• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.13 no.1
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• pp.40-44
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• 2002

Background and Objectives : Vocal abuse and misuse and muscle tension dysphonia that have various movements of false vocal folds may be related to the development of benign vocal folds lesions, such as vocal nodules, polyps, and cysts. This study was designed to determine whether benign vocal folds lesions were related with movements of false vocal folds on phonation. Material and Methods : One Hundred and seventy eight subjects were studied. All subjects received otolaryngological evaluation including videostroboscopy, objective voice measures. Patients were diagnosed as normal shape of vocal folds (group a), approximation of bilateral false vocal folds (group b), approximation of unilateral false vocal folds (group c), lateralized extension of false vocal folds (group d), and medialized approximation of posterior false vocal folds (group e). We analyzed the results of benign vocal folds lesions in each group. Results : Differences were found between the normal shaped group and the abnormal shaped group. No differences were found between each abnormal groups except group d and e. Conclusion : The shape of false vocal folds was related to the benign vocal folds lesions.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.13 no.1
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• pp.5-17
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• 2002

Objectives : Videostrobokymography(VSK) has been recently developed and reported by Sung et at. We aimed to analyze vibratory patterns and objective parameters in various benign vocal fold lesions using VSK, and examine the efficacy of VSK in clinical application. Materials and Methods : Using VSK, we analyzed the vibration pattern of normal vocal fold and various benign lesions, such as nodules, polyps, cysts, Reinke's edema and unilateral vocal fold paralysis. We also calculated objective parameters, open quotient and asymmetric index, and compared them with mean values of parameters in normal controls. Results : In nodules, polyps, and cysts, the open quotient on the site of the lesion was similar to the mean value in normal controls, however, on the other part of the vocal folds it was much larger than normal mean value. In Reinke's edema, irregular and asymmetric vibration was observed. The posterior portion of the vocal folds showed larger open quotients than the anterior portion. In the unilateral vocal fold paralysis, irregular vocal folds vibration and incomplete closure of the vocal folds were documented. Much larger asymmetric indices were calculated in the unilateral vocal fold paralysis than in normal controls and other lesions. The asymmetric index could be a good quantitative parameter of vibration from a patient with vocal fold paralysis. Conclusion : This study demonstrated that VSK could generate clear quantitative documentations of fine vibrations of vocal folds in many different benign lesions. VSK has a potential as an effective tool for quantitative analysis of vibratory patterns of the vocal folds iii clinical settings.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.9 no.1
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• pp.17-21
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• 1998

Benign vocal fold lesions such as polyps, nodules and edema are known to be caused by vocal trauma such as voice misuse and/or abuse. Even though these lesions are known to be caused by the same etiology, phonotrauma, they show widely different clinical features and different responses to voice therapy. Previous studies suggested that benign vocal fold lesions represent disturbance in the balance of the extracellular matrix(ECM) constituents of the vocal folds. Collagen is one of the major constituents of ECM. Among collagens, fibrillar collagens are most important ones for maintaining the structural integrity. On the basis of gross morphology, vocal polyps wert divided into angiomatous one and edematous one, and nodules were divided into conical one and sessile one. In these four groups, the pattern of distribution of various fibrillar collagens(type 1, 2, 3, 5) was studied by immunohistochemical staining using paraffin embedded tissues. Within each group, differences among collagen subtypes were insignificant. In edematous polyp, collagens were sparsely dispersed in lamina propria by diffuse edema. In angiomatous polyp, collagens were displaced into submucosal layer by hemorrhagic space. In nodules, collagens were stained compactly in lamina propria. Quite different distributions of fibrillar collagens between polyps and nodules are thought to suggest that vocal polyps and nodules are totally different disorders in their pathophysiology.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.15 no.2
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• pp.112-117
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• 2004

Background and Objectives : This study is purposed to investigate the statistically significant discrimination model for predicting vocal fold nodule and polyp's lesional grade, with patients' background data and objective voice evaluation parameters. Materials and Method : The retrospective research was carried out at the Ewha Womans University Hospital. 122 patients' voice examination data had been selected, and lesion screening (Grade I, II, and III) was conducted by 2 ENT specialists, with each patient's vocal fold pictures achieved during the laryngoscopy examination. Results : The Lesional Grade Discrimination Model with which the lesional grade of vocal fold nodules and polyps could be predicted was derived by the ordinal logistic regression analysis (using SPSS 10.0). With this model the lesional grades of 73 out of 122 patients(59.8%) were correctly predicted to their formerly screened ones. Conclusion : This model applied the multivariate approach, which statistically combined these currently used parameters, Jitter, Shimmer, MFR, MPT, and patient's background data such as gender and dysphonia period. It might explain the status of benign lesion of vocal folds, and furthermore expect the physiological function of vocal folds.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.13 no.1
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• pp.33-39
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• 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
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• v.8 no.2
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• pp.178-184
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• 1997

