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Evaluation of benign vocal cord lesions with laryngeal electromyography

Year 2014, Volume: 24 Issue: 3, 129 - 136, 19.06.2014

Abstract

Objectives: This study aims to identify patients with benign vocal cord lesions using laryngeal electromyography EMG and to investigate the presence of accompanying vocal cord paresis. Patients and Methods: Twenty-eight patients 18 males and 10 females; mean age 38.6±10.2 years; range 22 to 59 years who were diagnosed with benign vocal cord lesion using a rigid laryngostroboscopy underwent laryngeal EMG and the presence of neurogenic involvement was investigated. Results: Laryngostroboscopic examination revealed polyp in 85.7% n=24 , Reinke's edema in 10.7% n=3 , submucosal cyst in 10.7% n=3 , and contact granuloma in 3.6% n=1 . Of the patients, 14.2% n=4 were suspected to have vocal cord paresis. Laryngeal EMG revealed neurogenic involvement in at least one of the larynx muscles in 57.2% n=16 of the patients. Eight patients 28.6% had unilateral neurogenic involvement, while three 10.7% demonstrated isolated recurrent laryngeal nerve paresis two 7.2% demonstrated isolated superior laryngeal nerve paresis, and three 10.7% demonstrated combined recurrent and superior laryngeal nerve paresis. Six 21.4% of eight patients with bilateral neurogenic involvement had paresis in three laryngeal nerves, whereas in two 7.2% patients four laryngeal nerves were affected. Conclusion: Our study shows that vocal cord paresis frequently accompanies benign vocal cord lesions. Laryngeal EMG is useful to identify clinically suspected or unsuspected paresis with physical examination precisely.

