Minor Structural Alterations of the Vocal Fold Cover: Vocal Quality before and after Treatment

Brito, Tatiany Cíntia da Silva; Silva, Jullyane Florencio Pacheco da; Moraes, Bruno Teixeira; Vilela, Mirella Bezerra Rodrigues; Ximenes, Coeli Regina; Vasconcelos, Daniela de; Cardoso, Nathália Suellen Valeriano; Gomes, Adriana de Oliveira Camargo

doi:10.1055/s-0040-1719121

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Original Research • iao 25 (4) • Oct-Dec 2021 • https://doi.org/10.1055/s-0040-1719121 copy

Minor Structural Alterations of the Vocal Fold Cover: Vocal Quality before and after Treatment

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Minor structural alterations of the vocal fold cover are important causes of dysphonia. The variability in the type of alteration and the grade of vocal deviation affects the definition of the conduit and the results of treatment.

Objective

To characterize the occurrence, the selected treatments adopted and vocal quality before and after treatment in patients with minor structural alterations of the vocal folds cover.

Methods

This was a cross-sectional study based on the records of patients treated by an interdisciplinary team at the laryngology outpatient clinic of a public university hospital from 2010 to 2018. Data collection consisted of access to a database of information on otorhinolaryngological diagnostic hypotheses, intervention and perceptual-auditory vocal assessments before and after the treatment. Data from 102 subjects were analyzed. Association tests were applied between the perceptualauditory vocal results and the different alterations found and between these and the adopted treatments. The results of the degrees of vocal deviation before and after treatment were also compared.

Results

The degree of roughness was associated with the sulcus vocalis, and in this alteration the highest occurrence was mild degree of roughness. There was an improvement in the breathiness and general grade of vocal deviation after treatment.

Conclusion

Cysts were the most frequent structural alteration in the population studied. There was an association between the degree of general deviation and that of roughness in sulcus vocalis cases. The breathiness and the general grade of vocal deviation improved after treatment regardless of the type of treatment and alteration.

Keywords
vocal folds; voice disorders; speech therapy; voice quality; microsurgery

MINOR STRUCTURAL ALTERATIONS		n	%
Undifferentiated		28	11.0
Differentiated		81	31.8
	epidermoid cysts	35	13.7
	sulcus vocalis	25	9.8
	vasculodysgenesis	19	7.5
	laryngeal microdiaphragm	8	3.1
Associated		59	23.1
Total		255 ^* *corresponding to number of the alterations found in 102 subjects	100

DH	GENERAL DEGREE OF DYSPHONIA (PRE)								p ^* *Pearson chi-squared test- significance level at 5%	DEGREE OF ROUGHNESS (PRE)								p ^* *Pearson chi-squared test- significance level at 5%	DEGREE OF BREATHNESS (PRE)								p ^* *Pearson chi-squared test- significance level at 5%
	0		1		2		3			0		1		2		3			0		1		2		3
	N	%	N	%	N	%	N	%		N	%	N	%	N	%	N	%		N	%	N	%	N	%	N	%
UN	0	0.0	13	61.9	7	33.3	1	4.8	0.158	0	0	13	61.9	7	33.3	1	4.8	0.115	10	47.6	9	42.9	2	9.5	0	0.0	0.638
EC	4	16.0	10	40.0	9	36	2	8.0	0.659	6	24	10	40.0	8	32	1	4	0.455	11	42.3	13	50.0	2	7.7	0	0.0	0.968
SV	0	0.0	9	42.9	8	38.1	4	19	*0.046*	1	4.8	10	47.6	6	28.6	4	19	*0.020*	7	33.4	11	52.4	3	14.3	0	0.0	0.221
VD	4	23.5	9	52.9	3	17.6	1	5.9	0.076	4	23.5	9	52.9	3	17.6	1	5.9	0.400	10	58.8	6	35.3	1	5.9	0	0.0	0.478
LM	0	0.0	2	28.6	5	71.4	0	0.0	0.265	2	28.6	1	14.3	4	57.1	0	0.0	0.220	3	42.9	4	57.1	0	0.0	0	0.0	0.648
AS	4	9.1	21	47.7	16	36.4	3	6.8	0.933	5	11.4	22	50.0	14	31.8	3	6.8	0.729	21	47.7	19	43.2	4	9.1	0	0.0	0.914
T	12	8.9	64	47.4	48	35.6	11	8.1	-	18	13.3	65	48.1	42	31.1	10	7.4	-	61	45.2	62	45.9	12	8.9	0	0.0	-

HD	TREATMENTS
	(ST)		(S)		(MT)		(O)		p-value ^* *Pearson chi-squared test - significance level at 5%
	N	%	N	%	N	%	N	%
UN	11	73.0	0	0.0	1	7.0	3	20.0	0.083
EC	10	53.0	4	21.0	4	21.0	1	5.0	0.863
SV	7	50.0	2	14.0	3	21.0	2	14.0
VD	7	70.0	1	10.0	1	10.0	1	10.0
LM	1	50.0	0	0.0	1	50.0	0	0.0
OL	17	50.0	4	12.0	9	26.0	4	12.0	0.246
T	53	56.4	11	11.7	19	20.2	11	11.7	–

Degree	G		p-value ^* *Marginal Homogeneity Test (to compare pre and post results) - significance level at 5%	R		p-value ^* *Marginal Homogeneity Test (to compare pre and post results) - significance level at 5%	B		p-value ^* *Marginal Homogeneity Test (to compare pre and post results) - significance level at 5%
Degree	Pre (%)	Post (%)		Pre (%)	Post (%)		Pre (%)	Post (%)
0	3.6	32.1	*0.024*	7.1	32.1	0.098	42.9	75.0	*0.022*
1	57.1	39.3		60.7	39.3		46.4	21.4
2	28.6	25.0		25.0	25.0		10.7	3.6
3	10.7	3.6		7.1	3.6		0.0	0.0
T	100	100		100	100		100	100

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[1] Address for correspondence Adriana de Oliveira Camargo Gomes, PhD, Department of Speech Therapy, Federal University of Pernambuco, Av. Prof. Artur de Sá, s/n, Cidade Universitária, Recife, Pernambuco, 50670-420, Brazil (e-mail: acamargogomes@gmail.com).