The goal of this project is to evaluate with objective evidence the effectiveness of specific surgical and behavioral techniques in the treatment of selected voice problems. We will obtain, evaluate, and compare measurements of the changes produced by: (1) conventional microsurgical techniques versus laser microsurgery for the improvement of vocal fold vibratory function and glottal efficiency in patients with such benign lesions as vocal fold nodules, polyps, polypoid degeneration, hyperkeratosis, leukoplakia and sulcus vocalis. (2) Teflon injection versus Type I Thyroplasty for the improvement of vocal fold vibratory function and glottal efficiency of patients with recurrent laryngeal nerve paralysis. (3) behavioral techniques (voice therapy) for the improvement of vocal fold vibratory function and glottal efficiency of patients with vocal nodules, unilateral abducter paralysis, post-surgical dysphonia, or vocal symptoms of unidentified or idiopathic etiology. Patients will be studied prior to the initiation of, immediately following, and 3 months after the termination of treatment. Following team evaluation, unless a preference is expressed by the patient, random assignment to either of the two surgical groups (microsurgery vs laser, or Teflon vs Thyroplasty) will be made depending on etiology. However, those with a paralysis or vocal nodules will be seen first by a voice therapist and given 6-8 weeks of voice therapy. At the end of that course of treatment, they will be reexamined and all appropriate treatment data will be collected. If the patients have shown significant improvement (even if not total resolution) the course of voice treatment may be extended. If the treatment has met with little or no success, surgical intervention will be considered. In addition to perceptual judgments of voice improvement by the patient, research team, and a panel of trained observers, the vibratory characteristics of the vocal folds will be determined from analysis of the stroboscopic video recordings with supplemental data provided by inverse filtered airflow recordings. Glottal efficiency will be calculated from the inverse filtered airflow, intraoral air pressure and sound pressure level measurements. Electroglottography will be used to obtain estimates of the degree of abduction during phonation and the closing slope of the vocal folds. Acoustic analysis of the pre- and post-treatment audio tape recordings will include: mean fundamental frequency, variability of fo, frequency and amplitude perturbation, sound pressure level and long-term-average spectrum expressed in 1/3 octave intervals. The results of these analyses will (1) document the vibratory, acoustic and perceptual characteristics of the voices before and after treatment, (2) provide evidence for the evaluation of the effectiveness of the various treatment approaches and (3) provide clinical criteria for judging the success of voice treatment.
| Colton, R H; Woo, P; Brewer, D W et al. (1995) Stroboscopic signs associated with benign lesions of the vocal folds. J Voice 9:312-25 |
| Woo, P; Casper, J; Colton, R et al. (1994) Aerodynamic and stroboscopic findings before and after microlaryngeal phonosurgery. J Voice 8:186-94 |
| Woo, P; Casper, J; Colton, R et al. (1994) Diagnosis and treatment of persistent dysphonia after laryngeal surgery: a retrospective analysis of 62 patients. Laryngoscope 104:1084-91 |
