The effect of retinyl palmitate on healing of benign vocal fold lesions

The leading cause of vocal fold lesions such as nodules and polyps is phonotrauma, which causes microhematoma formation in the vocal fold cover that can initiate an inflammatory process. Vitamin A (Vit A) is essential for immunity, cellular differentiation and maintenance of respiratory epithelium. The aim of this study is to investigate the effect of Vit A (retinyl palmitate) on healing of vocal fold lesions, including vocal polyps and nodules. Eighteen patients with vocal fold lesions were included in the study. Of the patients, 13 had vocal polyps and 5 had vocal nodules. Patients received 90,000 IU oral Vit A in palmitate form daily for 2 months. In addition to Vit A treatment, only vocal hygiene recommendations were given to the patients, without any other medication or specific voice therapy. Pre- and post-treatment acoustic analysis [jitter % (jitt %), shimmer % (shim %), normalized noise energy (NNE), maximum phonation time (MPT), etc.] were performed. Lesion dimensions and stroboscopic findings were evaluated. Voice handicap index (VHI) was applied. Statistical analysis was performed between pre- and post-treatment measurements. Of the 18 patients, 8 had immature lesions (6 polyp-like lesions and 2 immature nodules) and 10 had mature lesion (7 polyps and 3 nodules). None of the patients showed complete healing. Partial response was seen in four patients with immature lesions. There were minimal changes in lesion dimensions, but this difference did not reach statistical significance. MPT of patients with immature lesions were close to significance level but overall MPT revealed no significant improvement (p = 0.051). Jitt %, shim % and NNE did not change significantly. In this study, the only statistically significant finding was VHI of the patients with immature lesions. Three of the patients complained of weight gain. Our data showed that Vit A at a given level of dose and duration seems to be ineffective in the treatment of benign vocal fold lesions. On the other hand, whether Vit A is effective on mature and immature lesions of vocal folds at higher doses and/or longer duration of treatment or not requires further studies.     

Markers of wound healing in vocal fold secretions from patients with laryngeal pathology

This study seeks to determine the ability of enzyme-linked immunosorbent assays of vocal fold secretions to detect and describe the inflammatory response in the vocal folds. Vocal fold and palatal secretions were collected during operation from patients with a range of vocal fold disorders and from control patients. The secretions were subjected to assays for interleukin-1beta, prostaglandin E2, and transforming growth factor beta. The results indicate a differential expression of mediators associated with the wound healing cascade in the vocal folds. The prostaglandin E2 levels clearly differentiated vocal fold secretions associated with laryngeal disease versus control sites. Furthermore, the interleukin-1beta concentrations were significantly elevated in subjects with epithelial lesions of the vocal folds as opposed to lesions of the lamina propria. Although still in its infancy, such analysis may ultimately hold scientific and clinical utility in the study and management of patients with vocal fold disease.     

喉结核临床表现及喉内镜观察

目的探讨现今喉结核的临床表现及喉内镜下的病变特点。方法回顾性分析1994年以来经病理确诊的36例喉结核患者的临床资料。结果患者年龄19-78岁，中位年龄39，5岁；声嘶为主要症状（83．3％）。纤维喉镜下见病变多累及声带、室带，病变形态以肉芽样或结节样增殖性病变为主；动态喉镜下见病变声带黏膜波及振动消失或减弱；24例喉部多部位病灶者中79，2％（19／24）并发活动性肺结核，12例喉部单一病灶者中75．0％（9／12）肺部正常。全部患者均行系统抗结核治疗，除失访10例外，其余26例均治愈。结论当今喉结核的局部症状不典型，全身症状不明显；可以发生于无肺结核者，其病变可累及喉部多处，以声带、室带多见。     

