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Laryngorhinootologie 2017; 96(09): 597-606
DOI: 10.1055/s-0043-110859
Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Phonochirurgie – eine retrospektive Analyse von 400 Eingriffen

Phonomicrosurgery – a retrospective analysis of 400 cases
Rudolf Reiter
,
Thomas Hoffmann
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Publication History

Publication Date:
12 June 2017 (online)

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Zusammenfassung

Einleitung Stimmstörungen sind u. a. durch Pseudotumore der Stimmlippen oder durch Stimmlippenparesen mit inkomplettem Glottisschluss bedingt und können eine phonochirurgische Therapie erfordern. Es sollten derartige Eingriffe hinsichtlich postoperativem Stimmergebnis und Sicherheit des Verfahrens analysiert werden.

Methode Im Rahmen einer retrospektiven Analyse von 400 konsekutiven phonochirurgischen Eingriffen wurden folgende Parameter erfasst: Verteilung der Pathologien, Einschätzung der Stimmqualität 6 Wochen nach dem chirurgischen Eingriff im Vergleich zu präoperativ durch den Patienten und Untersucher (RBH-System), Videolaryngostroboskopie, Komplikationen und histologisches Ergebnis.

Ergebnisse Im Kollektiv dominierten Stimmlippenpolypen (36 %), -zysten (12 %) und -paresen (10 %). Nach dem Eingriff verbesserte sich die Stimmqualität in 90 % der Fälle.

Bei 14 % war aufgrund einer Fehlkompensation eine postoperative Stimmtherapie erforderlich. Nach einer Stimmlippenaugmentation entwickelten sich je in einem Fall ein Larynxödem und eine temporäre Stimmlippenparese der Gegenseite. Die histologische Aufarbeitung erbrachte als Zufallsbefund einen malignen osteoklastären Riesenzelltumor, einen Granularzelltumor und ein Carcinoma in situ der Stimmlippe, welche einer weiterführenden chirurgischen Behandlung und Kontrollen zugeführt werden musste.

Diskussion Die mikrolaryngoskopische Phonochirurgie ist ein sicheres und effektives Therapieverfahren. Die histologische Aufarbeitung ist auch bei makroskopisch primär unsuspekten Tumoren sinnvoll, damit seltene Tumorentitäten oder Malignome nicht übersehen werden. Eine postoperative Observation ist zur frühzeitigen Erkennung und Behandlung von Komplikationen wie Larynxschwellung oder Stimmlippenparese anzuraten.

Abstract

Introduction Voice disorders caused by pseudotumors of the vocal folds or paralysis of the vocal folds with incomplete glottis closure frequently require phonomicrosurgery. These interventions were analyzed with regard to quality of voice after surgery and safety of the intervention.

Methods Retrospective analysis of 400 consecutive phonomicrosurgery interventions. The following parameters were collected: distribution of pathologies of the vocal folds, rating of the voice quality by both the surgeon (RBH-system) and patient and videolaryngstroboscopy six weeks after the intervention compared to the state prior to surgery, complications and results of histological examination.

Results In our collective vocal fold polyps (36 %), cysts (12 %) and paralysis (10 %) dominated. After the intervention the quality of voice improved in 90 % of all cases. In 14 % voice therapy was needed postoperatively because of hyperfunction.

After vocal fold augmentation one patient developed an edema of the larynx and another patient a temporary paralysis of the vocal fold of the opposite side. The histological examination showed as incidental findings a malignant osteoclastic giant cell tumor, a granular cell tumor and a carcinoma in situ of the vocal fold requiring further surgery and follow up.

Discussion Phonomicrosurgery is a safe and effective therapy. The histological examination is also useful in patients with macroscopically non suspicious lesions to recognize rare or malignant tumor entities. Patient observation with early detection as well as therapy of complications like edema of the larynx or vocal fold paralysis is recommended.

Schlüsselwörter

Phonochirurgie - Stimme - Heiserkeit - Stimmlippentumor - Stimmlippenparese

Key words

voice - dysphonia - phonosurgery - vocal fold paralysis - tumor of the vocal fold
 

