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Fibreoptic video laryngoscopy analysis of 60 patients with benign lesions of the Larynx.

BACKGROUND

Voice in human's life forms the major medium of communication. It is mainly achieved through its verbal use. Voice is used for non-verbal ways of expression also. Tone of the voice helps to express the mood and the attitude. Voice, in the non-verbal form sometimes expresses the emotions with a more powerful impact. The levels of vocal use vary in different individuals. So the impact of a voice disorder also varies in different individuals. In some professionals like radio announcers and actors, a vocal cord lesion like Rienke's oedema may affect the performer's "voice signature". The laryngologist faces the challenge and responsibility of accurate analysis and selection of the proper management. Fibreoptic video-laryngoscope is an excellent tool for the analysis of lesions of the larynx and the voice disorders. The live, natural colour and the high resolution pictures obtained on the monitor help to detect the lesions better and easily. The present study was conducted to analyse the usage of Fibre-optic video laryngoscopy in the management of different benign lesions of the Larynx. Scalco [1] used Karl Zeiss surgical microscope with suspension blades adapted from Killian and Lynch. Fibreoptic principle was first used for endoscopy in 1958 by Hirchwitz. [2] He used it for gastroscopy. Later Ikeda used the same principle for Bronchoscopy. [3] First successful photographic documentation of the larynx was made by Thomas French in 1884 with a laryngeal mirror and a primitive camera. [4] Hollinger and Brubaker introduced a special endoscopic camera which gave excellent photographs of the larynx. [5] Kleinsasser used a new instrument combining the use of a wide angle telescope and a telephoto lens with the laryngoscope which gave excellent observation and documentation facilities. Addition of the beam splitter and photo adapter to the Zeiss microscope enabled photography of the interior of the larynx through the operating microscope under magnification. [6] Ray [7] first used the colour television for documentation of endoscopic procedures. By attaching a video camera to the fibreoptic laryngoscope excellent pictures can be obtained. [4] The newer video endoscopes incorporate the miniature high resolution monochrome CCD (Charge-Coupled Device) chip at its distal end which make them very handy. They give superior high resolution life like colour images. The vocal cords will appear greyish in colour. The subepithelial capillaries shining through the healthy vocal cord epithelium are easily recognised. The remaining mucosa appears pinkish. The present study was conducted to use the modern equipment and analyse the advantages and various causes of fibreoptic video laryngoscopy.

Aims and Objectives

To evaluate patients presenting with voice disorders due to benign lesions and benign tumours of the larynx with Fibreoptic Video laryngoscopy with special reference to their incidence and aetiological factors; to analyse the advantages of fibreoptic video laryngoscopy.

MATERIALS AND METHODS

This study was conducted in the Otolaryngology Department of the Southern Railway Head Quarters Hospital, Madras during the period Feb. 1994 to Feb. 1995. The hospital caters to a population of 2 lakhs based in Madras. It also receives referred cases from the peripheral units of Southern Railway. Sixty (60) patients with benign lesions of the larynx were analysed. Benign lesions included neoplastic lesions and non-neoplastic lesions which presented as mass lesions of benign nature. A detailed history was elicited as per the special proforma. Thorough clinical evaluation including general physical, systemic and ENT examination was conducted. Haematological and Radiological studies were undertaken wherever necessary. All patients were analysed in detail with fibreoptic video laryngoscope. Vocal nodules were treated with voice therapy for 6 weeks. Lesions not responding to voice therapy were subjected to surgical excision under video-endoscopic control. All pedunculated polyps were excised through the fibreoptic video endoscope. Vocal granulomas were vapourised using laser. Cysts were ablated using laser. Sessile and larger polyps, Rienke's oedema and papillomas were excised by micro-laryngoscopy surgery. Clinical diagnosis was confirmed by histopathological examination. Post-operative cases were followed up. The average followup period was 3-6 months. The predisposing factors were looked into. The sex and age distribution was analysed. The patients were classified into four groups according to the level of the vocal usage. Kaufman's (1991) [8] classification was used

* Level I-Elite professional (Singer, actor).

* Level II-Professional voice user (Lecturer).

* Level III-Non-vocal professional (Teacher, lawyer).

* Level IV-Non-vocal nonprofessional (Labourer, clerk).

