[Phonosurgical therapy of nodular lesions of the vocal cords]

Nodular lesions of the vocal fold include contact oedema, contact thickenings and vocal nodules [1, 2], which all appear at the predilection sites of the vocal folds (junction of the anterior and middle thirds, slightly below the free edge). All nodular lesions develop as a consequence of acute or prolonged voice overuse or misuse. Contact oedema is characterized by an intact epithelium and subepithelial oedema (Fig. 1), while contact thickenings present somewhat thickened epithelium and subepithelial oedema. Vocal nodules are characterized by marked intraepithelial thickening, in conjunction with a certain degree of hyperkeratosis.

A series of 293 nodular lesions of the vocal fold was operated by the use of direct microlaryngoscopy (DML), indirect microstroboscopy (IMS) and indirect videostroboscopy (IVS). Based on the functional surgical results, indications were established for each of the surgical technique used. Corticoids were used postoperatively, while the voice therapy started 3 weeks after surgery.

During a 10-year-period 1550 surgical procedures were carried out for benign lesions of the vocal folds, including 293 operations for nodular lesions (18.9%). Surgery for vocal nodules was conducted in 268/293 overall operations for nodular lesions (91.5%). Indirect surgery was used in 221 patients (83.9%). It was established for indirect surgery, especially IVS, that it is a method of choice for the surgical treatment of nodular lesions. In some cases it is also suitable for unfavourable local anatomy and contraindications for general anaesthesia which is required for direct operations (DML). Indications for IVS and IMS were identical. DML was used according to a specific wish of the patient, or in cases when topical anaesthesia was not sufficient to carry out the procedure (about 3% of overall number of patients). Recovery of the vibration pattern was faster and more complete after indirect operations, especially after IVS (Table 1).

Indirect videostroboscopic procedure is the best surgical choice for nodular lesions of the vocal fold. It is characterized by precise excision, avoidance of local trauma to the tissues and excellent functional control [5-7].