  • Literatur

  • 1 Cohen SM, Kim J, Roy N. et al. Prevalence and causes of dysphonia in a large treatment-seeking population. Laryngoscope 2012; 122: 343-348
    CrossrefPubMedGoogle Scholar
  • 2 Reiter R, Hoffmann TK, Pickhard A. et al. Hoarseness-causes and treatments. Dtsch Arztebl Int 2015; 112 (19) 329-337
    PubMedGoogle Scholar
  • 3 Van Houtte E, Van Lierde K, D‘Haeseleer E. et al. The prevalence of laryngeal pathology in a treatment-seeking population with dysphonia. Laryngoscope 2010; 120: 306-312
    CrossrefPubMedGoogle Scholar
  • 4 Remacle M, Friedrich G, Dikkers FG. et al. Phonosurgery of the vocal folds: a classification proposal. Eur Arch Otorhinolaryngol 2003; 260: 1-6
    CrossrefPubMedGoogle Scholar
  • 5 Zeitels SM, Healy GB. Laryngology and phonosurgery. N Engl J Med. 2003; 349 (09) 882-892
    CrossrefPubMedGoogle Scholar
  • 6 Altman KW. (2007) Vocal fold masses. Otolaryngol Clin North Am 2007; 40 (05) 1091-1108
    CrossrefPubMedGoogle Scholar
  • 7 Jensen JB, Rasmussen N. Phonosurgery of vocal fold polyps, cysts and nodules is beneficial. Dan Med J 2013; 60 (02) A4577
    PubMedGoogle Scholar
  • 8 Nawka T, Martin A, Caffier PP. Microlaryngoscopy and phonomicrosurgery. HNO 2013; 61 (02) 108-116
    CrossrefPubMedGoogle Scholar
  • 9 Nawka T, Hosemann W. Voice disorder. Surgical procedures. Laryngorhinootologie 2005; 84 (Suppl. 01) S 201-212
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Schwartz SR, Cohen SM, Dailey SH. et al. Clinical practice guideline: hoarseness (dysphonia). Otolaryngol Head Neck Surg 2009; 141 (3 Suppl 2) S1-S31
    PubMedGoogle Scholar
  • 11 Reiter R, Brosch S. Laryngoplasty with hyaluronic acid in patients with unilateral vocal fold paralysis. J Voice 2012; 26 (06) 785-791
    CrossrefPubMedGoogle Scholar
  • 12 Reiter R, Brosch S. Voice assessment and demographic data of applicants for a school of speech therapists. Laryngorhinootologie 2008; 87 (05) 331-334
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Nawka T, Wiesmann U, Gonnermann U. Validation of the german version of the Voice Handicap Index. HNO 2003; 51 (11) 921-930
    CrossrefPubMedGoogle Scholar
  • 14 Hertegård S, Hallén L, Laurent C. et al. Cross-linked hyaluronan used as augmentation substance for treatment of glottal insufficiency: safety aspects and vocal fold function. Laryngoscope 2002; 112 (12) 2211-2219
    CrossrefPubMedGoogle Scholar
  • 15 Song PC, Sung CK, Franco Jr RA. Voice outcomes after endoscopic injection laryngoplasty with hyaluronic acid stabilized gel. Laryngoscope 2010; 120 (Suppl. 04) S199
    CrossrefPubMedGoogle Scholar
  • 16 Pickhard A, Reiter R. Benign vocal fold lesions. Laryngorhinootologie 2013; 92 (05) 304-212
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Benjamin B, Croxson G. Vocal cord granulomas. Ann Otol Rhinol Laryngol 1985; 94 (6 Pt 1) 538-541
    CrossrefPubMedGoogle Scholar
  • 18 Derkay CS, Wiatrak B. Recurrent respiratory papillomatosis: a review. Laryngoscope 2008; 118 (07) 1236-1247
    CrossrefPubMedGoogle Scholar
  • 19 Mallur PS, Rosen CA. Vocal fold injection: review of indications, techniques, and materials for augmentation. Clin Exp Otorhinolaryngol 2010; 3 (04) 177-182
    CrossrefPubMedGoogle Scholar
  • 20 Sielska-Badurek E, Domeracka-Kołodziej A, Zawadzka R. et al. Vocal fold paralysis in the Medical University of Warsaw‘s Ambulatory of Phoniatry in years 2000–2011. Otolaryngol Pol 2012; 66 (05) 313-317
    CrossrefPubMedGoogle Scholar
  • 21 Takano S, Nito T, Tamaruya N. et al. Single institutional analysis of trends over 45 years in etiology of vocal fold paralysis. Auris Nasus Larynx 2012; 39 (06) 597-600
    CrossrefPubMedGoogle Scholar
  • 22 Reiter R, Hoffmann TK, Rotter N. et al. Etiology, diagnosis, differential diagnosis and therapy of vocal fold paralysis. Laryngorhinootologie 2014; 93 (03) 161-173
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Cipriani NA, Martin DE, Corey JP. et al. The clinicopathologic spectrum of benign mass lesions of the vocal fold due to vocal abuse. Int J Surg Pathol 2011; 19 (05) 583-586
    CrossrefPubMedGoogle Scholar
  • 24 Marcotullio D, Magliulo G, Pietrunti S. et al. Exudative laryngeal diseases of Reinke‘s space: a clinicohistopathological framing. J Otolaryngol 2002; 31 (06) 376-380
    CrossrefPubMedGoogle Scholar
  • 25 Weller MD, Nankivell PC, McConkey C. et al. The risk and interval to malignancy of patients with laryngeal dysplasia; a systematic review of case series and meta-analysis. Clin Otolaryngol 2010; 35: 364-372
    CrossrefPubMedGoogle Scholar
  • 26 Montgomery J, White A. A decade of laryngeal dysplasia in Paisley, Scotland. Eur Arch Otorhinolaryngol 2012; 269: 947-951
    CrossrefPubMedGoogle Scholar
  • 27 Froboese N, Barth T, Brosch S. et al. Osteoclastic giant cell tumor of the vocal cord. Laryngorhinootologie 2015; 94 (04) 246-247
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Reiter R, Ruess J, Brosch S. et al. Refractory hoarseness in patient with granular cell tumor of the vocal cord. Laryngorhinootologie 2016; 95 (02) 125-126
    Article in Thieme ConnectPubMedGoogle Scholar