The impact of dysphonia on various groups was studied. The rate of recurrence after Fibreoptic video-endoscopic excision was studied. The statistical methods used were by calculating the standard error of difference between proportions and by chi-square test.

Equipment

A Pentax EB/VB 2000 fibreoptic video bronchoscope was used. The instrument consists of fibreoptic video endoscope, light source, video processor, microphone, VCR and TV monitor. The video endoscope has a solid state sensor called CCD (Charge-Coupled Device) in its distal end replacing the image glass fibre bundles of the ordinary fiberscope. The endoscope has a 2 mm channel which provides effective suction and allows the use of biopsy forceps and the fibre of Nd:YAG laser.

Procedure

Fibreoptic video endoscopy is done as a day patient procedure. Nasal cavity is sprayed with 4% lignocaine 10 minutes before the commencement of the procedure. The distal end of the endoscope is lubricated with lignocaine jelly. The scope is passed transnasally while observing the TV monitor avoiding injury to the nasal structures. It is gently advanced to the level of the epiglottis. Larynx is centred on the TV screen. The lesion is examined thoroughly. Examination is done during respiration, phonation, effort on closure and swallowing. In case of singers, vocal cord movements are observed during singing. Simultaneous recording is done in all cases. For further procedures, sedation with intravenous diazepam 5 mg with 0.3 mg atropine is given. The larynx is anaesthetised by instilling 4% lignocaine. Vocal nodules and pedunculated polyps are excised using the biopsy forceps. The remaining tags are also carefully removed to achieve smooth medial margin. Vocal granulomas and cysts are ablated using Nd:YAG laser. Contact method with fibre tact is used. The laser fibre is passed through the biopsy channel. The lesions are vapourised starting from the periphery till normal contour is obtained. Patient was kept under observation for one hour and then discharged. Followup examination is done after 2 weeks and then at regular intervals.

RESULTS

60 patients were included in the present studies who were attending the ENT Department of Southern Railway Head Quarters Hospital, Madras during the period Feb. 1994 to Feb. 1995. Among the 60 patients, 31 were male and 29 were female. The patients belonged to all age groups ranging from 1 to 60 years. More than 60% of the patients belonged to the age group of 11 to 40 years. There were 18/60 patients in the age group of 31 to 40 years (Table 1).

Among the 60 patients, 26 belonged to low socioeconomic group (43.33%), 20 to middle income group (33.33%) and 14 to High income group (23.33%), (Table 2).

The patients in this study belonged to a varied class of citizens with different professional and work back ground. Housewives constituted to 11 (18.33%), Teachers 12 (20%), Singers 9 (15%), manual labourers 07 (11.66%) and Nurses 6 (10%), (Table 3).

According to Kaufmann's Voice use the patients in the study were recognised and found to belong to Level I in 13, (21.66%), level II in 10 (16.66%), Level III in 12 (20%), Level IV in 25 (41.66%), (Table 4).

Predisposing factors were identified in the study and Vocal abuse was found in 17 (28.33%), Smoking in 16 (26.66%), Alcohol use in 10 (16.66%), URI in 8 (13.33%) and throat clearing in 7 (11.66%), (Table 5).

URI--Upper Respiratory tract Infection.

The voice symptoms were analysed and found that hoarseness of voice was the symptom present in all the lesions studied in this study group with a variable expression. Among the vocal cord nodules, it was present in all the 22 patients. In vocal polyps, hoarseness was present in all the 12 patients. Similarly, Vocal fatigue was found in Vocal nodules, Vocal polyps and Papilloma patients (Table 6).

VC: Vocal Nodule VP: Vocal Cord Polyp

PAP: Papilloma RC: Retention Cyst

TBL: Tuberculous Laryngitis SUL: Sulcus Vocalis

RO: Rienke's oedema VG: Vocal Granuloma

Few of the patients in the present study had non-vocal symptoms. They were Cough in 8 (13.33%) and Dysphagia in 5 (8.33%) as an associated symptom (Table 7).

Indirect Laryngoscopy (IDL) was done in all the patients as a part of ENT clinical examination and the following results were found; diagnosis of vocal nodules made in 14 patients (23.33%), Vocal polyps in 06 (10%), Papilloma in 04 (6.66%) and Retention Cyst in 02 (3.33%) (Table 8).

