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A Dissertation on a COMPARATIVE STUDY of BENIGN VOCAL CORD

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A Dissertation on a COMPARATIVE STUDY of BENIGN VOCAL CORD A D A COMPARATIVE STUD OF BENIGN VOCAL CORD MASS LESIONS USING VIDEOSTROBOSCOP,VOICE ANALSIS AND VOICE HANDICAP INDE BEFORE AND AFTER MICROLARNGEAL SURGER S THE TAMILNADU DR. M.G.R.MEDICAL UNIVERSIT I P fulf o equir F th w th degr o M.S.BRANCH IV (OTORHINOLARNGOLOG) GOVERNMENT STANLE MEDICAL COLLEGE & HOSPITAL THE TAMILNADU DR. M.G.R.MEDICAL UNIVERSIT, CHENNAI, TAMILNADU APRIL 2016 DECLARATION I, D. RAVIKUMAR.V, solemnly declare that the dissertation, titled “A COMPARATIVE STUD OF BENIGN VOCAL CORD MASS LESIONS USING VIDEOSTROBOSCOP,VOICE ANALSIS AND VOICE HANDICAP INDE BEFORE AND AFTER MICROLARNGEAL SURGER” is bonafidework done by me during the period of Dec 2014 to September 2015 at Government Stanley Medical College and Hospital, Chennai under the expert supervision of P.D.F.ANTHON IRUDHAARAJAN, MS., D.L.O., Department of Otorhinolaryngology, Government Stanley Medical College and hospitals, Chennai. This dissertation is submitted to The Tamil Nadu Dr. M.G.R. Medical University, in partial fulfillment of the rules and regulations for the M.S. degree examinations in Otorhinolaryngology to be held in April 2016. Place:Chennai-1 Date: 07-10-2015 D.RAVIKUMAR. V CERTIFICATE This is to certify that the dissertation - “A COMPARATIVE STUD OF BENIGN VOCAL CORD MASS LESIONS USING VIDEOSTROBOSCOP, VOICE ANALSIS AND VOICE HANDICAP INDE BEFORE AND AFTER MICROLARNGEAL SURGER” presented by Dr. RAVIKUMAR.V, is an original work done in the department of otorhinolarymgology, Government Stanley Medical College and hospital, Chennai in partial fulfilment of regulations of the The Tamil Nadu Dr. M.G.R. Medical University, for the award of degree of M.S. (Otorhinolaryngology) Branch IV, under my supervision during the academic period 2013-2016. Prof.Dr.ISSAC CHRISTIAN MOSES Prof..D.T.BALASUBRAMANIAN, M.S.,D.L.O., M.D FICP FACP THE DEAN Professor and Head of the Department Govt. Stanley Medical College, Govt. Stanley Medical College and Hospital and Hospital Chennai-1 Chennai-1. Pof.D.F.ANTHON IRUDHAARAJAN, MS., D.L.O., PROFESSOR OF OTORHINOLARYNGOLOGY, Govt.Stanley Medical College and Hospital,Chennai -1. Pa : C Dte:07-10-2015 ACKNOWLEDGEMENTS I wish to express my sincere thanks to Pof. D. ISAAC CHRISTIAN MOSES MD, FIC, FACP. DEAN, Government Stanley Medical College and Hospital for having permitted me to utilize the facilities of the hospital for conducting this study. My heartfelt gratitude to P. D. T. BALASUBRAMANIAN, M.S., D.L.O., Professor and Head of the Department, Department of Otorhinolaryngology, Government Stanley Medical College and Hospital for his constant motivation, valuable suggestions, and expert supervision during the course of this study. I express my whole hearted gratitude to Pof. D. F.ANTHON IRUDHAARAJAN, MS.,D.L.O., Professor of Otorhinolaryngology, and Chief of ENT UNIT II, and Pof. D. N. SEETHALAKSHMI, M.S., D.L.O., D.N.B., Professor of Otorhinolaryngology for supporting, guiding and encouraging me in this study. I wish to thank my Assistant Professors DR. K.ATHIAMAN M.S, DR.C.KARUPPASAM MS.,D.L.O, DR. C.BHARANIDHARAN D.L.O, DR.SARAVANA SELVAN M.S., DR. SURESH M.S., for