Day surgery for vocal fold lesions using a double-bent 60-mm Cathelin needle

Day surgery for vocal cord lesions overcomes the disadvantages of laryngomicrosurgery under general anesthesia. We present our experience with treatment of vocal fold lesions using a long double-bend Cathelin needle that can access all parts of the vocal cords. A 23G, 60-mm-long Cathelin needle was bent twice by 45^o at a distance of 1 and 2 cm from the tip, and was attached to a syringe. Under topical anesthesia and nasal endoscopy of the laryngopharynx, the needle was inserted percutaneously perpendicular to the skin, the direction of insertion being altered when the bends in the needle reached the skin surface. This allows the tip of the needle to access all parts of the glottis, allowing the performance of procedures such as biopsies, excision of lesions, and injection into the vocal folds. Between January 2011 and December 2013, we used this technique to perform vocal fold procedures in 566 patients presenting for treatment of spasmodic dysphonia (412 cases, 73 %) and other vocal fold lesions. Only minor complications, such as hematoma (3 patients, 0.5 %) and slight bleeding from the puncture site in the epiglottic vallecula (all patients, 100 %), which ceased spontaneously within 10 min, were seen. Erroneous puncture occurred in three patients (0.5 %) and the puncture had to be repeated in 38 patients (6.7 %). The procedure was completed successfully in all cases (100 %). Surgery for vocal fold lesions under topical anesthesia using our double-bend Cathelin needle technique is simple, safe, and useful.     

Return of vocal cord movement: an independent predictor of response to nonsurgical management of laryngeal cancers

OBJECTIVE: To determine whether return of vocal cord function after treatment of T2b/T3 laryngeal carcinoma is an independent prognostic factor for locoregional recurrence. STUDY DESIGN: A retrospective review of patients treated with radiation +/- chemotherapy between 2000 and 2005 for T2 with vocal cord paresis and T3 laryngeal carcinoma was conducted. METHODS: Only those patients obtained from the tumor registry with pre-and posttreatment video stroboscopies were included. Patients' charts were reviewed for local and regional recurrence after treatment. Fisher's exact test was used to determine significant association between recurrence and possible risk factors. RESULTS: Fourteen patients met the inclusion criterion. Six patients had T2 lesions with vocal cord paresis, and eight patients had T3 lesions. Fifty percent of patients with T2 and 75% of patients with T3 lesions had return of vocal cord function after treatment. Five of 14 patients did not have return of vocal cord function, and of these, 100% had locoregional recurrence. Of the nine patients who had return of vocal cord movement, none of the patients had recurrence. The proportion of recurrence was significantly higher for those whose vocal function did not return compared with the patients whose vocal function returned (100% vs. 0%, P < .01). CONCLUSION: The immobile vocal cord is associated with a worse prognosis and is therefore factored into the American Joint Commission on Cancer staging for laryngeal tumors. We show that vocal cord immobility is an independent prognostic factor of recurrence even after treatment and can predict treatment failure in T2 and T3 lesions of the larynx.     

Conductive hearing loss caused by third-window lesions of the inner ear.

BACKGROUND: Various authors have described conductive hearing loss (CHL), defined as an air-bone gap on audiometry, in patients without obvious middle ear pathologic findings. Recent investigations have suggested that many of these cases are due to disorders of the inner ear, resulting in pathologic third windows. OBJECTIVE: To provide an overview of lesions of the inner ear resulting in a CHL due to a third-window mechanism. The mechanism of the CHL is explained along with a classification scheme for these disorders. We also discuss methods for diagnosis of these disorders. DATA SOURCES: The data were compiled from a review of the literature and recent published research on middle and inner ear mechanics from our laboratory. CONCLUSION: A number of disparate disorders affecting the labyrinth can produce CHL by acting as a pathologic third window in the inner ear. The common denominator is that these conditions result in a mobile window on the scala vestibuli side of the cochlear partition. The CHL results by the dual mechanism of worsening of air conduction thresholds and improvement of bone conduction thresholds. Such lesions may be anatomically discrete or diffuse. Anatomically discrete lesions may be classified by location: semicircular canals (superior, lateral, or posterior canal dehiscence), bony vestibule (large vestibular aqueduct syndrome, other inner ear malformations), or the cochlea (carotid-cochlear dehiscence, X-linked deafness with stapes gusher, etc.). An example of an anatomically diffuse lesion is Paget disease, which may behave as a distributed or diffuse third window. Third-window lesions should be considered in the differential diagnosis of CHL in patients with an intact tympanic membrane and an aerated, otherwise healthy, middle ear. Clues to suspect such a lesion include a low-frequency air-bone gap with supranormal thresholds for bone conduction, and presence of acoustic reflexes, vestibular evoked myogenic responses, or otoacoustic emission responses despite the CHL. Imaging studies can help confirm the diagnosis.     

