Voice outcomes following treatment of benign midmembranous vocal fold lesions using a nomenclature paradigm

Laryngoscope. 2016 Feb;126(2):415-20. doi: 10.1002/lary.25488. Epub 2015 Sep 25.

Abstract

Objectives/hypothesis: Benign midmembranous vocal fold lesions (BMVFLs) are common voice disorders, but interpretation of outcomes following treatment is difficult due to the lack of a standardized nomenclature system for these lesions. Outcome results are increasingly important to third party payers. This study aimed to investigate the outcomes of patients with BMVFLs using a previously validated nomenclature, and to provide incidences and outcome results for each diagnosis.

Methods: A retrospective chart review of BMVFL patients was performed. Treatment was individualized but typically involved implementation of nonsurgical therapy followed by phonomicrosurgery as needed. A previously reported BMVFL stratification system was used.

Results: A total of 224 patients with BMVFLs were studied. Sixty-seven percent of all patients with a BMVFL underwent phonomicrosurgery. The most common BMVFL types were polyp and nonspecific vocal fold lesion. Pseudocyst represented 0.9% of the cohort. The Voice Handicap Index-10 (VHI-10) and acoustic data demonstrate a high degree of treatment success. The mean change in VHI-10 was greatest for cyst-subepithelial and polyp. Fibrous mass-ligamentous patients had the smallest mean change in VHI-10. Mean post-treatment VHI-10 scores of all the lesions except fibrous mass-ligamentous were within normal limits (<11).

Conclusions: This study represents the first outcomes-based report of BMVFLs using a strictly defined nomenclature system for stratification of lesions. Ligamentous fibrous mass lesions have a decreased response to treatment compared to all other lesions. This study demonstrates the ability to return most BMVFL patients to normal speaking voice capabilities following treatment.

Level of evidence: 4.

Keywords: Vocal cord lesions; nomenclature; speech therapy; vocal cord polyp; vocal nodules.

MeSH terms

  • Cognitive Behavioral Therapy / methods*
  • Female
  • Humans
  • Laryngeal Diseases / diagnosis
  • Laryngeal Diseases / physiopathology
  • Laryngeal Diseases / therapy*
  • Laryngoscopy / methods*
  • Male
  • Retrospective Studies
  • Terminology as Topic*
  • Vocal Cords / pathology
  • Vocal Cords / physiopathology*
  • Voice Quality*
  • Voice Training*