• 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.

• Phonetics and Speech Sciences
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• v.6 no.2
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• pp.107-114
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• 2014

MDVP and Praat are measured by nine variables in common; F0, jitter local, jitter absolute, jitter relative average perturbation, jitter period perturbation quotient, shimmer local, shimmer dB, shimmer amplitude perturbation quotient, and NHR. In the present study, 30 female subjects were divided by their disorders(control group, vocal nodule group), ages(from 18 to 50 years old), gender(women), and severities of voice disorder(GRBAS-G0, G1, G2). Then, the subjects' vowel /a/ was evaluated by MDVP and Praat. First, jitter and shimmer variables of the MDVP were significantly different by severities. Praat showed different jitter, shimmer, and NHR parameters by severities. Second, jitter and NHR levels of MDVP were meaningfully higher than Praat regardless their severities. The result of the research confirms the relationships among GRBAS, MDVP and Praat as well as the differences in acoustic variables between MDVP and Praat.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1983.05a
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• pp.10.3-10
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• 1983

Vocal strain occur chiefly in those whose occupations professional singers, teachers, actors, and so on. Continuous vocal strain may perpetuate and aggravate the condition and lead to formation of established vocal nodules. The nodes are at first red and soft. These fresh nodes are well responded by chewing method without surgery. Recently the author experienced three cases of singers nodule (one male professional classic singer, one female pop singer, one male teacher) treated by chewing method. The purpose of this paper is to discuss principles and methods of chewing with literature review.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.11 no.2
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• pp.161-166
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• 2000

Background and Objectives : Vocal fold hemorrhage occur by blood accumulation in Reinke's space by vocal trauma. It is mostly asymptomatic, but in some cases it may cause severe dysphonia. It is often seen in patients who use their voice professionally. However, recent changes of life style affected the phonation in general population. We studied to know what are the causes and what are the major factors to affect the vocal fold hemorrhages. Materials and Methods : 19 subjects were evaluated by using of questionaire and laryngoscopic examinations. We evaluated the factors to lead the change in voice directly, underlying causes, occupations and laryngeal findings. Results : The direct causes of the vocal fold hemorrhages were clearing throat, talking, coughing and singing. Reflux laryngitis and upper respiratory infection were the underlying diseases. Vocal fold hemorrhages were developed during the menstruation in 5 patients. Accompanying functional voice disorders were seen in 13 patients, such as, vocal fold nodule, nodule with varix, vocal polyp, Reinke's edema. Patients with reflux laryngitis had the habits of clearing throat as the direct cause of the vocal fold hemorrhages and had hyperkinetic functional voice disorders. Voice abuse was the direct cause of the vocal fold hemorrhages in patients who was in the period of the menstruation. The most common site of the hemorrhage was at the membranous portion of the vocal folds. Conclusions : Authors thought the forceful laryngeal activity was the cause of the vocal fold hemorrhages. And reflux laryngitis and menstruation was the risk factors of the vocal fold hemorrhages.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.26 no.2
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• pp.117-121
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• 2015

Background : Cepstral analysis which is obtained from Fourier transformation of spectrum has been known to be effective indicator to analyze the voice disorder. To evaluate the voice disorder, phonation of sustained vowel /a/ sound or continuous speech have been used but the former was limited to capture hoarseness properly. This study is aimed to compare the effectiveness in analysis of cepstrum between the sustained vowel /a/ sound and continuous speech. Methods : From March 2012 to December 2014, total 72 patients was enrolled in this study, including 24 unilateral vocal cord palsy, vocal nodule and vocal polyp patients, respectively. The entire patient evaluated their voice quality by VHI (Voice Handicap Index) before and after treatment. Phonation of sustained vowel /a/ sample and continuous speech using the first sentence of autumn paragraph was subjected by cepstral analysis and compare the pre-treatment group and post-treatment group. Results : The measured values of pre and post treatment in CPP-a (cepstral peak prominence in /a/ vowel sound) was 13.80, 13.91 in vocal cord palsy, 16.62, 17.99 in vocal cord nodule, 14.19, 18.50 in vocal cord polyp respectively. Values of CPP-s (cepstral peak prominence in text-based speech) in pre and post treatment was 11.11, 12.09 in vocal cord palsy, 12.11, 14.09 in vocal cord nodule, 12.63, 14.17 in vocal cord polyp. All 72 patients showed subjective improvement in VHI after treatment. CPP-a showed statistical improvement only in vocal polyp group, but CPP-s showed statistical improvement in all three groups (p<0.05). Conclusion : In analysis of cepstrum, text-based analysis is more representative in voice disorder than vowel sound speech. So when the acoustic analysis of voice by cepstrum, both phonation of sustained vowel /a/ sound and text based speech should be performed to obtain more accurate result.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.19 no.2
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• pp.142-145
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• 2008