Clearing microvascular lesions of the true vocal fold with the KTP/532 laser

Although used for treating vascular malformations, KTP (532 nm) lasers have not been used to treat microvascular lesions of the vocal fold. The efficiency of KTP laser operation in the continuous mode with a 0.4- or 0.6-mm beam (1- to 2-W aim for 3 to 7 seconds delivering a total energy of 3 to 7 J) was studied retrospectively in patients with microvascular lesions of the vocal fold (n = 14). The perceptual acoustic, phonatory function, and videolaryngostroboscopic data were evaluated before and after operation in 10 patients. At follow-up (mean, 7 months), the results were excellent in all patients. Their phonatory function (jitter, shimmer, grade, breathiness, and roughness) significantly improved (p < .01). The videolaryngostroboscopic rating showed significant improvement in the amplitude of vocal fold vibration and excursion of the mucosal wave (p < .05). No postoperative recurrence or complications were noted. The KTP laser operation is a useful, cost-effective, and time-saving procedure and can be considered as an option in management of patients with microvascular lesions of the vocal fold, particularly those with repeated hemorrhages. Because the operation is easy (compared to other surgical methods) and has no major side effects, the prospect of total patient recovery is excellent.     

The cricothyroid muscle does not influence vocal fold position in laryngeal paralysis

The status of the cricothyroid muscle, which is innervated by the superior laryngeal nerve, is believed to influence the vocal fold position in laryngeal paralysis. It is believed that isolated lesions of the recurrent laryngeal nerve generally result in the paralyzed vocal fold assuming a paramedian position but that with lesions of both the superior and recurrent laryngeal nerves, a more lateral (intermediate or cadaveric) vocal fold position can be expected. Twenty-six consecutive patients with unilateral vocal fold paralysis underwent transnasal fiberoptic laryngoscopy (TFL) and laryngeal electromyography (LEMG). By TFL, the vocal fold positions were paramedian in 8 patients, intermediate in 7, and lateral in 11. By LEMG, 13 patients had isolated recurrent laryngeal nerve lesions and 13 patients had combined (superior and recurrent laryngeal nerve) lesions. There was no correlation between the vocal fold position and the status of the cricothyroid muscle, i.e., the status of the cricothyroid muscle by LEMG did not predict the vocal fold position nor did the vocal fold position by TFL predict the site of lesion. In addition, we investigated the possibility that the degree of thyroarytenoid muscle recruitment (tone) might correlate with vocal fold position, but no relation was found. We conclude that 1. the cricothyroid muscle does not predictably influence the position of the vocal fold in unilateral paralysis; 2. thyroarytenoid muscle recruitment (tone) does not appear to influence vocal fold position; and 3. still unidentified and unknown factors may be responsible for determining vocal fold position in laryngeal paralysis.     

Benign keratoma of the vocal cords

Summary Benign keratomas are true benign tumors of the vocal cords that are to be differentiated clinically and histologically from malignant, inflammatory and reactive lesions which may also result in superficial keratinization. Clinically, keratomas present as flat, warty or papillary lesions with varying keratinization surrounded by a normal-appearing (healthy) epithelium. They are usually unilateral, with their extents varying from 2 to 3 mm in diameter to tumors occupying the entire vocal cord. Histology shows grade I or grade II epithelial hyperplasia without any signs of inflammation. In the present study 61 patients with benign keratomas were treated by excisional biopsies alone. Fifty-seven patients were followed for a minimum of 7 months and a maximum of 16.5 years. Two patients developed recurrent keratomas. To date none of the patients has developed an invasive vocal cord carcinoma or a carcinoma in situ.     

Noninvasive assessment of benign lesions of vocal folds by means of ultrasonography

OBJECTIVES: Although ultrasonography (US) has been widely used in various parts of the body, its application in laryngeal examination has been limited. Our objective was to evaluate the significance of US examination in benign lesions of the vocal folds. METHODS: Ultrasonographic examination of the vocal folds was performed in 14 patients in whom benign lesions of the vocal folds had been diagnosed by videolaryngoscopy and microlaryngoscopy. Microlaryngoscopic surgery was performed after US examination. Each lesion was analyzed for the following US features: shape, size, and echotexture (echogenicity and homogeneity). RESULTS: In total, 16 lesions were diagnosed in 14 patients by means of videolaryngoscopy and microlaryngoscopy. Ultrasonographic examination was capable of diagnosing 14 of the 16 lesions (87.25%). Ultrasonography mainly helped in the diagnosis of sessile polyps, nodules, and leukoplakia that were larger than 2 mm. The lesions were linear hyperechoic, heterogeneous hyperechoic, hypoechoic, and isoechoic if they were leukoplakia, nodules, hemorrhagic polyps, and other polypoid lesions, respectively. The results are better if the diagnosis follows the corresponding US echotexture pattern rather than videolaryngoscopy and microlaryngoscopy. CONCLUSIONS: Laryngeal US examination appears to be a useful diagnostic tool for supplementing microlaryngoscopy in the assessment of benign lesions of vocal folds. In contrast to these currently used imaging techniques, anesthesia is not necessary in laryngeal US examination. In addition, US is noninvasive, painless, and much less expensive than the other techniques.     

