The Pathological And Analysis Of Voice Parameters On Vocal Nodules After Microflap Surgery

Objective: In this article, we study the vocal nodules's treatment about microflap surgery. On the one hand, we researched operation-removed tissues of vocal nodules, observed the pathological changes of these tissues to understanding pathogenesis of it. In this case,we can guide people to prevent the disease and provide the basis for rehabilitation better. On the other hand, we starting from the changes of acoustic parameters before and after the treatment to explore the differences between different ways of treating patients with vocal nodules, so it can provide further feasibility evidence for microflap surgery to promotion the operation better.Methods:1. Select 20 vocal nodules cases and 20 vocal polyps cases, companined with 5 cases of normal vocal cord tissue as a blank control. All tissues fixed regularly, embedded in paraffin, and sliced. Each paraffin block make 4 slices, in which an ordinary glass slide (HE stain used),3 glass slides coated with silica gel (PAS staining, Masson staining and staining Weigert used). All slices for HE staining, PAS staining, Masson staining, and Weigert staining respectively. At last we observed the pathological changes under the microscope.2. Selected 60 patients with vocal nodules, and divided into three groups.20 cases with "microflap surgery",20 cases with "mucosal stripping under fibrolaryngoscope",20 patients with conservative treatment. All patients were given spray treatment for a week in our hospital with Pulmicort fog, while make the sound off for two weeks. Three groups of patients were observed by XION video laryngoscope made in Germany before the treatment and in the first week, the second week, the third week, and the forth week after these different treatments, and at the same time wih some objective voice detection. Also, we choose the control group of 20 cases, who sound normal, no history of voice disorder, no throat disease, without respiratory and nervous system disease, no smoke, and the electronic laryngoscope show that the vocal cords were normal appearance and movement normal. These 20 persons were also observed by XION video laryngoscope made in Germany and with the objective testing about voice. Objective monitoring of voice use XION baseband acoustic detection software to calculate the Jitter value and Shimmer value. The datas were statistically analyzed by spssl6.0.Results:1. After HE staining, the tissue of vocal nodules were observed that the mucosa with mild dysplasia, mitotic relatively common, and limit hyperplasia between spinous cell layer. Sometimes some spinous cells showed "squamous nest" phenomenon. The mucosa of epithelia were hyperkeratosis or incomplete keratosis, the basal cells growing actively, the epithelial foot extended and widened, such as "spikes" deep in lamina propria. In the lamina propria we can see fibroplasia, edema, mucoid degeneration, and amyloidosis. Vascular proliferative expansion can be seen, and the scattered inflammatory cell infiltration perivascular. Masson stain, vocal nodules generally normal tissue or collagen in reticular fibers. In the lesions, the arrangement of collagen fibers are more disordered, no laws exist in layers, disordered intertwined. PAS staining of vocal nodules rich in glycogen in epithelial tissues, showing amyloidosis myxoid degeneration. Weigert staining of vocal nodules tissue elastic fibers can be seen, the elastic fibers loss of the normal distribution in each layer of lamina propria sparse, scattered distribution, the number was reduced significantly, smaller in diameter, thin fibers, woven into a network, out of shape disorder.2. After different ways of treatments,60 cases of vocal nodules have different changes in the acoustic parameters jitter and shimmer values. The group with anesthesia and "microflap surgery", the shimmer values returned to normal in the third week after the treatment, the jitter value returned to normal in the forth week after the treatment. The group with " mucosal stripping under fibrolaryngoscope ", shimmer values returned to normal in the forth week after treatment, while the jitter value is still higher than normal. The group simply with the spray treatment, in the forth week after treatment, shimmer and jitter values are still higher than normal level.Conclusion1. This study suggests that pathological changes of vocal nodules is not limited to mucosal epithelium, lamina propria pathological changes have taken place. And the change is different from the vocal cord polyp.2. Through the comparison about the changes of acoustic parameters before and after different treatments, vocal nodules with "microflap surgery" treatment, will have smaller trauma on vocal cord, faster recovery on vocal form, and faster improvement of the acoustic parameters. All in all it is worth promoting.