• Phonetics and Speech Sciences
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• v.1 no.2
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• pp.43-49
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• 2009

Vocal polyps are benign phonotraumatic lesions which are traditionally treated using phonomicrosurgical techniques. In the case of hyperfunctional voice use, voice therapy is effective and results in voice improvement. However, the utility of voice therapy about vocal polyp is in great demand. The purpose of this study was to evaluate the effects of voice therapy in patients with vocal polyps. The authors reviewed the medical records of 193 patients with vocal nodules or vocal polyps, and 64 patients (31 nodules and 33 polyps) were enrolled. All of the subjects had received explanation of problems, vocal hygiene education, and been treated by the $SKMVTT^{(R)}$ (Seong-Tae Kim's multiple voice therapy technique) ranging from 4 to 16 sessions (mean: 8.6 sessions). All subjects were examined by perceptual assessment, acoustic and aerodynamic measures, and VRP (voice range profile). In perceptual assessment, patients with vocal nodules had more breathy and strained voices than the vocal polyp group. Both groups significantly reduced rough, breathy voice after voice therapy. Patients with vocal polyps had worse voice quality than patients with nodules in acoustic measures. Both groups showed reduced jitter and shimmer after voice therapy. In aerodynamic measures, MPT and Psub were increased, and MFR was reduced (p<.05). Participants' frequency range and intensity range were increased after voice therapy, but only frequency range resulted in a significant difference (p<.05). In conclusion, the therapeutic effect of voice therapy in patients with vocal nodules and polyps was demonstrated perceptually and acoustically. We can suggest that voice therapy, including advice, vocal hygiene, and $SKMVTT^{(R)}$ is a useful as an initial choice of treatment for patients with vocal polyps before considering a surgical approach.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.7 no.1
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• pp.56-60
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• 1996

The vocal efficiency(VE) can be calculated as the ratio of acoustic power to aerodynamic power. It relates to the vocal intensity, air Sow rate and subglottic pressure. In this study, we treated 20 cases of vocal polyps and 10 cases of vocal nodules by way of laryngo-microsurgery or laser laryngo-microsurgery. The VE was measured preoperatively and postoperatively in all cases. The results showed that there was a significant improvement of VE postoperatively than that of preoperative measurement(p＜0.01) in vocal Polyp group. However, there was no significant difference(p＞0.05) in vocal nodule group. Through comparing the results, we obtained the conclusion : The laryngo-microsurgery is the reliable method of management for the vocal polyps, but f3r the vocal nodules, the laryngo-microsurgery should be selected after other more conservative approaches fail to produce the desired results.

• 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.

• Phonetics and Speech Sciences
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• v.8 no.3
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• pp.39-49
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• 2016

The present study examined the change of aerodynamic features after laryngomicrosurgery in patients with vocal polyps. Aerodynamic evaluation was performed in thirty-nine patients (15 males and 24 females) one week before surgery and four weeks after surgery. Evaluation protocols of vital capacity, maximum sustained phonation(MXPH), and voicing efficiency(VOFT) were used to collect 29 phonatory aerodynamic measures, requiring voice with a comfortable pitch and loudness. Statistically significant changes were found for phonation time and airflow values in the MXPH protocol, while changes were also found for airflow values, subglottal pressure values and acoustic resistance values in the VOFT protocol. Although phonation time was increased in both male and female patients, gender-dependent changes were found in airflow measurements. Men's phonation time increased with no difference in airflow rate, but women's phonation time increased with decreased airflow rate and lower subglottal pressure. The changes of aerodynamic features may be affected by women's self-perceived change for vocal attitude, which was reducing sense of vocal effort after surgery.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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• pp.102-107
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• 2016

Background and Objectives : Vocal polyps are caused by inflammation induced by stress or irritation. Many patients with vocal polyps complain voice discomfort. For vocal polyps, surgery such as laryngeal microsurgery has been the mainstay of management. We analyzed the clinical features of vocal polyps, and how the size and location of vocal polyps affect the outcomes of surgery. Methods : We retrospectively reviewed 42 patients from March 2014 to December 2015, who were diagnosed as unilateral single vocal polyp. When we operated on a vocal polyp with laryngeal microscopy, we measured their size and location. The quality of voice was evaluated by GRABS scale, jitter, shimmer, NHR (noise to harmonic ratio), MPT (maximum phonation time), and VHI (voice handicap index) before operation and 4 weeks after operation. Results : When we divided the patients into large-sized vocal polyp group (the longest length >3 mm) and small-sized vocal polyp group (the longest length ${\leq}3mm$), all parameter differences tend to be greater at large sized vocal polyp. However, these differences were not statistically significant (p>0.05). When we divided into two groups depending on the volume of vocal polyp, no distinct tendency was found. When we compared the location (anterior, mid and posterior) of vocal polyp with the improvement of voice quality, more change was found at mid portion vocal polyp, except the difference of VHI. However, these differences were also not statistically significant (p>0.05). Conclusion : All parameter differences tend to be greater at large vocal polyp and polyp of the mid location.