All the patients were subjected to Fibreoptic Video laryngoscopy and the clinical examination findings were correlated with the IDL findings. It was found that vocal nodules were observed in 22, Vocal polyps in 12, Papilloma in 08 and Retention Cyst in 06, Tuberculous Laryngitis in 03, Sulcus Vocalis in 04 patients (n = 60), (Table 9).

Age incidence of different lesions of larynx in the study were observed and found that vocal nodules were in 15/22 patients among 21 to 40 years, Vocal polyp in 8/12 patients of 31 to 50 years age, papilloma in 3/6 in 1 to 10 years age and Retention cyst 3/6 and Sulcus Vocalis in 3/4 patients in 31 to 40 years age groups (Table 10).

Similarly, the sex distribution of different lesions of larynx were observed. It was found that vocal nodules in females were 14/22 (63.63%), Vocal polyp in 6/12 (50%) in males, papilloma in 8/8 in males (100%), Retention cyst 3/3 in males, Sulcus Vocalis 3/4 in females and Tuberculous Laryngitis 3/3 in males (Table 11).

Vocal Cord Nodules

The most common lesion observed was vocal nodule 22/60 (36.66%). The lesions ranged from 1-4 mm in size. Eight of them were less than 2 mm in size. 2 of them were less than 1 mm in size. 9 were bilateral (Figure 1). Excision under video endoscopic control was carried out in 18 patients. There were 3 cases of recurrence after surgery during a followup period of 3-6 months.

Vocal Cord Polyp

The second most common lesion was Vocal Cord Polyp 12/60 (20%). Seven of them were Pedunculated (58.33%) and five (41.66%) sessile. Six of them were gelatinous type (Figure 2). 3 were of telangiectatic type (Figure 3) and three mixed type (Figure 4). Seven of the polyps were excised on Fibre-optic video-endoscopic procedure and 5 by microlaryngeal surgery. Recurrence was observed after a period of 3-6 months followup in 1 patient.

Papillomatosis

8 patients with Papillomatosis (Figure 5) observed in this study (13.33%). All were male. It is the only type of true neoplasm observed. 5 were bilateral with involvement of anterior Commissure. 2 were unilateral with the lesion occupying the middle third of right vocal cord. 1 patient was with multiple Papillomatosis. In all cases vapourisation with laser under micro-laryngoscopy was carried out without disturbing the anterior Commissure region. In 3 cases recurrence was observed within a followup period of 3-6 months.

Retention Cyst

6 retention cysts were observed. 3 were over the middle third of the vocal cord (Figure 6). 3 were over the vestibular band near the anterior Commissure. Histopathological study showed 2 cysts were lined by squamous epithelium and the other by columnar. Both were ablated using contact laser under video laryngoscopy control. No recurrence was noted over a period of 3-6 months followup.

Tuberculous Laryngitis

3 patients were observed (Figure 7) 2 were male and 1 was female. Both were having associated pulmonary cavitary lesions. Anti-Tuberculous treatment was given to all the patients.

Sulcus Vocalis

4 patients with this lesion were observed (Fig 8). 1 was unilateral. All cases presented with fatigability of voice. One patient had a breathy voice. Speech therapy was advised in these patients. There was recurrence in 1 patient.

Vocal Granulomas

2 patients were observed with Vocal granulomas. One patient developed it after intubation for surgical excision of vocal cord polyp and 1 with prolonged intubation in an orthopaedic surgery. In both cases laser vapourisation was done under video-endoscopic control. No recurrence was noted over a period of 3-6 months followup.

DISCUSSION

The incidence of benign non-neoplastic lesions and benign neoplastic lesions of the Larynx were compared in the present study with some previous studies in Table 12. The difference is statistically insignificant as the p-value is 1.23 with p<0.1 taken as significant.

In the present study, among the 60 patients presenting with voice disorder indirect laryngoscopy could identify lesions in 35 patients; whereas by fibreoptic video laryngoscopy all the patients could be given a diagnosis. Such instances were compared and details are shown in Table 13. This difference was statistically significant with p-value 0.02 with <0.05 taken as significant.