their valuable tips and guidance. I also thank M.RADHAKALAISELVAN, Audiologist and Speech Pathologist of ENT Department Government Stanley Hospital for her expert assistance. I am grateful to all the other post-graduates who most willingly helped me during this study period. I also thank the staff nurse and theatre personnel, Government Stanley Hospital for their co-operation and assistance in the conduct of this study. Last but not least, I am indebted and grateful to all the Pnts who constitute the backbone of this study, who most willingly and selflessly subjected themselves to this study for the sake of the benefit of their community and without whom this study would not have been possible. CONTENTS S.N Tcs P No. 1 ABSTRACT I 2 INTRODUCTION 1 3 AIM AND OBJECTIVE 2 4 REVIEW OF LITERATURE 4 5 MATERIALS AND METHODS 43 6 RESULTS AND OBSERVATION 59 7 DISCUSSION 78 8 CONCLUSION 81 9 ANNEXURES A. BIBLIOGRAPHY B. PROFORMA C. ETHICAL COMMITTEE APPROVAL LETTER D. PATIENT INFORMATION SHEET E. INFORMED CONSENT FORM F. PLAGIARISM G. MASTER SHEET LIST OF FIGURES Fig -1 Shows Various Stages of Development of larynx Fig-2 Shows Larynx – Intrinsic muscles Fig-3A,3B Shows Various layers in the Body Cover Complex Fig-4 Shows Cover Body Complex Fig-5A Shows vocal cord cross sectional study Fig-5B Shows Basement membrane zone of Vocal Cord Fig-6 Shows Still and moving images explain the Talbot’s Law the basic principles of stroboscopy Fig-7 Shows schematic diagram of Vocal Nodule formation Fig-8 Shows Stroboscopic picture of B/L Vocal Cord Nodule Fig-9 Shows schematic diagram of Vocal Cyst formation Fig-9A Shows Stroboscopic picture of Rt Vocal Cord Cyst Fig-9B Shows Stroboscopic picture of Lt Vocal Cord Cyst Fig-10 Shows schematic diagram of Vocal Polyp formation Fig-10A Shows Stroboscopic picture of Rt Vocal Cord Polyp Fig-10B Shows Stroboscopic picture of Lt Vocal Cord Polyp Fig-11 Shows schematic diagram of Rienke’s Edema Formation Fig-12 Shows STROBOSCOPY UNIT Fig-12A Monitor Fig-12B CAMERA UNIT Fig-12C LIGHT SOURCE Fig-12D DIGITAL PRINTER Fig-12E FOOT PEDAL Fig-12F UPS Fig 13 PHONOLAB-ECLERIS VERSON 03.02 Fig-13A MONITOR Fig-13B PRINCIPAL UNIT Fig-13C MICROPHONE Fig-14 Shows Procedure of Using Endoscope Fig-15 Shows NORMAL MUCOSAL WAVE PATTERN SEQUENCE by video stroboscope Fig-16,16A,16B,16C, Shows Pre-OP Vocal Nodule, Intra-OP Rt Vocal Nodule Removal, Intra Op Lt Vocal Cord Nodule Removal, Post-OP Vocal Cord Status Fig-17,17A,17B Shows PRE-OP Vocal Polyp Rt, INTRA OP Rt Vocal Polyp Removal, POST OP Vocal Cord Status Fig-18,18A Shows PRE OP Vocal Cyst, POST OP Vocal Cord Status Fig-19,19A,19B Shows PRE-OP Vocal Cord Polyp, INTRA P(COBLATION) Polyp Removal, Post Op Vocal Cord Status LIST OF TABLES Tab-1 Shows Dimension Of Larynx Tab-2 Shows Ligaments Of Larynx Tab-3 Shows Functions of Laryngeal Muscles in Vocal Cord Tab-4 Shows FUNCTIONAL TWO-LAYERED STRUCTURE OF THE VOCAL FOLDS Tab-5 Shows Pre Operative Stroboscopic analysis Tab-6 Shows Fundamental Frequency Tab-7 Shows Standard Deviation of Pitch Tab-8 Shows Jitter Tab-9 Shows Shimmer Tab-10 Shows Harmonic Noise Ratio Tab-11 Shows Maximum Phonation Time Tab-12 Shows Voice Handicap Index Tab-13 Shows Sub group analysis Male and Female Tab-14 Shows Sub group analysis-Smokers and Non Smokers ABSTRACT Vocal cords are very delicated and intricate structure