Hsiung Ming-Wang
Department of Otolaryngology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Acta Otolaryngol. 2004 Mar;124(2):186-91. doi: 10.1080/00016480310014859.
Under normal conditions, the vocal fold mucus layer is too thin to permit observation using videolaryngostroboscopy (VLS) during phonation. However, vocal nodules (VNs) typically cause congealed and sticky mucus to appear on the vocal fold. Reports in the literature regarding this phenomenon are limited. The aim of this study was to review VLS recordings of VN patients, analyzing changes that occurred in the mucus layer that covers the vocal fold during vibration following VN surgery.
Using VLS, we studied the occurrence of, and changes in, vocal fold mucus layers in 160 VN patients before and after surgery.
Eighty-eight patients (55%) were found to have a mucus layer during preoperative examinations. Of these mucus layers, 21 (13%) were located on the anterior commissure or anterior third of the vocal fold (A), 58 (36.3%) on the junction of the anterior and middle thirds (M), 1 (0.6%) on the posterior third (P), 5 (3.1%) on both A and M and 3 (1.9%) on both M and P. Fifty-six (35%) cases were found to have a mucus layer during postoperative examinations. Of these, 44 (27.5%) were located on A, 8 (5%) on M, 1 (0.6%) on P and 3 (1.9%) on both A and M. These results indicate that changes in the mechanical force on the vocal fold, alteration of the laryngeal secretory gland and improper aerodynamic airflow result in increased mucus viscosity and aggregation in VN patients and that the combination of these factors further increases the severity of dysphonia.
Surgery to remove vocal nodes may be an effective method to eliminate both vocal bumps and aggregated mucus. Based on the present results, it is recommended that future research should compare surgery to remove VN against other mucus layer reduction methods in order to determine which is the most effective.
在正常情况下，声带黏液层太薄，以至于在发声时无法通过视频喉镜频闪检查（VLS）进行观察。然而，声带小结（VNs）通常会导致声带出现凝结且黏稠的黏液。关于这一现象的文献报道有限。本研究的目的是回顾声带小结患者的VLS记录，分析声带小结手术后振动过程中覆盖声带的黏液层发生的变化。
我们使用VLS研究了160例声带小结患者手术前后声带黏液层的出现情况及变化。
术前检查发现88例患者（55%）有声带黏液层。在这些黏液层中，21例（13%）位于声带前联合或声带前三分之一处（A），58例（36.3%）位于前、中三分之一交界处（M），1例（0.6%）位于后三分之一处（P），5例（3.1%）同时位于A和M处，3例（1.9%）同时位于M和P处。术后检查发现56例（35%）患者有声带黏液层。其中，44例（27.5%）位于A处，8例（5%）位于M处，1例（0.6%）位于P处，3例（1.9%）同时位于A和M处。这些结果表明，声带机械力的变化、喉分泌腺的改变以及不当的空气动力学气流导致声带小结患者黏液黏度增加和聚集，并且这些因素的共同作用进一步加重了发声困难的严重程度。
切除声带小结的手术可能是消除声带肿物和聚集黏液的有效方法。基于目前的结果，建议未来的研究应比较切除声带小结的手术与其他减少黏液层的方法，以确定哪种方法最有效。
