Etiologies of Dysphonia in Patients Referred to ENT Clinics Based on videolaryngoscopy

Document Type : Original

Authors

1 faculty member

2 Faculty Member

3 independent

Abstract

Introduction:
Laryngeal dysfunction may be divided into three categories; organic, neurologic and functional disorders. Dysphonia and hoarseness are the most common symptoms and, in some cases, the only signs of laryngeal dysfunction. In differential diagnosis of any type of chronic hoarseness, a neoplastic process must be considered and, thus continuous light video laryngoscopy can provide important information on the presence of neoplastic lesions in order to prevent disease progression via early detection and action.
 
Materials and Methods:
This cross-sectional, descriptive-analytical study was carried out on 197 patients with voice disorders admitted to Ayatollah Rouhani Hospital for video laryngoscopy. Available sampling was used and the results achieved were analyzed using SPSS17 statistical software.
 
Results:
A total of 197 patients (mean age, 40.72 ±15.17 years) participated in this study, 56.9% of whom were male. From analysis of video laryngoscopy, organic dysphonia was found to be the most common cause of voice disorders, while functional and neurologic dysphonia were observed in 8.6% and 5.6% of patients, respectively. Vocal nodules and Reinke's edema were among the most common causes of organic dysphonia, with a frequency of 24.4% and 23.4%, respectively; while laryngeal carcinoma accounted for 2.5% of all diagnosed cases with organic causes.
 
Conclusion: 
Since the presence of voice disorders for more than 3 weeks can be a sign of laryngeal dysfunction, early diagnosis using noninvasive methods such as video laryngoscopy and appropriate medical measures can help prevent the disease progression and eliminate the need for actions such as laryngectomy.
 
 
 

Keywords

Main Subjects


1. Boon DR, McFarlane SC, Von Berg SL, Zarick RI. Voice and Voice therapy. Boston: Pearson/ Allyn and Bacon 2006.
2. Carding P. Voice Pathology in the United Kingdom. BMJ. 2003; 327: 514–5.
3. Reymond H, Colton, Janina K, Casper, Leonard R. Understanding Voice  Problems; A Physiological Perspective For Diagnosis and Treatment 3rd Ed Lippincott Williams and Wilkins. 2006.
4. Probst R, Iro H, Grevers G. Basic Otorhino- laryngology. 2st ed. 2006: 385–96.
5. Holsinger FC, Kies MS, Weinstock YE, Lewin JS, HajibashiS, Nolen DD, et al. Examination of the larynx and pharynx. New Engl J Med. 2008; 358: e2.
6. Mendes AP, Salema L, Rodrigues A, Conceição I,  Bonança F, Santos M. Prevalence of Vocal Problems in Portuguese Primary and Secondary School Level Teachers. Distúrb Comun, São Paulo. 21(3): 315–25.
7. Preciado-Lopez J, Peres-Fernandez C, Calazada-Urindo M, Preciado-Ruiz P. Epidemiology study of Vice Disorder Among Teaching Professionals of La Rioja, Spain. J Voice. 2008; 22(4): 489–508.
8. Silverman E-M, Zimmer CH. Incidence of chronic hoarseness among school-age children. Journal Speech Hearing Dis. 1975; 40: 211–5.
9. Makhdoom N, Abouloyounet A, Bokhary HA, KO, Gazzaz ZJ, Azab BA, et al. Prevalence of gastro- esophageal reflux disease in patient with laryngeal and voice disorders. Saudi Med J, 2007; 28 (7):    1068–71.
10. Abtahi SM, Hashemi SM, Raghae M, Hoarseness. Result of an 8-Year Study on a Patient who Underwent Direct Laryngoscopy for chronic in Isfahan Ayatalah Kashani Hospital. Iranian Journal of Otorhinolaryngology. 2003; 15(1):38–42.
11. Wang CP, Ko JY, Wang YH, HU YL, Hsiao TY. Vocal process granuloma – A result of long-term observation in 53 patients. Oral Oncol (2009), doi:10. 1016/j. oraloncology 2009;45(9) 821-5.
12. Roy N, Merrill RM, Thibealt S, Parsa RA, Gray SD, Smith EM. Prevalence of voice disorder in teachers and the general population. J Speech Lang Hear Res 2004; 47: 281–93.
13. Smith E, Gray SD, Dove H, Kirchner L, Heras H. Frequency and effects of teachers voice problems. J Voice. 1997; 11: 81–7.
14. De Medrio AM, Barreto SM, Assuncao AA. Voice disorders (dysphonia) in public school female teachers working in Belo Horizonte: prevalence and associated factors. J Voice 2008; 22: 676–87.
15. Dabirmoghadam P, Azimian S, Mokhtari Z. Stroboscopic findings in patients with benign laryngeal lesions.Tehran University Medical J.70 (8): 508–13.
16. Miller MK, Verdolini K. Frequency and risk factors for voice problems in teachers of singing and control subjects. J Voice. 1995; 9: 342–8.
17. Thibeault S, Merrill RM, Roy N, Gray SD, Smith EM. Occupational risk factors associated with voice disorders among teachers. Ann Epidemiol. 2004; 14: 786–92.
18. Yick-yu Lee S, Qian Lao X, Tak-sun Yu. A Cross sectional Survey of Voice Disorders among Primary School Teachers in Hong Kong. J Occup Health 2010; 52: 344–52.
19. Roy N, Merrill RM, Thibeault S, Gray SD, Smith EM. Voice disorders in teachers and the general population: effects on work performance,
attendance, and future career choices. J Speech Lang Hear Res 2004; 47:542–51.
20. Smith E, Kirchner HL, Taylor M, Hoffman H, Lemke JH. Voice problems among teachers: differences by gender and teaching characteristics. J Voice 1998;12: 328–34.
21. Urrutikoetxea A, Ispizua A, Matellanes F. Vocal pathology of teachers: a video laryngo-stroboscopic study of 1046 teachers. Laryngologie, Otolologie et Rhinologie 1995; 116: 255–62.
22.Sala E, Laine A, Simberg S, Pentti J, Suonpaa J. The prevalence of voice disorders among day care center teachers compared with nurses: a questionnaire and clinical study. J Voice 2001; 15: 413–23.
23. Ghahramani A. Mokhtary-amirmajdy N, Direct Laryngoscopy in Laryngeal and Hypopharynx disease. The Iranian Journal of Otorhino- laryngology, Winter -2007. 18(46): p. 185-90.
25. Colton RH, Woo P, Brewer DW et al. Stroboscopic signs associated with benign of vocal folds. J Voice. 1995; 9: 312–25.
25. Poel PJ. Jong F, S.H., Consistency of the Preoperative and Intraoperative Diagnosis of Benign Vocal fold lesions. J Voice, 2002. 17(3): p. 425-33.
26.Takano SH, Nito T, Tamaruya N, et al. Single institutional analysis of tends over 45 years in etiology of vocal fold paralysis. Auris Nases Larynx. 2012; 39: 597–600.
27. Hirose H, Clinical statistics of the causes of vocal fold paralysis. Bunko – do 1992; 127–44     (in Japanese).
28. Kelchner LN, Stemple JC, Gerdeman B, et al. Etiology, Pathophysiology, Treatment choices, and Voice Result for Unilateral Adductor Vocal Fold Paralysis: A 3-Year Retrospective.