that help a human being to Breath, Speak as well as to sings. It is a micro structure and their functions are very accurate, even a small change in it by a lesion can produce enormous change in its function (Voice and Singing). Video Laryngo Stroboscopy is the process in which the normal and pathological vibrating pattern of vocal cord is made visible during phonation. Voice is analysed using Voice analyser and Voice Handicap Index. AIM The present study is aimed at examining the objective and subjective parameters using Stroboscopy voice analysis and Voice Handicap Index(VHI) of patients with Benign Vocal Cord Lesions before and after Microlaryngeal surgery. METHOD This study was conducted in the Department of Otorhinolaryngology of Government Stanley Medical College and Hospital during the period of December 2014 to September 2015. Based on the inclusion and exclusion criteria,38 patients with voice disorders I were selected and sub categorized into Vocal Cord Nodule, Vocal cord Polyp, Vocal cord Cyst. Among 38 Patients 16 are presented as Vocal cord Nodule,16 Presented as Vocal cord Cyst and 6 Presented as Vocal Cord Polyp which includes both male and females. After getting valid consent from the patients, pre operative and Postoperative subjective and objective parameters using Stroboscopy voice analysis and Voice Handicap Index(VHI) were evaluated and analysed. RESULTS Pre and Post operative assessment of patients with benign vocal cord mass lesions using stroboscopy, voice analyses and Voice Handicap index is a useful way to assess the degree of improvement following surgery. Both the patients and surgeon were provided with definitive evaluation with respect to the benefit following surgery and speech therapy. II INTRODUCTION INTRODUCTION The voice is an integral part of the unique human ability to communicate by speech. The larynx is the major source of sound used during speaking. Phonation is the generation of sound by vibration of vocal cords. Benign vocal cord mass lesions such as polyps, nodules and cysts affect voice production. The objective measurement of the degree of pathology in the vocal folds is performed by using various parameters of videostrobosocopic examination. A comparison of pre operative and post operative changes in the vocal folds can show the degree of improvement. Videostrobosocopic examination may also be combined with analysis of voice parameters to assess the improvement or worsening of voice after Micro Laryngeal surgery. The present study aimed at examining the subjective and objective parameters using stroboscopic voice analysis and VHI Of patients undergoing Microlaryngeal Surgery for Benign Vocal Cord Mass Lesions. 1 AIM AND OBJECTIVES AIM OF THE STUDY A Comparative Study Of Benign Vocal Cord Mass Lesions Using Videostroboscopy, Voice Analysis And Voice Handicap Index Before And After Microlaryngeal Surgery. OBJECTIVE OF THE STUDY 1. Comparing pre and post operative vocal cord vibratory changes in a patient with benign vocal cord lesions using stroboscopy. 2. Comparing pre and post operative voice changes in a patient with benign vocal cord mass lesions using voice analysis. 3. Assessing the subjective improvement of patients voice using voice handicap index before and after Microlaryngeal Surgery.
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