In the Diagnosis of laryngeal lesions, fibreoptic video laryngoscopy is significantly superior to the conventional method of IDL. Its diagnostic accuracy equals that of microlaryngoscopy examination. The advantages over microlaryngoscopy are: It can be done as an office procedure; no general anaesthesia is needed; it is least traumatic; It can be carried out in patients with systemic diseases unfit to undergo rigid endoscopy; the colour monitor will give high resolution magnified images which will help to visualise minute details; The instrument channel will allow forceps and other instruments for biopsy and excision procedures; good documentation facilities; useful for good teaching practice. A comparative study of vocal nodules with studies of other authors was done and shown in the Table 14. The difference of incidence of Vocal nodules in various age groups was found to be statistically significant with p-value 0.043 (p significant at <0.05).

In 1988 Lancer J. et al [11] conducted a study on vocal nodules. In that study, vocal nodules were more commonly found in middle aged women and young boys. The predisposing cause found was vocal abuse. In the present study, vocal abuse was found as a predisposing factor in all the cases. Walter et al [12] had reported recurrence rate of 20% after surgery. In the present study, the recurrence rate was in 8 patients (13.33%). In a comparative study of Vocal polyps of the present study with the study of Jones SR et al [13] the polyps were observed occurring in the same age group, same gender and with smoking as a risk factor. The Studies had a statistical insignificance with p-value at 0.61 with p taken as 0.05 (Table 15). In the present study, all the lesions were originating from the vocal cords.

Papillomas were found to be the most common benign neoplasm of the larynx (83%) in the study conducted by Shaw/9) It constituted 11.29% of all the benign lesions. In the present study, it formed 10% of the entire lesions and it was the only type of true neoplasm observed. In the study by Steven R Jones et al, [13] 84% of the true neoplasms were Papillomas. Equal incidence in both sexes were cited by Bolye et al. [14] In the present study, all the affected patients were male. The lesions in the adults were solitary type. Similar observations were made by Ferguson (1944) [15] and Cunning (1950)/16) A comparative study on Laryngeal Cysts showed that the incidence was 10% in the present study and in PM Robinson [14] study it was 6.08% and in a study by Shaw [9] it was 4.7%, (Table 16). The difference was statistically significant with p-value 0.453 (with P value significant at 0.05).

In the present study, all the lesions were unilateral. Similar observations were made by Monday et al (1983), (Table 17). [18]

In the study by Shaw, [15] Tuberculous laryngitis formed 2.9% of the lesions. In the present study, it was 5% of all the benign lesions. Travis et al [19] described pain, odynophagia and otalgia in 75% of cases and all had pulmonary cavitary lesions. In the present study, pain was present in 50% and all the cases had pulmonary cavitary lesions. Lee STS et al [20] observed 5 cases of sulcus vocalis between the ages of 19-40 years. In the present study, the patients were between 31-40 years of age. Hirano et al (1990) [21] observed unilateral sulcus vocalis in 25% of the cases. In the present study, 50% were unilateral, 66.6% were having bilateral involvement. All the patients presented with vocal fatigability.

The incidence of Rienke's oedema in the present study was 5%; 40% in males and 20% in females when compared to the study of White AD et al [22] (Table 18).

Vocal Granulomas by Shaw [19] formed 2.12% of all benign lesions. In the present study, 3.33% were vocal granulomas. The incidence of predisposing factors; Intubation and Vocal abuse were similar in the present study and a study by Shaw [19] (Table 19).

In a study of 27 cases, Feder et al [23] found vocal abuse, intubation and gastro-oesophageal reflux as predisposing factors. In the present study, all granulomas were located over vocal process. Similar observation was made by Kleinsasser. [6] All the affected were males. In the Kleinsasser [6] study, all the contact granuloma patients were male.