Background and Object: The aim of this study is to evaluate the change of patient's subjective voice handicap index (VHI) and acoustic parameters before and after laryngeal microsurgery for benign vocal cord disease. Materials and Method: We analyzed 78 patients who received laryngeal microsurgery for benign vocal cord disease from January 2004 to February 2007 retrospectively. There were 28 vocal polyp, 40 vocal nodule, 5 intracordal cyst and 5 Reinke's edema. Jitter, shimmer, harmony to noise ratio (HNR) were analyzed before surgery and 2-3months after surgery using the Doctor's speech science program. The voice handicap index introduced by the Pittsburgh Voice Center was used to examine patient's subjective change of voice quality. Results: Acoustic parameters of jitter, shimmer and HNR were improved in patients with vocal polyp and vocal nodule after surgery. The acoustic parameters were not improved in patients with Reinke's edema, statistically. Only jitter was improved significantly in patients with intracordal cyst (p<0.05). The VHI was significantly improved after surgery. The change of jitter and shimmer was significantly correlated with the change of VHI after surgery. Conclusion: The acoustic parameters and VHI were significantly improved in patients with benign vocal disease after laryngeal microsurgery.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1978.06a
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• pp.6.4-7
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• 1978

The author has experienced 50 cases of vocal nodules and polyps in our department for 3 years from May 1974 to April 1977. These nodules were removed out with laryngeal forcep under indirect laryngoscopy and maximum phonation time and timbre of the voice were analyzed before and after operation. Very shortened phonation time of the patient with vocal nodule has returned to normal range (Male : 30 seconds, Female: 20 seconds) and the voice timbre has recovered to almost normal voice postoperatively. The author has made a brief literature review.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.20 no.1
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• pp.52-56
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• 2009

Background and Objectives : Vocal nodule is common inflammatory vocal cord lesion which could be improved by voice rest or voice therapy. But some patients, who do not have any improvement after voice therapy, should take laryngomicorsurgery or additional long-term voice therapy. So we try to find prognostic factors which affect the results of voice therapy. Materials and Methods: There are 36 patients (response group) whose symptoms improved after initial voice therapy and 16 patients (no response group) whose symptoms did not improve at all. We compared clinical features (durations of symptoms, voice abuse, laryngopharyngeal reflux), GRBAS scale, acoustic analysis, aerodynamic analysis and voice handicap index between the two groups from January, 2006 to June, 2008. Results: Response group underwent voice therapy 4.5 times (ave.) and no response group underwent 6.7 times (ave.). No response group has longer duration of symptoms, higher GRBAS scale score, higher NIH ratio, and higher MFR than those of response group. Conclusion : This study found that the prognosis of voice therapy in patients who have longer duration of symptoms, high NIH ratio, and bad perceptional test result is not likely to be good. In those cases, we should recommend earlier surgery, voice therapy after surgery, and inform about the necessity of long-term voice rehabilitation or voice therapy in order to get favorable compliance.

• Phonetics and Speech Sciences
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• v.4 no.4
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• pp.147-154
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• 2012

The purpose of this study is to examine the effect of voice improvement when vocal training, which relaxes the vocal contact, is applied to children with vocal nodules. Subjects included 20 5- to 12-year-old boys with vocal nodules in Otolaryngology and for whom voice therapy had been advised. The vocal therapy was conducted for 40 minutes per a week for a total of eight times. Results were evaluated by videostroboscopy, auditory-perceptual evaluation of GRBAS Scale, aerodynamic test, and acoustic analysis before and after therapy. As a result, first, the size of vocal nodules was reduced and the unstable pattern of vocal contact was improved. Glottic closure was increased and Phase symmetry was decreased during vocal vibration. Mucosal wave was increased and muscle tension of the larynx was reduced. Second, auditory-perceptual evaluation showed that subjects' overall quality of voice improved. GRBAS Scale Evaluation showed that the characteristics of the subjects' voice which were rough, breathy, and strained and breathy were reduced after therapy. Third, the measurements of acoustic parameters showed a statistically significant improvement. The fundamental frequency of the subejects' voice was increased and values of Jitter and Shimmer, NHR, [H1-H2] decreased. Fourth, the maximum phonation time of children was increased. These results imply that vocal relaxation training conducted in this study has a very positive effect to improve the voice of children with vocal nodules.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.26 no.2
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• pp.97-100
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• 2015

Benign vocal fold lesions, such as vocal nodules, polyps and Reinke's edema, usually result from chronic voice overuse. Conservative management such as voice therapy and pharmacotherapy are used as the primary treatment techniques. The main purpose of voice therapy is to identify and reduce voice misuse to achieve the optimal voice. But complete resolution may not be possible in all patients after voice therapy. Furthermore, some patients with voice-related occupations, voice rest and voice therapy are sometimes difficult, which makes it hard to carry out the treatment. When conservative therapy is ineffective, laryngeal microsurgery can be performed under general anesthesia. However, potential complications following laryngeal suspension and violation of the layered structure of the vocal fold during surgery should be considered before surgery. In recent decades, emerging literatures have demonstrated the potential usefulness of vocal fold steroid injection as an alternative treatment option for benign vocal fold lesions. The most advantageous feature of vocal fold steroid injection is the maintenance of regional anti-inflammatory effects while preventing the potential systemic adverse effects of the steroid. Many non-surgical treatment methods can be conducted using different approaches in the office setting. It can be applied as an alternative treatment modality for the management of various benign vocal fold lesions.