Voice is the sound made by the vibration of vocal folds caused by air passing out through the larynx and the upper respiratory tract, the focal fold being approximated. The vocal cords extend through the laryngeal cavity bilaterally and are primarily responsible for voice production. Phonation is the process by which vocal folds produce certain sounds through quasi periodic vibration. Voice disorders occur with changes in pitch, volume, tone and other quality of voice.

The various causes of voice disorders can be due to structural, inflammatory, traumatic causes and laryngopharyngeal reflux. This study was done to analyses the various causes of voice disorders and their management strategies due to nonmalignant lesions of larynx in patients who attended ENT department, in the period of our study.

A prospective study with 60 patients from June 2022 to May 2023 clinically diagnosed with voice disorders in nonmalignant lesions of larynx who attended our OPD.  After detailed history taking and thorough clinical examination, these patients were subjected to routine blood investigations, patient with suspected benign lesions of larynx were examined with video laryngoscopy and the underlying causes of voice disorder was diagnosed and they were managed appropriately and followed up for 3 months

In our study, 11.7% of participants were aged 31-35 years, 20% were aged 36-40 years , 15% were aged 41 -45 years, 28.3% were aged 46-50 years, 25% were aged 51-55 years . 

60% of patients were male and 40% were female

8.3% of the patients belonged to upper middle class ,38.3% belonged to lower middle class,  41.7% belonged to upper lower class, 11.7% belonged to lower class

In our study 36.7% were agricultural labourers, 21.7% were into business , 25% were housewives, 16.6%  were teachers.

Clinical presentation:

35% of the cases had habit of smoking, 35% of the caes had habit of alcohol intake, 45% has betel nut chewing habit , 35% had tobacco chewing habit, 58.3% had habit of vocal abuse and 55% were having poor dental hygiene.

5% of the patients had chronic laryngitis, 1.7% had contact ulcers, 21.7% had cysts ,5% had granulomas, 1.7% had papilloma, 5% had Reinke’s edema, 1.7% had Tuberculous laryngitis, 15% had vocal nodules, 43.3% had vocal polyp.

Vocal cord lessions were more commomly seen among cases of advanced age group. There was a statistically significant association between gender and vocal cord lessions. Male gender was frequently associated with vocal cord lessions. It was observed that more number of house wives had vocal cord lessions.

Treatment:

Follow up:

Benign lessions of larynx constitute an interesting array of lessions. These lessions were defined as abnormal mass of tissue in the larynx, the growth of which exceeds and is uncoordinated with that of normal tissue and persist in the same excessive manner after cessation of stimuli which evoke the change. Benign lessions such as vocal nodules, vocal polyps, intracordal cyst, mucosal haemorrhage seems to be due to vibratory trauma. Secondary influences like smoking, allergy, acid reflux, infection may increase the mucosa’s vulnerability to the kind of injuries that may occur during mucosal oscillation.

In the study done by Singhal P et al., the most common complaints were hoarseness of voice, cough, foreign body sensation and throat pain, in our study the most common complaints were hoarseness, voice fatigue, foreign body sensation and dysphagia.

In the study done by Chaitanya V et al., majority of the patients suffered the symptoms from a duration of 15 days to 1.5 years. In our study, 3.3% of the patients had symptoms for <1 week, 20% of the cases had symptoms for more than a week to 1 month ,60% of cases had symptoms for more than a month to 6 months, 16.7% cases had for more than 6 months.

In our study, it was observed that there was a significant association between personal habits and vocal cord lessions. It was observed that chewing of pan, vocal abuse and poor orodental hygiene were frequently associated with vocal cord lessions. In the study conducted by Chaitanya V et al., they have observed that among neoplastic lessions 50% of the cases had history of tobacco smoking in the form of cigarette, 33.3% had alcohol addiction, 6.8% had both smoking and alcohol history ,3.3% had betelnut chewing history, 3.3% had history of toacco chewing.

In our study, it was observed that 5% of the cases had chronic laryngitis ,1.7% had contact ulcers, 21.7% had cysts, 5% had granulomas, 1.7% had papilloma, 5% had Reinke’s edema, 1.7% had Tuberculous laryngitis, 15% had vocal nodules, 43.3% had vocal polyp. In the study done by Chaitanya V et al., the non-neoplastic lessions constituted about 62.5% of cases with vocal polyp being the commonest type seen in 33.7%, the second most common cause noted was vocal cord nodule 22.22%.

In our study 53% of the patients were managed by microlaryngeal surgery and speech therapy, 46% were managed by medical and speech therapy whereas in the study done by Singhal P et al; 96% of the patients were managed by surgery and voice rest, 6% were managed by speech therapy.

In our study, the success rate was 89% following microlaryngeal surgery and speech therapy, 85% following medical and speech therapy. In the study done by Singhal P et al; 93.6% of the patients were normal without any recurrence after microlaryngeal surgery followed by speech therapy.

The laryngeal dysfunction produces symptoms which can vary from mild hoarseness to life threatening stridor. Laryngeal lessions can create lot of mental and emotional tension in the patient and family. Early diagnosis of the lesion can lead to effective management. All available methods of study should be utilized to make the diagnosis as early as possible. Microlaryngeal surgery and voice rest offer a cost effective, useful and safe method for management of benign laryngeal lesion.

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