Summary

Benign lesions of the larynx include neoplastic and nonneoplastic lesions. They are broadly classified together because clinically they behave similarly. Any lesion affecting the larynx will cause some kind of voice disorder. Voice disorders caused by benign lesions are correctable by surgery. In the present study, 60 patients of benign lesions of the larynx were studied. Diagnosis was established by history, clinical examination, routine blood and urine examination, fibreoptic video laryngoscopy and biopsy. The advantages of video endoscopy were analysed. 80% of the lesions observed were non-neoplastic lesions. All the neoplastic lesions observed were Papillomas. Vocal cord nodules were the most common lesion observed. They formed 36.66% of the study. Vocal polyps formed 20%. 13.33% of the lesions were Papillomatosis. 10% of the lesions observed were retention cysts. Tuberculous laryngitis formed 5%. There were 6.66% cases of sulcus vocalis. Rienke's oedema was in 5% and vocal granulomas in 3.33%. All lesions presented with some kind of voice disorder. 95% of cases presented with hoarseness. Other vocal symptoms include vocal fatigue (43.33%), breathy voice (10%), voice breaks (11.66%) and reduction in voice range (52.5%). Patients in the level I voice use presented early and the commonest symptom among them was vocal fatigability (43.33%). Other symptom was voice breaks (60%). In all patients of vocal nodules, vocal abuse was found to be the predisposing factor. 58% of the patients affected with polyps were smokers. Of the two cases of vocal granulomas, previous endotracheal intubation was the predisposing cause.

CONCLUSION

86.66% of the benign lesions observed were non-neoplastic type. 13.33% were true neoplastic lesions. All the neoplastic lesions were Papillomas. Vocal nodules were the commonest benign lesions observed (36.66%). Fibreoptic laryngoscopy was found significantly superior to the conventional methods of diagnosis. The diagnosis efficacy equals microlaryngoscopy. The advantages of the fibreoptic video laryngoscopy are it could be done as an office procedure, no general anaesthesia is needed, it is less traumatic, it can be used in patients with neck stiffness and trismus. The high resolution magnified images enable to visualise minute details. Instrumentation can be done through separate channel. It permits good documentation and teaching methods.

REFERENCES

[1] Scalco AN, ShipMan WF, Tabb HG. Microscopic suspension laryngoscopy. Annals of Otology, Rhinology Laryngology 1960; 69(4):1134-8.

[2] Winston P, Epstein SS. Papillomas of the larynx - a clinico pathological study. Journal of Laryngology and Otology 1958; 72(6):452-64.

[3] Ikeda S. Flexible broncho fiberscope. Annals of Otology, Rhinology and Laryngolog 1970; 79:916.

[4] Eijiyanagisawa, Yanagisawa R. Laryngeal photography. The Otoloaryngologic Clinics of North America 1991; 24(5).

[5] Holinger PH, Johnston KC. Benign tumours of the larynx. Annals of Otology, Rhinology and Laryngology 1951; 60(2):496-509.

[6] Kleinsasser O. Microlaryngoscopy and Endolaryngeal micro surgery. Philadelphia: WB Saunders Co., c1968:48-54.

[7] Rayl JI, Rourka D. Application of colour television in bronchooesophagology. Transactions of American Broncho Oesophagological Association 1974; 54:137.

[8] Kaufman JA, Issacson G. Spectrum of vocal dysfunction. The Otolaryngologic Clinics of North America 1991; 24(5):985-8.

[9] Shaw H. Tumours of the larynx. In: Ballantyne J, Groves J. eds. Scott-Brown's diseases of the Ear, Nose and Throat. 4th edn. Butterworths, London: 1979:421-36.

[10] Mcfarlane, Walterson TL. Vocal nodule - endoscopic study and treatment. Seminars in Speech and Language 1990; 11:47-59.

[11] Lancer JM, Syder D, Jones AS, et al. A Vocal cord nodules: a review. Clinical Otolaryngology 1988; 13(1):43-51.

[12] Walter B, Larsen BI. Hoarseness in children, followup on no therapy, surgical or voice therapy alone or combined. Acta Otolaryngologica 1994; (Suppl 412):40-2.

[13] Jones SR, Myers EN, Barnes L. Benign neoplasms of larynx. The Otolaryngologic Clinics of North America 1984; 17(1):151-6.

[14] Boyle WF, McCoy EG. Treatment of papilloma of the larynx in children. The Laryngoscope 1970; 80(7):1063-77.

[15] Ferguson CF Scott HW. Papillomatosis of the larynx in the childhood: a report of 15 cases. New England Journal of Medicine 1944; 230:477-82.

[16] Cunning DS. Diagnosis and treatment of laryngeal tumors. JAMA 1950; 142(2):73-7.

[17] Robinson PM. Prospective study of complications of endoscopic laryngeal surgery. Journal of Laryngology and Otology 1991; 105:356-8.

[18] Monday LA, Cornut G, Bouchayer M, et al. Epidermoid cysts of the vocal cords. Annals of Otology, Rhinology and Laryngology 1983; 92(2 Pt 1):124-7.

