DETERMINE THE INCIDENCE AND CLINIC-DEMOGRAPHIC PROFILE OF PATIENTS UNDERGOING MICROLARYNGEAL SURGERY FOR VARIOUS PATHOLOGIES OF THE LARYNX AT TERTIARY CARE HOSPITAL.

Aim: to determine the incidence and clinic-demographic profile of patients undergoing microlaryngeal surgery. Materials and Methods: this is a prospective study of 100 patients attending an outpatient department with laryngeal lesions evaluated irrespective of their age, sex, and occupation. Biopsy-confirmed malignant cases were excluded. Result: of the 100 patients, 84 of them exhibited benign lesions and rest 16 patients showed malignant pathology. Most commonly seen benign vocal lesion is vocal nodule (37.0%) followed by vocal polyp (28.0%). Along with hoarseness of voice, other symptoms reported were cough and throat pain, Dysphagia and fever. Improvement in symptoms was seen after the treatment. Conclusion: Microlaryngeal surgery is a good therapeutic tool in both benign and malignant lesions. The differentiation of benign from malignant lesions is vital. Microlaryngoscopic examination has proved to be the best modality for visualizing these lesions and arriving at a clinical diagnosis Keywords: Benign, Larynx, Voice change, Vocal nodule

Prevalence of Voice Disorders in Primary Level School Teachers of Nepal: A Pilot Study

Introduction: Among professional voice users teachers are found to be at an exceptionally high risk of developing voice problems because of stress inherent in their occupation and the environmental conditions in which they work. In this pilot study conducted in the Terai region of Nepal we determine the prevalence of voice disorders in primary level school teachers and aetiological factors associated with it. Subjects and Methods: One hundred and thirty-seven teachers of primary level Government school of Morang district, Nepal irrespective of age and sex were enrolled in this study from December 2015 to November 2016 in the Department of Otorhinolaryngology and Head and Neck, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. All were subjected to detail history, clinical examination including indirect laryngoscopy(IL) and flexible nasopharyngolaryngoscopy(NPL). Informed consent and ethical clearance was taken from the ethical board. Observation: Out of 137 teachers included in study the sex, age, teaching experience, materials used in classroom, noise, habits of teachers were studied in regards to prevalence of voice disorder and vocal nodule. Prevalence of voice disorders was (47%) and vocal nodule was (12%). There was strong statistical significance with gender, teaching experience, tobacco use and noise in class room with P value of < 0.05. Whereas increasing age of teachers has weak relation but significant P = 0.049. Conclusion: This study shows a high prevalence of voice disorders among teachers. There are various risk factors which are associated with it, some are non-modifiable such as age, gender. Some are modifiable such as tobacco use, noise in class-room and teaching duration.

Use of Voice Handicap Index (VHI) as Predictor of Outcome of Non-surgical Treatment in Vocal Nodules

Introduction Vocal Nodule is commonest benign vocal cord lesion which causes varying degree of dysphonia having serious impact on personal and professional well being. Voice Handicap Index (VHI) is a psychometrically validated tool for measuring pshycosocial handicapping effect of voice disorder. Materials and Methods From data available since last 18 months, patients who had undergone treatment for vocal nodule were selected as study population. In Group A, 50 patients were selected who required surgery and Group B, 50 patients who responded to medical treatment. Patients filled in VHI-30 form at time of diagnosis and subjected to voice therapy and adjunctive medical treatment for 1 month and reassessed using VHI-30. Successful treatment consisted of absence of pathology by laryngoscopy and decrease of VHI total score ≥18. Results The cut-off score was calculated using Receiver Operating Characteristics (ROC). VHI cut-off of total score was 45 (Sensitivity 94%, Specificity76%). The cut-off score for functional, physical and emotional domains are 14(Sensitivity 94%, Specificity 64%) , 15(Sensitivity 92%, Specificity 60%) and 15(Sensitivity 90%, Specificity 66%) respectively. Discussion Hard consistency of nodules can explain refractoriness to speech therapy and higher VHI score. The physical subscale of VHI was higher among both groups indicating patients’ perceptions of laryngeal discomfort and voice output affected them more. According to our study patients with higher VHI score should be counselled for MLS at earliest instead of speech therapy for one month which would not have given good outcome. Conclusion These scores give a good idea about categories of patients who will not benefit by non-surgical treatment and hence early surgical intervention will obviate the duration of handicap and delay in appropriate treatment.

