• The Journal of the Korea Contents Association
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• v.11 no.9
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• pp.429-436
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• 2011

There have been several studies reporting that vocal misuse and abuse causes voice problems, as well as laryngeal disease such as laryngitis, vocal nodules, vocal polyp. But few researches have investigated amounts or rates of vocal misuse or vocal abuse of patients. Therefore, the author of this study developed measuring device for vocal misuse and abuse behaviors and compared frequency of vocal misuse and abuse behaviors of normal children and children with vocal nodules. The subjects of this study were five normal children and five children with vocal nodules who were male, lower graders of elementary schools(first to third graders). Based on the results of this study, the frequency of the children with vocal nodules in vocal misuse and abuse using was 5,411(${\pm}145$) and that of the normal children was 3,133(${\pm}257$). The frequency of vocal misuse and abuse behaviors of the children with vocal nodules was around 1.5 time significantly higher than that of normal children(p<.001).

• Phonetics and Speech Sciences
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• v.9 no.4
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• pp.99-106
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• 2017

Clinical data about vocal nodules have seldom been reported, even though vocal nodules are commonly diagnosed in outpatient speech and voice clinic. This study aims to investigate clinical characteristics of the patients who are diagnosed with vocal nodules. This study analyzed the data for 10 years from the 319 patients diagnosed with vocal nodules (45 males and 274 females with the mean age of 39.4 ranging from 2 to 83) in terms of gender, age, occupation, voice change initiation pattern, change with time, throat clearing, smoking history, type of voice abuse, acoustic analysis, maximum phonation time, GRBAS, and VHI. Thirteen patients (4.08%) had unilateral vocal nodule and 306 patients (95.9%) had bilateral vocal nodule, the majority of which had a pattern of asymmetry (73.9%). The glottal closure pattern was hourglass in 72.1% of patients, posterior chink in 17.9% of patients, and irregular in 7.9% of patients. The most common occupational category was professional voice users (43.4%). The voice abuse pattern included excessive talking in 96 patients (76.8%), loud voice in 78 (62.4%) patients, and excessive singing in 17 patients (21.6%). The patients showed worse scores in G, B, and S than in R and A for the GRBAS evaluation. The most recommended treatment for vocal nodules was voice therapy. The current clinical data will be helpful for treatment planning for the patients of vocal nodule.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.64-68
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• 1995

Vocal folds injury from vocal abuse is important topics of phonosurgery. Recent advances in diagnostic equipment, phonosurgery and speech analysis equipment have provided a lot of Information about fine movement of the vocal folds. However, predicting the reaction of the vocal folds to phonatory trauma remains difficult. The vocal folds need to withstand great vibratory and shearing stress and anchoring fibers of basement membrane Bone play a role in maintaining structural integrity of histologically different epidermis and superficial layer of lamina propria(cover of vocal folds). The purpose of this study is to demonstrate the changes of anchoring fibers in vocal polyp using transmission electron microscope. Various defects were observed : a irregular thickening of basement membrane, a near absence of normal anchoring fiber, a lot of electron dense material in superficial layer of lamina propria, a destruction of hemidesmosome and many vesicles carrying electron dense material In basal keratinocyte. These observations were suggestive of a hyperactivity of basal keratinocyte of vocal folds epithelium in response to vibratory stress.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.14 no.1
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• pp.40-46
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• 2003

Background and Objectives : The vocal fold granuloma has been associated with vocal abuse, gastroesophageal reflux, endotracheal intubation and habitual throat clearing etc.. Granuloma is benign growth of hypertrophic granulation tissue. It is usually located on the posterior third of vocal fold, in one or both vocal process of the arytenoid cartilage In spite of the voice therapy, steroid therapy, anti-reflex therapy and surgical procedure. The distinct advantage and uniform success rate of each methods have not been generally shown. Authors report that localized injection of botulinum toxin type A (BOTOX$^{\circledR}$) is the promising method both as an initial treatment and as an alternative treatment in patients who do not respond to standard therapy or who are poor surgical candidates. Materials and Method : We carried out a retrospective study of 9 patients with the diagnosis of vocal fold granuloma on the videostroboscopic examination from Jan 2000 to Mar 2003. The botulinum toxin type A was injected into one or both thyroarytenoid muscle or lateral cricoarytenoid muscle under the electromyography. The average dosage ranges from 6U to 8U per injection. Results : Unilateral vocal fold granuloma in 7 patients had been resolved completely within 2-3 months after first injection : 5 patients received th\ulcorner GER medical therapy in addition to the Botulinum toxin injections, 2 patients was resolved completely who had shown recurrence after $CO_2$ laser vaporization. 2 patients who had shown recurrence after $1^st$ injection were also completely resolved within 6 months after further injections. Conclusion : We expect that localized injection of Botulinum toxin type A can provide an alternative treatment for the refractory cases to the traditional forms of therapy and avoid the recurrence in conjunction with proper medical and voice therapy against GER and vocal abuse.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.13 no.1
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• pp.40-44
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• 2002

Background and Objectives : Vocal abuse and misuse and muscle tension dysphonia that have various movements of false vocal folds may be related to the development of benign vocal folds lesions, such as vocal nodules, polyps, and cysts. This study was designed to determine whether benign vocal folds lesions were related with movements of false vocal folds on phonation. Material and Methods : One Hundred and seventy eight subjects were studied. All subjects received otolaryngological evaluation including videostroboscopy, objective voice measures. Patients were diagnosed as normal shape of vocal folds (group a), approximation of bilateral false vocal folds (group b), approximation of unilateral false vocal folds (group c), lateralized extension of false vocal folds (group d), and medialized approximation of posterior false vocal folds (group e). We analyzed the results of benign vocal folds lesions in each group. Results : Differences were found between the normal shaped group and the abnormal shaped group. No differences were found between each abnormal groups except group d and e. Conclusion : The shape of false vocal folds was related to the benign vocal folds lesions.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.2 no.1
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• pp.24-30
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• 1986