• Phonetics and Speech Sciences
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• v.3 no.3
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• pp.149-155
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• 2011

The purpose of the present study was to identify the differences in GRBAS scales between vocal sample types (sustained vowels and connected speech) for specific laryngeal conditions (vocal nodules, vocal polyps and vocal paralysis) and the relations between GRBAS scale and Shimmer value in each vocal sample type. In this study, the total of 60 voice samples of 30 patients (10 vocal nodules, 10 vocal polyps, 10 vocal paralysis) were examined and MDVP (Multi-dimensional Voice Program) was used to analyze Shimmer value. Three listeners rated two types of samples which were sorted randomly based on GRBAS scale. Three-way ANOVA, one-way ANOVA and paired t-test were used. The outcome of this study was as follow. 1) GRBAS scales varied in vocal sample types. Listeners tended to assess voices as better quality when they listened connected speech rather than sustained vowels. 2) G score of GRBAS and Shimmer were positively correlated with statistical significance. This results show that 1) vocal specialists should consider the sample types in evaluating the severity of voice problem and 2) G score could be a simple and clear method.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.22 no.1
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• pp.47-51
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• 2011

Background and Objectives: Vocal polyps arc one of the most frequent benign laryngeal diseases. They arc usually found at the midpoint of the vocal fold. They are mainly caused by vocal overuse. Vocal polyps arc usually removed surgically. Generally, age-related changes to speech are attributed to change in anatomy and physiology of the speech mechanism. These changes result in increased variability in the acoustic properties of speech with age. Still, not 'all studies of age-related changes in speech have taken differences between the young group and adult group after laryngeal microsurgery into account. The aim of this investigation was to compare improvement of acoustic analysis in young patients and elderly patients with vocal polyps, before and after the laryngeal microsurgery. Materials and Method: One hundred and twenty-eight patients who underwent laryngeal microsurgery for vocal polyps from 2008 through 2011 were reviewed retrospectively. 105 of the 128 patients under age 60 were classified as adult group (AG), and remaining 23 patients as elderly group (EG). The speech of AG and EG were evaluated before and after surgery for identification of differences for age group across measures of fundamental frequency (F0), Jitter, Shimmer and Maximum phonation time (MPT). Results: There were not significant differences between two groups for improvement of F0, Jitter, Shimmer, NHR, and MPT before and after surgery. The findings suggest that elderly group compares quite well with adult group in effectiveness of surgery. However, comparison between elderly group and young group (Age under 40) there was significant difference of improvement in Jitter and Shimmer. Conclusion: In general, the results of the present research showed significant improvement in vocal quality after phonosurgery of vocal polyp in both elderly and adult group. However, comparison of improvement between elderly group and young group, there were significant differences of improvement in jitter and shimmer. Therefore, in treatment planning of elderly group, we should consider age related changes of vocal cord.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.15 no.2
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• pp.112-117
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• 2004

Background and Objectives : This study is purposed to investigate the statistically significant discrimination model for predicting vocal fold nodule and polyp's lesional grade, with patients' background data and objective voice evaluation parameters. Materials and Method : The retrospective research was carried out at the Ewha Womans University Hospital. 122 patients' voice examination data had been selected, and lesion screening (Grade I, II, and III) was conducted by 2 ENT specialists, with each patient's vocal fold pictures achieved during the laryngoscopy examination. Results : The Lesional Grade Discrimination Model with which the lesional grade of vocal fold nodules and polyps could be predicted was derived by the ordinal logistic regression analysis (using SPSS 10.0). With this model the lesional grades of 73 out of 122 patients(59.8%) were correctly predicted to their formerly screened ones. Conclusion : This model applied the multivariate approach, which statistically combined these currently used parameters, Jitter, Shimmer, MFR, MPT, and patient's background data such as gender and dysphonia period. It might explain the status of benign lesion of vocal folds, and furthermore expect the physiological function of vocal folds.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.13 no.1
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• pp.5-17
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• 2002

Objectives : Videostrobokymography(VSK) has been recently developed and reported by Sung et at. We aimed to analyze vibratory patterns and objective parameters in various benign vocal fold lesions using VSK, and examine the efficacy of VSK in clinical application. Materials and Methods : Using VSK, we analyzed the vibration pattern of normal vocal fold and various benign lesions, such as nodules, polyps, cysts, Reinke's edema and unilateral vocal fold paralysis. We also calculated objective parameters, open quotient and asymmetric index, and compared them with mean values of parameters in normal controls. Results : In nodules, polyps, and cysts, the open quotient on the site of the lesion was similar to the mean value in normal controls, however, on the other part of the vocal folds it was much larger than normal mean value. In Reinke's edema, irregular and asymmetric vibration was observed. The posterior portion of the vocal folds showed larger open quotients than the anterior portion. In the unilateral vocal fold paralysis, irregular vocal folds vibration and incomplete closure of the vocal folds were documented. Much larger asymmetric indices were calculated in the unilateral vocal fold paralysis than in normal controls and other lesions. The asymmetric index could be a good quantitative parameter of vibration from a patient with vocal fold paralysis. Conclusion : This study demonstrated that VSK could generate clear quantitative documentations of fine vibrations of vocal folds in many different benign lesions. VSK has a potential as an effective tool for quantitative analysis of vibratory patterns of the vocal folds iii clinical settings.

• 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.