[Phonosurgery and conservative therapy of contact hyperplasia of the vocal cords]

Functional-traumatic lesions of the vocal folds include mucous stranding, "nodular" lesions, polyps, cysts; contact hyperplasia and haematoma [1]. Unlike the other lesions, contact hyperplasia is localized at the medial surface of the vocal processes. These are bilateral lesions, often asymmetric, with a central depression resembling an ulcer (Fig. 1). The epithelium is thickened, and evidences of a slight inflammatory process are present. The lesion is the result of the prolonged voice misuse, and is particularly frequent within entertainment professionals [6]. In addition, many patients have some apparent signs of gastric reflux. Contact hyperplasia interferes with glottic closure, but has almost no relation with the vibration pattern. The treatment is phonosurgical, followed by voice therapy. This paper is aimed to check the results of our therapeutic strategy.

We studied 51 patients with contact hyperplasia, who were classified into two groups: a group with massive hyperplasia and a group with minor lesions. The former group of patients underwent surgery as a primary mode of treatment, while the latter group was first treated by voice therapy, and the operative treatment was carried out only in patients who did not show significant voice improvement. Massive lesions were operated on by the use of direct microlaryngoscopy (DML), while some patients were treated by indirect surgery (microstroboscopy--IMS and videostroboscopy--IVS).

Over the last 10 years we operated 1550 patients with benign vocal fold lesions. There were only 51 cases with contact hyperplasia (3%). Surgery was the first choice of treatment in 7 subjects (14%), who were operated by the use of DML. The other 14 patients were first treated by voice therapy followed by indirect surgery (IMS and IVS). Surgery was performed in 21 patients (41%).

Treatment of contact hyperplasia is somewhat prolonged in relation to other benign vocal fold lesions. Small growths are better treated by indirect procedures, to avoid additional trauma to the local tissue of this "sensitive" area.