References

  • Dikkers FG, Nikkels PG. Benign lesions of the vocal folds: histopathology and phonotrauma. Ann Otol Rhinol Laryngol 1995;104:698-703.
  • Courey MS, Shohet JA, Scott MA, Ossoff RH. Immunohistochemical characterization of benign laryngeal lesions. Ann Otol Rhinol Laryngol 1996;105:525-31.
  • Marcotullio D, Magliulo G, Pietrunti S, Suriano M. Exudative laryngeal diseases of Reinke's space: a clinicohistopathological framing. J Otolaryngol 2002;31:376-80.
  • Koufman JA, Amin MR, Panetti M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg 2000;123:385-8.
  • Johns MM. Update on the etiology, diagnosis, and treatment of vocal fold nodules, polyps, and cysts. Curr Opin Otolaryngol Head Neck Surg 2003;11:456-61.
  • Dursun G, Sataloff RT, Spiegel JR, Mandel S, Heuer RJ, Rosen DC. Superior laryngeal nerve paresis and paralysis. J Voice 1996;10:206-11.
  • Koufman JA, Postma GN, Cummins MM, Blalock PD. Vocal fold paresis. Otolaryngol Head Neck Surg 2000;122:537-41.
  • Heman-Ackah YD, Barr A. Mild vocal fold paresis: understanding clinical presentation and electromyographic findings. J Voice 2006;20:269-81.
  • Merati AL, Shemirani N, Smith TL, Toohill RJ. Changing trends in the nature of vocal fold motion impairment. Am J Otolaryngol 2006;27:106-8.
  • Simpson CB, Cheung EJ, Jackson CJ. Vocal fold paresis: clinical and electrophysiologic features in a tertiary laryngology practice. J Voice 2009;23:396-8.
  • Simpson CB, May LS, Green JK, Eller RL, Jackson CE. Vibratory asymmetry in mobile vocal folds: is it predictive of vocal fold paresis? Ann Otol Rhinol Laryngol 2011;120:239-42.
  • Sulica L, Blitzer A. Vocal fold paresis: evidence and controversies. Curr Opin Otolaryngol Head Neck Surg 2007;15:159-62.
  • Altman KW. Laryngeal asymmetry on indirect laryngoscopy in a symptomatic patient should be evaluated with electromyography. Arch Otolaryngol Head Neck Surg 2005;131:356-9.
  • Heman-Ackah YD, Batory M. Determining the etiology of mild vocal fold hypomobility. J Voice 2003;17:579-88.
  • Koufman JA, Walker FO. Laryngeal electromyography in clinical practice: indications, techniques, and interpretation. Phonoscope 1998;1:57-70.
  • Sataloff RT, Mandel S, Manon-Espaillat R, Heman-Ackah YD, Abaza M. Basic aspects of the electrodiagnostic evaluation. In: Sataloff RT, Korovin GS, editors. Laryngeal electromyography. Clifton Park: Delmar Learning, a Division of Thomson Learning; 2003. p. 8-58.
  • Sataloff RT, Mandel S, Manon-Espaillat R, Heman- Ackah YD, Abaza M. Laryngeal electromyography. In: Sataloff RT, Korovin GS, editors. Laryngeal Electromyography. Clifton Park: Delmar Learning, a Division of Thomson Learning; 2003. p. 59-85.
  • Akbulut SA, Oguz H, Inan R. Larengeal elektromyografi. KBB Forum 2013;12:10-8.
  • Yin SS, Qiu WW, Stucker FJ. Major patterns of laryngeal electromyography and their clinical application. Laryngoscope 1997;107:126-36.
  • Koufman JA, Postma GN, Whang CS, Rees CJ, Amin MR, Belafsky PC, et al. Diagnostic laryngeal electromyography: The Wake Forest experience 1995- 1999. Otolaryngol Head Neck Surg 2001;124:603-6.
  • Ertekin C. İğne elektromyografisi. İzmir: Ege Üniversitesi Basımevi; 1998.
  • Rubin AD, Praneetvatakul V, Heman-Ackah Y, Moyer CA, Mandel S, Sataloff RT. Repetitive phonatory tasks for identifying vocal fold paresis. J Voice 2005;19:679-86.
  • Koufman JA, Belafsky PC. Unilateral or localized Reinke's edema (pseudocyst) as a manifestation of vocal fold paresis: the paresis podule. Laryngoscope 2001;111:576-80.
  • Koufman JA. Evaluation of laryngeal biomechanics by fiberoptic laryngoscopy. In: Rubin JS, Sataloff RT, Korovin GS, Gould WJ, editors. Diagnosis and Treatment of Voice Disorders. New York: Igaku-Shoin; 1995. p. 122-34.

Benign vokal kord lezyonlarının larengeal elektromiyografi ile değerlendirilmesi

Year 2014, Volume: 24 Issue: 3, 129 - 136, 19.06.2014

Abstract

Amaç: Bu çalışmada benign vokal kord lezyonu bulunan hastalar larengeal elektromiyografi ile EMG değerlendirildi ve eşlik eden vokal kord parezisi varlığı araştırıldı.Hastalar ve Yöntemler: Rijit larengostroboskop ile benign vokal kord lezyonu saptanan 28 hastaya 18 erkek, 10 kadın; ort. yaş 38.6±10.2 yıl; dağılım 22-59 yıl larengeal EMG yapıldı ve nörojenik tutulum varlığı değerlendirildi.Bulgular: Larengostroboskopik muayenede hastaların %85.7’sinde n=24 polip, %10.7’sinde n=3 Reinke ödemi, %10.7’sinde n=3 submüköz kist, %3.6’sında n=1 kontakt granülom vardı. Hastaların %14.2’sinde n=4 muayenede vokal kord parezisinden şüphelenildi. Larengeal EMG değerlendirilmesinde hastaların %57.2’sinde n=16 bir veya birden fazla larenks kasında nörojenik tutulum bulgusu saptandı. Hastaların sekizinde %28.6 nörojenik tutulum tek taraflı iken, üçünde %10.7 izole reküren larengeal sinir parezisi, ikisinde %7.2 izole süperior larengeal sinir parezisi ve üçünde ise %10.7 kombine tek taraflı reküren ve superior larengeal sinir parezisi vardı. İki taraflı nörojenik tutulum olan sekiz hastanın %28.6 altısında %21.4 üç larengeal sinirde, ikisinde %7.2 ise dört larengeal sinirde nörojenik tutulum saptandı.Sonuç: Bu çalışmada vokal kord parezisinin benign vokal kord lezyonlarına yüksek oranda eşlik edebileceği gösterilmiştir. Larengeal EMG klinik olarak şüphe edilen veya muayenede şüphelenilmeyen parezinin kesin olarak tanınmasını sağlar