Prevention of anterior glottic stenosis after transoral microresection of glottic lesions involving the anterior commissure with mitomycin C

OBJECTIVE: To evaluate the effectiveness of topical mitomycin C (MMC) in preventing anterior glottic stenosis (AGS) after transoral microresection of glottic lesions involving the anterior commissure (AC). STUDY DESIGN: Prospective clinical study. METHODS: Sixteen patients with benign or malignant glottic lesions involving the AC were studied. The lesions were removed by transoral microsurgery using a CO2 laser or cold microinstruments. In all patients, the anterior glottis was treated topically with 0.4 mg/mL MMC for 5 minutes at the end of surgery. The postoperative vocal folds and voice quality of patients were evaluated using video strobolaryngoscopy and voice recordings. RESULTS: Four patients had local recurrences after surgery and were treated with repeat microsurgery. Postoperatively, five patients (31%) developed acceptable small webs in the anterior glottis; one resolved with web lysis and a second with topical MMC. Postoperative vocal quality was affected mainly by the extent of vocal fold resection and the subsequent wide glottal gaps and extensive scarring, rather than by MMC use per se. Significant local side effects or atrophy of the vocal folds owing to MMC were not found. CONCLUSION: Topical MMC may be useful for preventing AGS and subsequent dysphonia after transoral microresection of glottic lesions involving the AC.     

Dysphonia in the aging: physiology versus disease.

A chart review from 151 dysphonic patients over the age of 60 was done to define aging related voice disorders. Overwhelmingly, patients suffered from dysphonia due to disease processes associated with aging rather than to physiologic aging alone. These include: 1. central neurological disorders affecting laryngeal function (e.g., stroke, Parkinson's disease, essential tremor, Alzheimer's disease); 2. benign vocal fold lesions (e.g., Reinke's edema, benign and dysplastic epithelial lesions); 3. inflammatory disorders (e.g., laryngitis sicca, medication effect); 4. laryngeal neoplasia; and 5. laryngeal paralysis. Typical laryngeal findings of vocal fold bowing and breathiness consistent with presbylarynges were present in only six patients. Presbylarynges is not a common disorder and should be a diagnosis of exclusion made only after careful medical and speech evaluation.     

Parálisis unilateral de cuerda vocal de causa extralaríngea: etiología y pronóstico

Introduction and methodologyUnilateral vocal cord paralysis without laryngeal lesions is a relatively frequent entity. It can be the manifestation of numerous diseases from the thorax, neck, skull or systemic. The objective is to study the extralaryngeal etiology of unilateral vocal cord paralysis, its prognosis and the relationship of both with different clinical variables. Retrospective study of 116 patients with complete unilateral vocal cord paralysis without laryngeal lesions. The patients underwent cervical-thoracic CT +/– evaluation by Neurology with brain MRI to establish the etiology and follow-up for at least 1 year.ResultsThe most common extralaryngeal cause of vocal cord paralysis was cervical surgery (46.5%), followed by tumor (24.1%). Idiopathic paralysis were 15.5%. An association was obtained between sex and etiology (p <0.01), men in relation to malignant pathology and women to iatrogenic disease. Cardiovascular, cerebrovascular, tumor and idiopathic etiology predominate in elderly patients; while in younger patients the surgical one (p <0.01). 18.1% recovered vocal cord mobility. The female sex was related to its recovery (p <0.01). Tobacco and malignant etiology were related to its persistence (p <0.01).ConclusionsThe first extralaryngeal cause of unilateral CV paralysis is surgical followed by lung and thyroid neoplasms. There is a great diversity of lesions that can cause it, in many cases it involves the diagnosis of malignant tumors. Its recovery is more frequent in female patients, non-smokers and with benign pathology.     

