Phonomicrosurgery in Vocal Fold Nodules Quantification of Outcomes in Professional and Non-Professional Voice Users

There are few data demonstratina the specific extent to which surgical intervention for vocal fold nodules (VFN) improves vocal function in professional (P\i'Ll) and nonprofessional voice users (NVU). The objective of this study was to compare and quantify results after phonomicrosurgery for VFN in these patient groups. METHODS: In a prospective clinical study, surgery was performed via microlaryngoscopy in 37 female patients with chronic VFN manifestations (38 +/- 12 yrs. mean SD). Pre- and postoperative evaluations of treatment efficacy comprised videolaryngostroboscopy, auditory-perceptual voice assessment, voice range profile (VRP), acoustic-aerodynamic analysis, and voice handicap index (VHI-9i). The dysphonia severity index (D51) was compared with the vocal extent measure (VEM). RESULTS: PVU (n=24) and NVU (n=13) showed comparable laryngeal findings and levels of suffering (VHI-9i 16 +/- 7 vs 17 8), but PVU had a better pretherapeutic vocal range (26.8 +/- 7.4 vs 17.7 +/- 5.1 semitones, p<0.001) and vocal capacity (VEM 106 +/- 18 vs 74 +/- 29, p<0.01). Three months postoperatively, all patients had straight vocal fold edges, complete glottal closure, and recovered mucosal wave propagation. The mean VHI-9i score decreased by 8 6 points. DSI increased from 4.0 +/- 2.4 to 5.5 +/- 2.4, and VEM from 95 +/- 27 to 108 +/- 23 (p<0.001). Both parameters correlated significantly (r-=0.82). The average vocal range increased by 4.1 +/- 5.3 semitones, and the mean speaking pitch lowered by 0.5 +/- 1.4 semitones. CONCLUSIONS: These results confirm that phonomicrosurgery for VFN is a safe therapy for voice improvement in both PVU and NVU who do not respond to voice therapy alone. Top-level artistic capabilities in PAP were restored, but numeric changes of most vocal parameters were considerably larger in NVU.