Clinical Research Of Voice Analysis And Surgery Technique In Patients With Sulcus Vocalis

Objective The objective of this work was to compare objective parameters difference of patients with sulcus vocalis and subjects with normal voice between sexes.Methods1.1 Subjects SelectionFrom January 2005 to July 2006, 27 patients with sulcus vocalis were diagnosed through videolaryngostroboscopy and Microlaryngoscopy during surgery at the Department of Otolaryngology,Zhujiang Hospital.The population included 12 male patients whose ages ranged between 23 and 48 years with a mean age of 37.5 years and 15 female patients whose ages ranged between 18 and 51 years with a mean age of 34.9 years. Laryngeal inflammation, laryngeal trauma, vocal nodules, polyp of vocal cord, Reinke's edema, laryngeal elevated lesions and previous laryngeal surgery were excluded from the study. Sixty subjects with normal voice were selected at random. There were 30 men and 30 women.Ages ranged between 19 and 53 years, with a mean age of 30.3 years. Normal phonation was required. Neurologic diseases, laryngeal diseases and respiratory diseases were excluded. There was no smoking history.1.2 Methods1.2.1 Experiment ProcessThe acoustic parameters were measured in a sound-proof room using a standardized protocol, where noise loudness bellowed 45 dB.A Computerized Speech system under software control(Dr. Speech 4.0 for Windows Software) was used for peocessing and analysis of the data. A constant mouth-to-microphone diatance of 10cm was maintained.The subjects were instructed to sustain the vowel sound/(?)/Maximal phonation time was calculated while subjects sustained the vowel/(?)/as long as possible on one breath.1.2.2 Assessment ParametersThe objective parameters, including fundamental frequency(F0), fundamental frequency perturbation(jitter), amplitude perturbation(shimmer), fundamental frequency standard deviation(FOSD), normalized noise energy(NNE), harmonic to noise ratio(HNR), signal to noise ratio(SNR) and maximal phonatory time(MPT).1.3 Statistical AnalysisThe numeric values of the various parameters examined were summarized by descriptive statistics: means, SDs. Results were expressed by x±s. Statistical analysis was performed with the SPSS 13.0 for Windows package. Statistical analyses were performed with independent-samples t test. P＜0.05 indicated statistics difference significantly. Results The value of FOSD was no difference significiantly between tested andcontrol groups in male (t=-1.817, P=0.095) The values of F₀, jitter, shimmer, NNE, HNR, SNR and MPT were different significantly between tested and control groups in male (jitter, shimmer: P＜0.05; F0, NNE, HNR, SNR and MPT: P＜0.01). For F₀, jitter, shimmer, NNE, the values of the male patients with sulcus vocalis were superior to those of male control groups; but for HNR, SNR and MPT, the values of the male patients with sulcus vocalis were inferior to those of male control groups. In female groups, the values of jitter, shimmer, NNE, F₀SD and MPT were different significantly between tested and control groups (P＜0.05). For jitter, shimmer, NNE and F₀SD, the values of the female patients with sulcus vocaliswere superior to those of female control groups; but for MPT, the values of the female patients with sulcus vocalis were inferior to those of female control groups. The F₀ of female patients with sulcus vocalis improved and the HNR, SNR of female patients with sulcus vocalis decreased, but these differences did not reach significance(F₀., t=-0.613, P=0.543; HNR: t=1.340, P=0.187; SNR: t=1.633, P=0.110).Conclusion Analysis of voice is subjective estimate, which can discriminate normal and pathological voice. There is difference between male and female in objective parameter of voice, such as F0, NNE, MPT, et al. The values of NNE, jitter, shimmer, MPT indicates the character of voice of sulcus vocalis sensitively. With the value of F0, it is useful to help diagnose the patients with sulcus vocalis. Objective To investigate the effectiveness of Mucosal microflap technique with suspension microlaryngoscopy surgery in patients with sulcus vocalis, so as to find a way of reserving normal high quality phonatory function after sulcus vocalis surgery.Methods1.1 Patients SelectionFrom July 2002 through August 2005, 31 consecutive patients with sulcus