Glottal function index: a predictor of glottal disorders in children

OBJECTIVES: Hyperkinetic laryngeal behaviors may be used to achieve glottal closure in the presence of vocal cord disorders. In adults, the Glottal Function Index (GFI) is a validated self-administered survey used to evaluate glottal insufficiency. In children, the relationships between glottal closure and vocal cord lesions have not been examined. We undertook to evaluate the efficacy of the GFI in detecting disorders of the vocal cords in children. METHODS: We evaluated 100 consecutive children who underwent flexible fiberoptic laryngoscopy. A 4-item GFI questionnaire was administered to the parents of each study subject on study entry. The videotapes of the examinations were evaluated and scored by 3 investigators in a blinded manner. The GFI scores were compared in subjects with and without vocal cord findings. RESULTS: The final analysis included 100 children 2 to 16 years of age. The-mean age of the study group was 7.3 years (+/-3.9 years). Of the 100 patients, 54 had vocal cord disorders. The most common was vocal cord nodules, in most cases combined with bowing of the vocal cords; the two variables were highly correlated (p < .01). We performed a receiver operating characteristics test between the presence of vocal cord disorders and the GFI score. We found that the "optimal" score, on which the sensitivity and specificity curves cross, was 3. Of the 54 patients who had vocal cord disorders, the index identified 38 patients (70%), whereas the patients' complaints identified only 30 patients (55.6%). This difference was statistically significant (p < .05). CONCLUSIONS: The GFI is a reliable 4-item symptom index with excellent correlation to the presence of vocal cord lesions in children.     

Congenital laryngeal anomalies presenting as chronic stridor: a retrospective study of 55 patients

Objectives

Congenital laryngeal anomalies are less frequent, but their causes are surprisingly variable. In addition, a variety of synchronous airway lesions as well as comorbidities are accompanied. The objective of this study was to review of patients with congenital laryngeal anomalies presenting as chronic stridor in our experiences.

Methods

Fifty-five patients, 30 male (54.5%) and 25 female (45.4%), were enrolled in this study, and their hospital records were retrospectively reviewed.

Results

The most frequent diagnosis was laryngomalacia (36.4%), followed by subglottic stenosis (30.9%) and vocal cord paralysis (29.1%). Twenty-six (47.3%) of the 55 patients had synchronous airway lesions, whereas thirty-one (56.4%) had various comorbidities. Further analysis was performed in patients diagnosed with laryngomalacia, subglottic stenosis, or vocal cord paralysis, which are major causes of congenital laryngeal stridor. The frequency of synchronous airway lesions was not different significantly in these three groups. On the other hand, the frequency of establishment of airway in patients with laryngomalacia was significantly lower compared to those with subglottic stenosis or vocal cord paralysis. Moreover, median duration of the symptoms and the proportion of patients with poor outcome and decease in laryngomalacia were shorter and lower than that in subglottic stenosis or vocal cord paralysis.

Conclusions

While a variety of congenital airway anomalies were causes of chronic stridor, laryngomalacia was the most frequent diagnosis. Severe condition and progression of symptoms should increase suspicion of the synchronous airway lesions and/or comorbidities, which may be important factors for outcome as well as indication of surgical intervention.     

Histologic behavior of the inflammatory process in autologous fat implantation in rabbit vocal folds

Fat implantation in the vocal fold is described as a method of repairing vocal fold histostructural lesions that correlate with mucosal wave abnormalities. The aim of this study was to evaluate the histologic behavior of autologous fat implants. A fat block was implanted in pockets surgically created in the vocal folds of rabbits, and the inflammatory process induced was compared to the status of the contralateral vocal fold. Twenty-four rabbits were allocated into 3 groups to be sacrificed 1 week, 3 weeks, and 3 months after the implantation. The fat autograft did not cause any unexpected fibrosis, and we consider it a relatively safe material for implantation, with a low tendency to induce epithelial reaction and the ability to repair the histostructure of the vocal fold.     