References

  • Dikkers FG, Nikkels PG. Benign lesions of the vocal folds: histopathology and phonotrauma. Ann Otol Rhinol Laryngol 1995;104:698-703.
  • Courey MS, Shohet JA, Scott MA, Ossoff RH. Immunohistochemical characterization of benign laryngeal lesions. Ann Otol Rhinol Laryngol 1996;105:525-31.
  • Marcotullio D, Magliulo G, Pietrunti S, Suriano M. Exudative laryngeal diseases of Reinke's space: a clinicohistopathological framing. J Otolaryngol 2002;31:376-80.
  • Koufman JA, Amin MR, Panetti M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg 2000;123:385-8.
  • Johns MM. Update on the etiology, diagnosis, and treatment of vocal fold nodules, polyps, and cysts. Curr Opin Otolaryngol Head Neck Surg 2003;11:456-61.
  • Dursun G, Sataloff RT, Spiegel JR, Mandel S, Heuer RJ, Rosen DC. Superior laryngeal nerve paresis and paralysis. J Voice 1996;10:206-11.
  • Koufman JA, Postma GN, Cummins MM, Blalock PD. Vocal fold paresis. Otolaryngol Head Neck Surg 2000;122:537-41.
  • Heman-Ackah YD, Barr A. Mild vocal fold paresis: understanding clinical presentation and electromyographic findings. J Voice 2006;20:269-81.
  • Merati AL, Shemirani N, Smith TL, Toohill RJ. Changing trends in the nature of vocal fold motion impairment. Am J Otolaryngol 2006;27:106-8.
  • Simpson CB, Cheung EJ, Jackson CJ. Vocal fold paresis: clinical and electrophysiologic features in a tertiary laryngology practice. J Voice 2009;23:396-8.
  • Simpson CB, May LS, Green JK, Eller RL, Jackson CE. Vibratory asymmetry in mobile vocal folds: is it predictive of vocal fold paresis? Ann Otol Rhinol Laryngol 2011;120:239-42.
  • Sulica L, Blitzer A. Vocal fold paresis: evidence and controversies. Curr Opin Otolaryngol Head Neck Surg 2007;15:159-62.
  • Altman KW. Laryngeal asymmetry on indirect laryngoscopy in a symptomatic patient should be evaluated with electromyography. Arch Otolaryngol Head Neck Surg 2005;131:356-9.
  • Heman-Ackah YD, Batory M. Determining the etiology of mild vocal fold hypomobility. J Voice 2003;17:579-88.
  • Koufman JA, Walker FO. Laryngeal electromyography in clinical practice: indications, techniques, and interpretation. Phonoscope 1998;1:57-70.
  • Sataloff RT, Mandel S, Manon-Espaillat R, Heman-Ackah YD, Abaza M. Basic aspects of the electrodiagnostic evaluation. In: Sataloff RT, Korovin GS, editors. Laryngeal electromyography. Clifton Park: Delmar Learning, a Division of Thomson Learning; 2003. p. 8-58.
  • Sataloff RT, Mandel S, Manon-Espaillat R, Heman- Ackah YD, Abaza M. Laryngeal electromyography. In: Sataloff RT, Korovin GS, editors. Laryngeal Electromyography. Clifton Park: Delmar Learning, a Division of Thomson Learning; 2003. p. 59-85.
  • Akbulut SA, Oguz H, Inan R. Larengeal elektromyografi. KBB Forum 2013;12:10-8.
  • Yin SS, Qiu WW, Stucker FJ. Major patterns of laryngeal electromyography and their clinical application. Laryngoscope 1997;107:126-36.
  • Koufman JA, Postma GN, Whang CS, Rees CJ, Amin MR, Belafsky PC, et al. Diagnostic laryngeal electromyography: The Wake Forest experience 1995- 1999. Otolaryngol Head Neck Surg 2001;124:603-6.
  • Ertekin C. İğne elektromyografisi. İzmir: Ege Üniversitesi Basımevi; 1998.
  • Rubin AD, Praneetvatakul V, Heman-Ackah Y, Moyer CA, Mandel S, Sataloff RT. Repetitive phonatory tasks for identifying vocal fold paresis. J Voice 2005;19:679-86.
  • Koufman JA, Belafsky PC. Unilateral or localized Reinke's edema (pseudocyst) as a manifestation of vocal fold paresis: the paresis podule. Laryngoscope 2001;111:576-80.
  • Koufman JA. Evaluation of laryngeal biomechanics by fiberoptic laryngoscopy. In: Rubin JS, Sataloff RT, Korovin GS, Gould WJ, editors. Diagnosis and Treatment of Voice Disorders. New York: Igaku-Shoin; 1995. p. 122-34.
There are 24 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

