A Retrospective Multicenter Analysis of Vocal Fold Sulcus Disorders

Vocal fold sulci are depressions that may be linear; sulcus vergeture (SVE) or like a pit; sulcus vocalis (SVO). The occurrence of SVE in family groups and the preponderance of reports from specific geographical areas suggest a hereditary etiology. Our objectives are to audit the possibility of a geographical variability between SVE and SVO and to study the patterns of presentation and treatment.

Following ethics clearance, a 3-year retrospective case-series review of the demographics of vocal fold sulcus was conducted at voice centers in India, USA, Germany, and Australia. Sulcus cases were noted with details of associated lesions, sex, performers, age, and treatment given. The denominator was benign mucosal glottic lesions such as cysts and polyps.

Of a total of 351 cases of sulcus, 239 were SVE, with associated lesions in 56% (47% in SVO). A total of 50/239 SVE and 56/112 SVO were found in vocal performers (p < 0.00001). A total of 160/239 SVE and 64/112 SVO were found in men. Sulcus of both types made up 20% of benign lesions in Sydney, 17% in Mumbai, which were significantly higher than New York (4%) and Germany (3.5%). SVE comprised 82% of cases (Mumbai), 72% (Sydney), 70% (New York) and 8.5% (Germany) with a significantly higher geographical variability than SVO.

Both SVO and SVE were found predominantly in men. SVO was significantly more prevalent in performers, suggesting phonotrauma in its formation. SVE showed significant geographical variation, suggesting regional variation in its prevalence, supporting heredity in its formation, unlike SVO.