Evaluation of laryngopharyngeal reflux in patients with suspected laryngopharyngeal reflux, chronic otitis media and laryngeal disorders

We investigated the prevalence of laryngopharyngeal reflux in patients with signs and symptoms of reflux, chronic otitis media and benign and malignant vocal cord lesions. Three groups of patients in Ankara Ataturk Education and Research Hospital ENT–Head and Neck Surgery Clinics were compared between 2005 and 2006. The first group had patients with signs and symptoms of reflux, the second group consisted of patients with chronic otitis media, and in the third group had patients with laryngeal pathology, i.e. vocal cord lesions. The results of pH monitoring of all the three groups of patients were analyzed for laryngopharyngeal reflux. In the evaluation, two different criteria, based on reflux number and time spent in reflux, were used. It was investigated whether there was a difference in terms of reflux among these three groups. Also, the effects of reflux in etiopathogenesis of chronic otitis media and vocal cord lesions are discussed. A total of 84 patients were studied, with 22 patients with signs and symptoms of reflux in Group 1, 42 patients with chronic otitis media in Group 2, and 20 patients with vocal cord lesions in Group 3. No statistical difference could be detected among the groups in terms of the two criteria mentioned above. The frequency of laryngopharyngeal reflux in patients with chronic otitis media and vocal cord lesions was found to be as high as than in the patients with signs and symptoms of reflux. During the treatment of chronic otitis media and laryngeal disorders, we advise reflux work-up, and in case if there is reflux, we recommend reflux treatment in addition to treatment of primary disease.     

Acoustic, aerodynamic, and videostroboscopic features of bilateral vocal fold lesions

Successful treatment of bilateral vocal fold lesions depends on the accuracy of the diagnosis. For example, the preferred treatment for vocal fold nodules is voice therapy: in contrast. treatment for a unilateral vocal fold lesion with a contralateral reactive vocal fold lesion (UVFL/RL) usually involves phonosurgery and voice therapy. Differentiation between vocal fold nodules and a UVFL/ RL is often challenging. The purpose of this study was to facilitate diagnostic accuracy and improve treatment for patients with bilateral vocal fold lesions by attempting to identify distinct features of patients with either vocal fold nodules or a UVFL/RL with acoustic, aerodynamic, stroboscopic, and patient self-perception measures. The objective voice analysis, Voice Handicap Index, and laryngovideostroboscopic examinations of 85 patients with bilateral vocal fold lesions were reviewed. The results indicated that the patients with a UVFL/RL presented a diagnostic profile that was significantly different from that of patients with vocal fold nodules. Statistically significant differences were found for 1) symmetry of vocal fold vibration, 2) amplitude perturbations, 3) estimated subglottic pressure, and 4) Voice Handicap Index. These results suggest that a composite assessment of acoustic, aerodynamic, and videostroboscopic phonatory features facilitates differentiation between patients with vocal fold nodules and those with a UVFL/RL. The improved diagnostic accuracy afforded by multiparametric assessment provides a comprehensive framework for the treatment of these two distinct vocal fold disorders.     

内侧微瓣技术治疗声带良性病变手术前后嗓音主客观分析

目的探讨经支撑喉镜显微镜下内侧微瓣技术治疗声带良性病变的手术疗效及嗓音主客观分析在评价其疗效中的作用。方法对34例声带息肉、6例声带囊肿共40例患者行显微嗓音手术内侧微瓣技术切除病变,手术前后分别行动态喉镜检查、嗓音声学检测及嗓音障碍指数量表评估。以20例(男、女各10例)嗓音正常成年人作对照组。结果全组病例术后第4周行动态喉镜检查示声带黏膜光滑,活动好,开闭佳,手术前后各嗓音声学参数及嗓音障碍指数量表评分变化均有统计学意义(P<0.05),声学参数与嗓音障碍指数评分之间无明显相关性。结论内侧微瓣技术治疗局限声带内侧的良性病变具有安全、切除病变精确彻底、创伤小等优点,疗效满意,符合微创和功能外科的发展趋势;嗓音声学检测、动态喉镜检查及患者自我评估三者相结合可对手术疗效起到综合评估作用。     

Outcome analysis of benign vocal cord lesions by videostroboscopy, acoustic analysis and voice handicap index

Benign vocal cord lesions affect vibratory vocal fold function resulting in significant dysphonia. A prospective study of 30 patients with benign vocal fold lesions was undertaken at our centre to compare the pre and post operative voice using videostroboscopy, voice analysis and voice handicap index. The vibratory pattern of the cord improved as evidenced by the stroboscopic parameters-symmetry, mucosal wave and glottic closure (p<0.05). Voice analysis showed a trend towards normalcy but the values obtained did not attain statistical significance. Voice handicap index showed a reduction in the total and the subscales scores. Videostroboscopy along with acoustic analysis and voice handicap index are useful tools in the objective and subjective assessment of the effectiveness of treatment in patients with benign vocal cord lesions. Their routine use in a voice clinic is recommended.