vocalis underwent mucosal microflap technique with suspension microlaryngoscopy surgery. There were 17 men and 14 women. Ages ranged between 23 and 54 years, with a mean age of 47.8 years. Among these, 5 patients with sulcus vocalis merging polyp of vocal cord, 8 cases merging chronic hypertrophic laryngitis, 3 cases merging cyst of vocal cord, 9 cases merging polyp of vocal cord and chronic hypertrophic laryngitis, 4 cases merging leukoplakia of cocal cord and chronic hypertrophic laryngitis, 1 case merging polyp of vocal cord and hemangioma of larynx, 1 case merging polyp of vocal cord and Reinke edema.This disease leaded to the presenting symptoms of breathy hoarseness and vocal fatigue. A furrow along the medial edge of the vocal folds,glottal incompetence and absence of the mucosal wave were observed through videolaryngostroboscopy. According to Ford's variants schema, the 31 patients included 18 unilateral cases(12 cases with type 2 sulcus and 6 cases with type 3 sulcus), 13 bilateral cases(5 cases with type 2 sulcus and 4 cases with type 3 sulcus) and 4 mixed cases(type 2 sulcus one side and type 3 sulcus another).1.2 Methods1.2.1 Surgery TechniqueAll surgical procedures were performed by the same surgeon. The intervention is carried out under general anesthesia with orotracheal intubation and s NO.6.5 tube for patients already tracheotomized. Suspension laryngoscopy is performed by means of a double-valve surgical laryngoscope allowing adequate exposure of the vocal fold region. The approach involved a longitudinal epithelial cordotomy with release of the depth of the sulcus from its deepest attachment, followed by simple redraping of the epithelium and superficial lamina propria. First, place an anterior-to-posterior directed incision laterally on the superior surface of the vocal fold to just above the vocal ligament. The incision should only penetrate the epithelium and superficial lamina propria. Next, dissect gently to separate the sulcus from the vocal fold ligament, fromlateral to medial. Cut sharply to separate the sulcus from the vocal-fold ligament. Continue to dissect the cover from the body to a depth of 3 mm below the sulcus. Finally, adjust the shape of the vocal fold and suture the wound with 5-0 monofilament polypropylene. All surgical procedures were performed by the same surgeon(Huang Jinzhong, MD).1.2.2 Assessment ParametersPre- and postoperative videolaryngostroboscopy and vocal function studies were carried out. Vocal function studies consisted of objective measures of jitter, shimmer, NNE and maximum phonation time. The 31 patients with sulcus vocalis were examined 1 or 2 weeks preoperatively and followed up 1 and 6 months postoperatively. The laryngostroboscopic examination, acoustic recordings were used to assess the surgical outcome. The objective parameters, including fundamental frequency perturbation(jitter), amplitude perturbation(shimmer), normalized noise energy (NNE) and maximal phonatory time (MPT).1.3 Statistical AnalysisThe numeric values of the various parameters examined were summarized by descriptive statistics: means, SDs. Results were expressed by x±s. Statistical analysis was performed with the SPSS 13.0 for Windows package.Statistical analyses of preoperative and postoperative voice assessment data including the values of jitter, shimmer, NNE and MPT were performed with repeated measures. P＜0.01 indicated statistics difference significantly.ResultsVideolaryngostroboscopic findings: one month postoperatively, chronic hyperemia and nylon were observed. Complete or near-complete glottal closure during phonation was found, six months postoperatively: Satisfactory glottal closure was observed, and there was a satisfactory mucosal wave during phonation in all.Acoustic analyses: As the acute inflammatory response resolved, the voice quality greatly improved at four weeks after surgery. With 6 months, the voice began to reach its best quality. There was a statistically significant decrement in jitte, shimmer and NNE from the preoperative to the postoperative performance. The value of MPT increased significantly (P＜0.01).Conclusion Mucosal microflap technique with suspension microlaryngoscopy surgery may cure sulcus vocalis and reserve good voice function. It is a free, safe and effective technique for pathological sulcus vocalis.