Vocal nodule due to vocal hyperfunction is one of the representative chronic diseases of vocal folds, and it can be cured by surgical movement, and/or voice therapy. The present study is, focusing on the latter, to compare the acoustic and aerodynamic results of the pretreatment with those of posttreatment, and then to investigate the objective date on the efficiency of the voice therapy for the patients with vocal nodules. 11 females(age : 7-49) and 5 males(age : 8-40), total 16 patients wi vocal nodules treated by voice therapy were participated as subjects. Six measurements and comparisons of pretreatment and posttreatment of the results were performed : litter, shimmer, and noise-to-harmonic ratio as acoustic analyses ; maximum phonation time, mean flow rate, and the subtraction of mean flow rate from maximum flow rate as aerodynamic analyses. As a result, 14 of 16 subjects showed improvement at more than 4 of 6 measurements, and in group data, every measurements of posttreatment was improved significantly than the pretreatment. On the whole, the improvement of aerodynamic aspects was more statistically significant than that of acoustic ones.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.12 no.2
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• pp.133-139
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• 2001

Background and Objectives : There are so many methods to investigate the causes of voice disorders. However, they were almost invasive or non-physiologic methods. And none of them showed the laryngeal movements. Phonation pharyngogram is non-invasive method to see the laryngeal movement directly. Authors studied to evaluate the availability of phonation pharyngogram in laryngeal nodule. Materials and Methods : 30 laryngeal nodules and 10 control groups were evaluated. Acoustic analysis and maximum phonation time were measured and pharyngogram was taken during sustaining /a/ phonation immediately after swallowing the barium. We measured the width of hypopharyngeal wall, shape of hypopharyngeal wall and pyriform sinus apex, level difference between both true vocal folds, angle of subglottis, location of true vocal folds, elevated distance of vocal folds and shape of c-spine. Results : Jitter, Shimmer of laryngeal nodule were higher than control group and maximum phonation time was shorter in laryngeal nodule. There was a significance in width of hypopharyngeal wall, shape of pyriform sinus apex, level difference between both true vocal folds, elevated distance of vocal folds and shape of c-spine. Conclusions : Authors knew that there were differences when we used the phonation pharyngogram between normal group and laryngeal nodule group.

• Speech Sciences
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• v.11 no.4
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• pp.101-120
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• 2004

Vocal nodule is one of the representative chronic diseases of vocal folds, and it can be cured by voice therapy. However, the existing therapeutic methods about vocal nodule are in great demand. The purpose of this study was to evaluate the effect of therapeutic methods between Accent method and SK-MVTT (Seong-Tae Kim's multiple voice therapy technique), which was designed by the author. We identified 40 females, who diagnosed having vocal nodules, aged from 21 to 52 years (mean age: 40 years). Twenty females were treated by the SK-MVTT and the other 20 females the Accent method. All subjects received 12 sessions of treatment, and were evaluated after finishing the 6th and the 12th session. The results showed that the SK-MVTT produced a better results compared to the Accent method. The SK-MVTT was better especially at the initial stage of voice therapy compared to the Accent method. In this study, we can suggest that SK-MVTT may be useful in improving the voice qualities of vocal nodule patients. However, more data should be collected and evaluated before it can widely be used in other clinics.

• Phonetics and Speech Sciences
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• v.10 no.4
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• pp.155-161
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• 2018

The purpose of this study was to evaluate the efficacy of a multiple voice therapy technique ($SKMVTT^{(R)}$) using laughter for the treatment of various benign vocal fold lesions. To achieve this, 23 female patients diagnosed with vocal nodules, vocal polyp, and muscle tension dysphonia through videostroboscopy were enrolled in vocal hygiene and $SKMVTT^{(R)}$. All of the patients were treated once a week for 4 to 12 sessions. The GRBAS scale was used to confirm the changes in voice quality before and after the treatment. Acoustic analysis was performed to evaluate jitter, shimmer, NHR, fundamental frequency variation, amplitude variation, PFR, and dB range. Videostroboscopy was performed to confirm the changes in the laryngeal features before and after the treatment. After the $SKMVTT^{(R)}$, the results of the perceptual evaluation demonstrated that the G, R, and B scales significantly improved. An acoustic evaluation also demonstrated that jitter, shimmer, NHR, vAm, vFo, PFR, and dB range also significantly improved after the $SKMVTT^{(R)}$. In comparison to the videostroboscopic findings, the size of the vocal nodules and vocal polyp decreased or disappeared after the treatment. In addition, the size of the cuneiform tubercles decreased, the length of the aryepiglottic folds became longer, and the laryngeal findings of the supraglottic compressions improved after the $SKMVTT^{(R)}$. These results suggest that the $SKMVTT^{(R)}$ is effective in improving the vocal quality of patients with benign vocal fold lesions. In conclusion, it seems that laughter and inspiratory phonation suppressed abnormal laryngeal elevation and lowered laryngeal height, which seems to have the effect of improving hyperfunctional phonation.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.19 no.1
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• pp.58-61
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• 2008

A 66-year-old woman described a 6-month history of hoarseness after upper respiratory infection. She was a house wife and referred from an outside clinic under a diagnosis of vocal fold nodules. Strobovideolaryngoscopy revealed bilateral vocal fold lesions, and decreased mucosal wave of both vocal folds. She was brought to the operating room for microsuspension laryngoscopy. Under general anesthesia, dual intracordal cysts on left vocal fold were completely resected with microflap technique. The lesion on the right vocal fold turned out to be a reactive fibrous mass, which was also resected. Dual intracordal cysts were confirmed histopathologically. The one was an epidermoid cyst lined with squamous epithelium, and the other was a mucus retention cyst lined with cuboidal epithelium. Postoperative voice was acceptable by the patient and the mucosal vibration has much improved after the surgery.