[19] Travis LW, Hybels RL, Newman MH. Tuberculosis of larynx. The Laryngoscope 1976; 86(4):549-58.

[20] Lee STS, Niimi S. Vocal fold sulcus. Journal of Laryngology and Otology 1990; 104(11):876-8.

[21] Hirano M, Yoshida T, Tanaka S, et al. Sulcus vocalis: functional aspects. Annals of Otology, Rhinology and Laryngology 1990; 99(9 Pt 1):679-83.

[22] White A, Sim DW, Maran AG. Reinke's oedema and thyroid function. Journal of Laryngology and Otology 1991; 105(4):291-2.

[23] Feder, Michael. Hyperactive, hyperacidic, intubation granuloma. Archives of Otolaryngology 1984; 110: 582- 4.

Swathilal S.A. (1), Praveen N. (2)

(1) Assistant Professor, Department of ENT, Government Medical College, Kozhikode, Kerala.

(2) Associate Professor, Department of Plastic Surgery, Government Medical College, Thiruvananthapuram, Kerala.

Financial or Other, Competing Interest: None.

Submission 09-03-2017, Peer Review 22-03-2017, Acceptance 24-03-2017, Published 30-03-2017.

Corresponding Author:

Dr. Swathilal S. A, Assistant Professor, Department of ENT, Governmen t Medical College, Kozhikode, Kerala.

E-mail: drntpraveen@gmail.com

DOI: 10.14260/jemds/2017/461

Caption: Figure 1. Showing the Vocal Nodule A. Unilateral. B. Bilateral

Caption: Figure 2. Showing the Vocal Polyp[R]

Caption: Figure 3. Showing the Telangiectatic Vocal Polyp[R]

Caption: Figure 4. Showing Gelatinous Polyp

Caption: Figure 5. Showing the Retention Cyst

Caption: Figure 6. Showing the Tuberculous Laryngitis

Caption: Figure 7. Showing the Sulcus Vocalis
Table 1. Showing the incidence of
Age and Gender distribution of Patients (n = 60)

Age in Years        Male   Female

10-Jan               06      03
20-Nov               04      02
21-30                06      06
31-40                7       07
41-50                5       06
51-60                01      03
61-70                02      02
Total 60 patients    31      29

Table 2. Showing the Socioeconomic
Status in the Study Group (N = 60)

Grade    No. of Patients   Percentage

Low            26            43.33%
Middle         20            33.33%
High           14            23.33%
Total          60             100

Table 3. Showing incidences of Occupational
Background in the Study Group (n = 60)

Occupation         No. of Patients   Percentage

Housewives               11            18.33%
Manual Labourers         07            11.66%
Clerks                   06             10%
Teachers                 12             20%
Students                 04            6.66%
Instructors              05            8.33%
Nurses                   06             10%
Singers                  09             15%
Total                    60             100

Table 4. Showing the Kauffmann's Levels
of Voice use in the Study (n=60)

Level   No. of Patients   Percentage

I             13            21.66%
II            10            16.66%
III           12             20%
IV            25            41.66%
Total         60             100

Table 5. Showing The Different
Predisposing Factors in The Study (N=60)

Predisposing Factors   No. of Patients   Percentage

Vocal Abuse                  17            28.33%
Smoking                      16            26.66%
Alcohol                      10            16.66%
URI                          08            13.33%
Throat Clearing              07            11.66%
Intubation                   02            3.33%
Total                        60             100

Table 6. Showing the Symptoms
Vs. Lesions of Larynx (n = 60)

Symptoms     VC   VP   PAP   RC   TBL   SUL   RO   VG

Hoarseness   22   12   07    04   03    04    03   02

Vocal        08   07   05    1     0     3    1    1
Fatigue

Breathy      0    0     0    0     1     1    2    2
Voice

Voice        0    3     0    1    01     0    01   01
Breaks

Reduction    20   9    01    0    04     0    2    0
in Voice
Range

Table 7. Showing the Non-Vocal Complaints
in the Study Group (n = 60)

