The Sean Parker Institute for the Voice, Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medicine, New York, New York, USA.
Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Laryngoscope. 2021 Nov;131(11):2523-2529. doi: 10.1002/lary.29531. Epub 2021 Apr 9.
OBJECTIVES/HYPOTHESIS: To examine patterns of recurrence of benign phonotraumatic vocal fold lesions over time for insights into pathophysiology.
Case series with mathematical modeling.
Medical records and stroboscopic exams of adults who underwent microlaryngoscopic resection of phonotraumatic vocal fold lesions over a 13-year period were reviewed for time to recurrence after surgery. Uniform and log-normal probability distributions were fitted to the time to recurrence curves for vocal fold polyps, midfold masses, and pseudocysts. Model fits were compared using the Akaike information criterion corrected, a standard measure of the goodness of fit. Stochastic simulations were used to verify that the mechanistic hypotheses were concordant with the selected probability distributions and empiric data.
Of 567 patients who underwent microlaryngoscopic resection, 65 had a recurrence (16 polyps, 14 midfold masses, and 35 pseudocysts). Midfold mass and pseudocyst recurrences were predominantly seen in younger women. Polyps were best fit by a uniform distribution rather than log-normal, whereas midfold masses and pseudocysts were better fit by log-normal rather than uniform. Stochastic simulations suggest that polyps recur sporadically according to a paroxysmal-developmental model, whereas midfold mass and pseudocyst recurrences follow a force-multiplication, damage-accumulation process.
Vocal fold polyps are acute lesions evenly distributed by age and gender that recur uniformly over time, suggesting they arise from sudden tissue reactions to phonotraumatic stress. Pseudocysts and midfold fibrous masses are chronic lesions predominantly found in young women that recur with log-normal distribution over time, suggesting gradual damage accumulation in larynges predisposed to enhanced phonotrauma.
4 Laryngoscope, 131:2523-2529, 2021.
目的/假设：通过检查良性声带创伤性病变随时间的复发模式，深入了解其病理生理学机制。
病例系列研究及数学建模。
对 13 年来接受声带创伤性病变显微喉镜切除术的成年人的病历和频闪喉镜检查结果进行了回顾性分析，以了解术后复发的时间。采用均匀分布和对数正态分布对声带息肉、中隔肿块和假性囊肿的复发时间曲线进行拟合。使用已校正的 Akaike 信息准则（一种衡量拟合优度的标准）比较模型拟合度。使用随机模拟来验证机制假设与所选概率分布和经验数据是否一致。
在 567 例行显微喉镜切除术的患者中，有 65 例（16 例声带息肉、14 例中隔肿块和 35 例假性囊肿）出现了复发。中隔肿块和假性囊肿的复发主要见于年轻女性。息肉最好用均匀分布拟合，而不是对数正态分布，而中隔肿块和假性囊肿则更适合用对数正态分布拟合。随机模拟表明，息肉根据突发-发育模型呈散发性复发，而中隔肿块和假性囊肿的复发则遵循力量倍增、损伤积累的过程。
声带息肉是急性病变，按年龄和性别均匀分布，随时间呈均匀复发，提示其是由声带创伤性应激引起的组织突然反应所致。假性囊肿和中隔纤维性肿块是慢性病变，主要见于年轻女性，随时间呈对数正态分布复发，提示易发生增强性声带创伤的喉部逐渐积累损伤。
4 级喉镜，131：2523-2529，2021。
