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A COMPARATIVE STUD OF BENIGN VOCAL CORD MASS LESIONS USING VIDEOSTROBOSCOP ,VOICE ANAL SIS AND VOICE HANDICAP INDE BEFORE AND AFTER MICROLAR NGEAL SURGER
S
THE TAMILNADU DR. M.G.R.MEDICAL UNIVERSIT I P F
M.S.BRANCH IV
(OTORHINOLAR NGOLOG )
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 ANAL SIS AND
VOICE HANDICAP INDE BEFORE AND AFTER
MICROLAR NGEAL 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 IRUDHA ARAJAN, 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 ANAL SIS AND VOICE
HANDICAP INDE BEFORE AND AFTER MICROLAR NGEAL
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.
P .D .ISSAC CHRISTIAN MOSES P ..D .T.BALASUBRAMANI AN, 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.
P .D .F.ANTHON IRUDHA ARAJAN, MS., D.L.O., PROFESSOR OF OTORHINOLARYNGOLOGY, Govt.Stanley Medical College and Hospital,Chennai -1.
P : C
D :07-10-2015
ACKNOWLEDGEMENTS
I wish to express my sincere thanks to P . 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 P . D . F.ANTHON
IRUDHA ARAJAN, MS.,D.L.O., Professor of Otorhinolaryngology, and
Chief of ENT UNIT II, and P . 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.ATHI AMAN 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 P 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 T P N .
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