Level       No. of Patients   Percentage

Cough              8            13.33%
Dysphagia          5            8.33%

Table 8. Showing the Lesions
Observed on Indirect Laryngoscopy

Lesions                  No. of Patients   Percentage

Vocal Nodule                   14            23.33%
Vocal Polyp                    06             10%
Papilloma                      04            6.66%
Retention Cyst                 02            3.33%
Tuberculous Laryngitis         02            3.33%
Sulcus Vocalis                 01             1.66
Rienke's oedema                01            8.33%
Vocal Granulomas               01            1.66%

Table 9. Showing the Lesions Observed
on Fibreoptic Video Laryngoscopy (n = 60)

Lesions                  No. of Patients   Percentage

Vocal Nodule                   22            36.66%
Vocal Polyp                    12             20%
Papilloma                      08            13.33%
Retention Cyst                 06             10%
Tuberculous Laryngitis         03             05%
Sulcus Vocalis                 04            6.66%
Rienke's oedema                03            8.33%
Vocal Granulomas               02            3.33%

Table 10. Showing the Incidence of Age in
Different Benign Lesions of Larynx (n=60)

Age in   VN-   VP-   PAP-   RC-   TBL-   SUL-   RO-   VCG-
Years    22    12     08    06     03     04    03     02

1-10     00    00     03    00     00     00    00     00
10-20    04    00     02    00     01     00    00     00
21-30    07    01     00    00     00     00    01     00
31-40    08    03     01    03     00     03    00     01
41-50    02    05     01    01     01     00    01     00
51-60    00    02     00    01     01     01    01     00
61-70    01    01     00    01     00     00    00     01

Table 11. Showing the Gender Incidence of
Different Tumours in the Study Group (n = 60)

Lesions               Male-31       Female-29

Vocal Nodule-22       08 (36.36%)   14 (63.63%)
Vocal Cord Polyp-12   06 (50%)      06 (50%)
Papilloma-8           08 (100%)     0 (0%)
Retention Cyst-06     03 (50%)      03 (50%)
Tuberculous           03 (100%)     00 (0%)
Laryngitis-03
Sulcus vocalis-04     01 (25%)      03 (75%)
Rienke's oedema-03    01(33.33%)    02 (66.66%)
Vocal Granulomas-02   01 (50%)      01 (50%)

Table 12. Showing the Comparative
Study with the Present Study

Study                        Non Neoplastic   Neoplastic

Hollinger and Johnston [5]   990 (82.7%)      207 (17.3%)
Shaw [9]                     1300 (86%)       205 (14%)
Present Study                52 (86.66%)      8 (13.33%)

Table 13. Showing the Missed
Diagnoses in the Study (n = 60)

Lesions                Indirect            Video
                   Laryngoscopy-35    laryngoscopy-60

Vocal Nodule              14                 22
Vocal Cord Polyp          06                 12
Papilloma                 04                 08
Retention Cyst            02                 06
Tuberculous               02                 03
Laryngitis
Sulcus Vocalis            02                 04
Rienke's oedema           03                 03
Vocal Granulomas          02                 02

Table 14. Showing the Comparative
Study of Vocal Nodules

                McFarlane et al [10]   Present Study

Adult Females         30 (68%)            63.63%
Children              11 (25%)            18.11%
Adult Males            3 (7%)             18.11%

Table 15. Showing the Comparative
Study with Jones SR et al

            Jones. S.R. et al [13]   Present Study

Age Group        30-50 yrs.          21-60 yrs.
Males                76%                 50%
Smokers              85%                 50%

Table 16. Showing the Incidence of
Retention Cysts of Larynx--A Comparative Study

Study                 Percentage

P.M. Robinson [17]      6.08
Shawt [9]                4.7
Present Study             5

Table 17. Showing a Comparative Study of Site of Lesion

Site               Kleinsasser [19]   Present Study

Vocal Cords              55%              50
Vestibular bands         25%              50
Epiglottis               20%               0

Table 18. Showing Distribution among Males and Females

Study                  Male      Female

AD White et al [22]   03 (5%)   58 (95%)
Present study         02 (%)     01(%)

Table 19. Showing Comparative study of the
Incidence of Predisposing Factors of Granulomas

Predisposing Factor   Shaw [9]   Present Study

Intubation              56%          50%
Vocal abuse             44%          50%
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Title Annotation:Original Research Article
Author:Swathilal, S.A.; Praveen, N.
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Date:Mar 30, 2017
Words:4669
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