.6%) and 8 of the vocal polyp (61.5%) had GERD in the esophagogram. However, the recovery rate after the voice therapy had no significant difference in both the vocal nodule and vocal polyp with GERD. In patients with the vocal nodule, 47 of 49 (95.9%) improved after the voice therapy. 6 of them were found the clearly decreased lesion in the stroboscopy. But, in patients with the vocal polyp, 7 of 13 (53.8%) improved after the voice therapy and did not have improvement through the stroboscopy. Conclusion : If the treatment of GERD is given with the voice therapy after the evaluation of GERD, it is helpful to increase the effects of the voice therapy. And, if patients were improved partially or unimproved after voice therapy, it was important to evaluate all factors-motivation, compliance and cooperation-related with patients will. Through this, some factors might be minimized except diseases differences.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.20 no.1
• /
• pp.42-46
• /
• 2009

Background and Objectives : Vocal polyps and nodules are representative chronic benign laryngeal disease. Treatment options for vocal polyp and nodule in general include voice therapy or laryngeal microsurgery. The purpose of this study was to analyze voice results before and after laryngeal microsurgery. Materials and Method: Vocal polyp and vocal nodule patients were treated by laryngeal microsurgery from March 2004 to December 2006 at Kosin University Hospital. All were women. Voice analysis studies were done before and after laryngeal microsurgery. Five measurements were performed: MPT, Fo, jitter, shimmer and NHR. Results: There was significant improvement in the vocal polyp patients regarding MPT, jitter, shimmer and NHR. Also there was significant improvement in the vocal nodule patients regarding MPT, jitter and shimmer. Conclusion: MPT, jitter, shimmer and NHR will be effective acoustic parameters in documenting the quantitative changes in the vocal polyp patients. MPT, jitter and shimmer will be effective acoustic parameters in documenting the quantitative changes in the vocal nodule patients before and after laryngeal microsurgery.

• Phonetics and Speech Sciences
• /
• v.8 no.4
• /
• pp.123-129
• /
• 2016

This study investigates the relationship between dysphonia severity index(DSI) and voice handicap index(VHI). Seventeen patients with a vocal nodule and twenty patients with laryngopharyngeal reflux(LPR) patients participated in this study. Results showed that there is no significant difference in either DSI or VHI between vocal nodule and LPR patients, with a weak negative correlation between DSI and VHI. Results also showed that there is significant difference only in both MPT and Fhi of all DSI parameters between vocal nodule and LPR patients. These results suggest that voice evaluation should be conducted both objectively in terms of acoustical and aerodynamic parameters and subjectively in terms of GRBAS and VHI.

• Phonetics and Speech Sciences
• /
• v.9 no.4
• /
• pp.99-106
• /
• 2017

Clinical data about vocal nodules have seldom been reported, even though vocal nodules are commonly diagnosed in outpatient speech and voice clinic. This study aims to investigate clinical characteristics of the patients who are diagnosed with vocal nodules. This study analyzed the data for 10 years from the 319 patients diagnosed with vocal nodules (45 males and 274 females with the mean age of 39.4 ranging from 2 to 83) in terms of gender, age, occupation, voice change initiation pattern, change with time, throat clearing, smoking history, type of voice abuse, acoustic analysis, maximum phonation time, GRBAS, and VHI. Thirteen patients (4.08%) had unilateral vocal nodule and 306 patients (95.9%) had bilateral vocal nodule, the majority of which had a pattern of asymmetry (73.9%). The glottal closure pattern was hourglass in 72.1% of patients, posterior chink in 17.9% of patients, and irregular in 7.9% of patients. The most common occupational category was professional voice users (43.4%). The voice abuse pattern included excessive talking in 96 patients (76.8%), loud voice in 78 (62.4%) patients, and excessive singing in 17 patients (21.6%). The patients showed worse scores in G, B, and S than in R and A for the GRBAS evaluation. The most recommended treatment for vocal nodules was voice therapy. The current clinical data will be helpful for treatment planning for the patients of vocal nodule.