The vocal nodule is one of the major causes of hoarseness. The patholphysiologic mechanism of the vocal nodule is relatively well-known. Chronic mechanical stimuli, such as vocal abuse, causes vocal nodule by a tissue reaction of the vocal cords. Among the 841 patients, who visited the Vocal Dynamic Laboratory at Severance Hospital complaining of the dysphonia between the period of May 1981- May 1985, 169 patients were selected who were diagnosed as vocal nodule by indirect laryngoscopy and a series of phoniatric examination. (omitted)

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.11 no.2
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• pp.185-187
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• 2000

The etiology of vocal fold granuloma was identified : post-endotracheal intubation, vocal abuse, acid reflux and idiopathic. The identification of the cause or causal factor is important, since the treatment must be fundamental directed at them. Treatment have included voice therapy and antireflux measures. Surgical excision is considered in patients who do not respond to medical management. In this study, a case of vocal fold granuloma resolved who underwent injection of the affected vocal fold. Botulinum toxin type A is probably successful by decreasing the strength during adduction in the arytenoid region which, when very intense, would perpetuate the granuloma. Localized injection of this neurotoxin is promising both as an initial treatment and as an alternative treatment in patients who do not respond to standard therapy.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.9 no.1
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• pp.17-21
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• 1998

Benign vocal fold lesions such as polyps, nodules and edema are known to be caused by vocal trauma such as voice misuse and/or abuse. Even though these lesions are known to be caused by the same etiology, phonotrauma, they show widely different clinical features and different responses to voice therapy. Previous studies suggested that benign vocal fold lesions represent disturbance in the balance of the extracellular matrix(ECM) constituents of the vocal folds. Collagen is one of the major constituents of ECM. Among collagens, fibrillar collagens are most important ones for maintaining the structural integrity. On the basis of gross morphology, vocal polyps wert divided into angiomatous one and edematous one, and nodules were divided into conical one and sessile one. In these four groups, the pattern of distribution of various fibrillar collagens(type 1, 2, 3, 5) was studied by immunohistochemical staining using paraffin embedded tissues. Within each group, differences among collagen subtypes were insignificant. In edematous polyp, collagens were sparsely dispersed in lamina propria by diffuse edema. In angiomatous polyp, collagens were displaced into submucosal layer by hemorrhagic space. In nodules, collagens were stained compactly in lamina propria. Quite different distributions of fibrillar collagens between polyps and nodules are thought to suggest that vocal polyps and nodules are totally different disorders in their pathophysiology.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.32 no.1
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• pp.24-28
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• 2021

Background and Objectives Vocal polyp is one of the most common benign diseases of vocal fold caused by overuse of voice. Laryngeal microsurgery is the first treatment of choice for vocal polyp. However, surgery has many risks such as side effects of general anesthesia, injury of tooth and psychological burden. And we often experience reduction of vocal polyps without surgical procedure. The purpose of study is to evaluate the effect of non-surgical treatment such as vocal hygiene education and proton pump inhibitor (PPI) in patients with vocal polyp. Materials and Method We performed retrospective study for seventy-three patients of vocal polyp who treated with non-surgical modalities such as vocal hygiene education and PPI over three months. Treatment outcomes and risk factors such as age, sex, polyp size, position, symptom duration, presence of laryngopharyngeal reflux (LPR) symptoms, smoking history, voice abuse history and vocal hygiene education were evaluated by comparison between polyp size improved group and non-improved group. Results 5.5% of enrolled patients showed complete response and 23.3% showed partial response without surgery. Polyp size improved group significantly carried out more practice of vocal hygiene education treatment than the non-improved group (p=0.040). And the presence of LPR symptoms [hazard ratio (HR) 3.368, confidence interval (CI) 1.055-10.754, p=0.040] and not performing of vocal hygiene education (HR 3.664, 95% CI 1.078-12.468, p=0.038). Conclusion Vocal hygiene education can be a useful treatment option when making a decision to treat with vocal polyp.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.11 no.2
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• pp.161-166
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• 2000

Background and Objectives : Vocal fold hemorrhage occur by blood accumulation in Reinke's space by vocal trauma. It is mostly asymptomatic, but in some cases it may cause severe dysphonia. It is often seen in patients who use their voice professionally. However, recent changes of life style affected the phonation in general population. We studied to know what are the causes and what are the major factors to affect the vocal fold hemorrhages. Materials and Methods : 19 subjects were evaluated by using of questionaire and laryngoscopic examinations. We evaluated the factors to lead the change in voice directly, underlying causes, occupations and laryngeal findings. Results : The direct causes of the vocal fold hemorrhages were clearing throat, talking, coughing and singing. Reflux laryngitis and upper respiratory infection were the underlying diseases. Vocal fold hemorrhages were developed during the menstruation in 5 patients. Accompanying functional voice disorders were seen in 13 patients, such as, vocal fold nodule, nodule with varix, vocal polyp, Reinke's edema. Patients with reflux laryngitis had the habits of clearing throat as the direct cause of the vocal fold hemorrhages and had hyperkinetic functional voice disorders. Voice abuse was the direct cause of the vocal fold hemorrhages in patients who was in the period of the menstruation. The most common site of the hemorrhage was at the membranous portion of the vocal folds. Conclusions : Authors thought the forceful laryngeal activity was the cause of the vocal fold hemorrhages. And reflux laryngitis and menstruation was the risk factors of the vocal fold hemorrhages.