Hoarseness of voice – an institutional study

<p class="abstract"><strong>Background:</strong> Hoarseness is one of the earliest signal of local and systemic disease. It should be emphasized that hoarseness is not a disease in itself but a symptom of disease or disturbance of larynx or laryngeal innervation. The aim of the study was to analyse various causes and conditions associated with hoarseness of voice.</p><p class="abstract"><strong>Methods:</strong> We studied 150 patients in a prospective randomised study with inclusion criteria of hoarseness of voice, attending otolaryngology outpatient department of Dayanand medical college and hospital, Ludhiana, irrespective of their age, sex and duration of disease. No exclusion criteria were applied. All the routine investigations like Hb, BT, CT, TLC, DLC, urine-for albumin and sugar were carried out in all patients. X-ray chest- PA view and X-Ray soft tissue neck- AP and lateral view were done when required. Larynx was examined by flexible fibreoptic laryngoscopy followed by biopsy if suspicious looking area was seen. 4% lignocaine spray was used orally and nasally to provide local anaesthesia.</p><p class="abstract"><strong>Results:</strong> In the present study of 150 cases 87 were males and 63 were females with M:F ratio of 1.4:1 and age ranged from 10–90 years with majority of cases in 4th and 6th decade of their life. All patients had history of hoarseness of voice with most of patients having duration of disease between one month to one year. On flexible fibreoptic laryngoscopy 27% of cases showed normal study, vocal nodule was most common, seen in 20% of cases, 10% showed vocal cord palsy and 10% had laryngopharyngeal reflux disease. Bilateral lesion (72.6%) predominated overall, with left sided (15.2%) of larynx affected more as compared to right side (12%).</p><p><strong>Conclusions:</strong> Flexible fibreoptic laryngoscopy is an effective alternative for diagnosis of laryngeal lesions and various causes of hoarseness of voice. Vocal nodule has been found as the commonest cause of hoarseness of voice followed by vocal cord palsy and laryngopharyngeal reflux disease. </p>

Comparative study of benign vocal fold lesions in a tertiary health centre

<p class="abstract"><strong>Background:</strong> The present study was carried out to analyze the factors associated with different vocal fold lesions and to diagnose various benign vocal fold lesions at an early stage by their demographic profile and clinical presentations.</p><p class="abstract"><strong>Methods:</strong> Patients with history of hoarseness of voice as a predominant symptom, cough, pain, foreign body sensation, dryness of throat and with a dominant history of vocal abuse, smoking or alcoholism were included in the study. Patients with acute infections, carcinomas, vocal cord palsy or other neurological diseases were excluded from the study.</p><p class="abstract"><strong>Results:</strong> The males comprised 66.7% of patients in the study and the commonest age group involved was 30-40 years. Vocal abuse was the leading risk factor in 80% patients. Hoarseness of voice was the predominant symptom in 83% patients followed by vocal fatigue. Bilateral vocal fold involvement was seen in 50% of the cases. All vocal nodule cases had bilateral vocal fold involvement. The vocal nodules were the commonest lesion seen (35%). Intra-operative and post-operative use of intravenous steroids was also found beneficial. Statistical analysis was done using Chi-square test. Significance level was assessed with P value &lt;0.05. The bilateral involvement in all the vocal nodule cases was found significant.</p><strong>Conclusions:</strong> Voice therapy and cessation of smoking and alcohol can significantly reduce the incidence of these benign vocal fold lesions. It’s not only surgery that’s important in managing vocal fold lesions, but the post-operative care equally plays a vital role.