İbrahim Gül This is me

Sevtap Akbulut This is me

Arif Şanlı This is me

H. Mustafa Paksoy This is me

Rahşan Adviye İnan This is me

Derya Berk This is me

Publication Date June 19, 2014
Published in Issue Year 2014 Volume: 24 Issue: 3

Cite

APA Gül, İ., Akbulut, S., Şanlı, A., Paksoy, H. M., et al. (2014). Benign vokal kord lezyonlarının larengeal elektromiyografi ile değerlendirilmesi. The Turkish Journal of Ear Nose and Throat, 24(3), 129-136.
AMA Gül İ, Akbulut S, Şanlı A, Paksoy HM, İnan RA, Berk D. Benign vokal kord lezyonlarının larengeal elektromiyografi ile değerlendirilmesi. Tr-ENT. June 2014;24(3):129-136.
Chicago Gül, İbrahim, Sevtap Akbulut, Arif Şanlı, H. Mustafa Paksoy, Rahşan Adviye İnan, and Derya Berk. “Benign Vokal Kord lezyonlarının Larengeal Elektromiyografi Ile değerlendirilmesi”. The Turkish Journal of Ear Nose and Throat 24, no. 3 (June 2014): 129-36.
EndNote Gül İ, Akbulut S, Şanlı A, Paksoy HM, İnan RA, Berk D (June 1, 2014) Benign vokal kord lezyonlarının larengeal elektromiyografi ile değerlendirilmesi. The Turkish Journal of Ear Nose and Throat 24 3 129–136.
IEEE İ. Gül, S. Akbulut, A. Şanlı, H. M. Paksoy, R. A. İnan, and D. Berk, “Benign vokal kord lezyonlarının larengeal elektromiyografi ile değerlendirilmesi”, Tr-ENT, vol. 24, no. 3, pp. 129–136, 2014.
ISNAD Gül, İbrahim et al. “Benign Vokal Kord lezyonlarının Larengeal Elektromiyografi Ile değerlendirilmesi”. The Turkish Journal of Ear Nose and Throat 24/3 (June 2014), 129-136.
JAMA Gül İ, Akbulut S, Şanlı A, Paksoy HM, İnan RA, Berk D. Benign vokal kord lezyonlarının larengeal elektromiyografi ile değerlendirilmesi. Tr-ENT. 2014;24:129–136.
MLA Gül, İbrahim et al. “Benign Vokal Kord lezyonlarının Larengeal Elektromiyografi Ile değerlendirilmesi”. The Turkish Journal of Ear Nose and Throat, vol. 24, no. 3, 2014, pp. 129-36.
Vancouver Gül İ, Akbulut S, Şanlı A, Paksoy HM, İnan RA, Berk D. Benign vokal kord lezyonlarının larengeal elektromiyografi ile değerlendirilmesi. Tr-ENT. 2014;24(3):129-36.