Cho Jung-Hae, Choi Yong-Sug, Joo Young-Hoon, Park Young-Hak, Sun Dong-Il
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
J Voice. 2018 Jan;32(1):109-115. doi: 10.1016/j.jvoice.2017.02.011. Epub 2017 Mar 18.
We investigated the clinical significance of contralateral reactive lesions in patients undergoing laryngeal microsurgery for benign vocal fold lesions such as vocal polyps and cysts.
This was a retrospective, single institution cohort study.
Patient medical records were reviewed for demographic characteristics; acoustic, aerodynamic, and perceptual analyses; and Voice Handicap Index score before and after laryngeal microsurgery. Definitive diagnoses were made via intraoperative microlaryngoscopic evaluations. Clinical parameters were assessed to identify risk factors for contralateral reactive lesions. We evaluated surgical outcome using voice analysis.
We enrolled 268 patients (109 men and 159 women) with benign vocal fold lesions. A total of 195 (72.8%) had a contralateral reactive vocal fold lesion. A multivariable analysis revealed that being a never smoker and having a hoarseness duration ≥6 months, vocal polyps, and small primary lesions were independent risk factors for contralateral reactive lesions (P <0.05). The preoperative perceptual evaluation and maximum phonation time were significantly worse in patients with a contralateral reactive lesion than in those without one (P = 0.014, P = 0.004, respectively). The voice parameters in patients who underwent excision of the contralateral reactive lesion were generally better than those who received conservative treatment, particularly the noise-to-harmonic ratio (P = 0.004).
Contralateral reactive vocal fold lesions are frequently detected in patients with vocal polyp and cyst. The reactive lesions had an adverse effect on voice quality. Simultaneous excision of primary and contralateral reactive lesions may be an alternative treatment for better voice outcome.
我们研究了在接受喉显微手术治疗声带息肉和囊肿等良性声带病变的患者中，对侧反应性病变的临床意义。
这是一项回顾性单机构队列研究。
回顾患者病历以获取人口统计学特征、声学、空气动力学和感知分析，以及喉显微手术前后的嗓音障碍指数评分。通过术中显微喉镜评估做出明确诊断。评估临床参数以确定对侧反应性病变的危险因素。我们使用嗓音分析评估手术结果。
我们纳入了268例患有良性声带病变的患者（109例男性和159例女性）。共有195例（72.8%）出现对侧反应性声带病变。多变量分析显示，从不吸烟、声音嘶哑持续时间≥6个月、声带息肉以及原发性病变较小是对侧反应性病变的独立危险因素（P<0.05）。有对侧反应性病变的患者术前感知评估和最长发声时间明显比没有该病变的患者差（分别为P = 0.014，P = 0.004）。接受对侧反应性病变切除的患者的嗓音参数总体上优于接受保守治疗的患者，尤其是噪声与谐波比（P = 0.004）。
在声带息肉和囊肿患者中经常检测到对侧反应性声带病变。这些反应性病变对嗓音质量有不良影响。同时切除原发性和对侧反应性病变可能是改善嗓音结果的一种替代治疗方法。
