Voice quality is an integral part of communication and personal identity. For individuals suffering from vocal fold polyps (VFPs), changes in voice quality can significantly affect their daily lives. In a study recently published in the Journal of Voice, researchers directed their attention toward examining how the size of vocal fold polyps could potentially influence voice quality. Below, we delve into the findings of this study, discussing the implications for patients with VFPs and the associated challenges for clinical decision-making.
Study Overview
Title: “Evaluation of Voice Quality in Patients With Vocal Fold Polyps: The Size of a Polyp Matters or Does it?”
Journal: Journal of Voice, Official Journal of the Voice Foundation
DOI: 10.1016/j.jvoice.2019.04.009
Authors: Öcal Bülent, Tatar Emel Ç, Toptaş Gökhan, Barmak Elife, Saylam Güleser, Korkmaz Mehmet H.
Date of Publication: March 2020
Background and Objectives
Vocal fold polyps are benign lesions on the vocal folds that can lead to dysphonia, or impaired voice quality. The study conducted by Öcal Bülent et al. focused on the relationship between the morphological features of VFPs, such as size and shape, and various subjective and objective voice parameters. Previous literature has provided mixed opinions on whether the size of a polyp is influential in dictating voice quality and, consequently, treatment approach.
The main objective of the research was to evaluate whether there is a correlational relationship between the size-related morphological features of VFPs and perceptual, aerodynamic, and acoustic parameters of voice quality. By ascertaining this connection, the study aims to inform clinical protocols in the management of VFPs.
Methodology
The study recruited a cohort of 47 patients, consisting of 30 males and 17 females with vocal fold polyps, with mean ages of 45.2 and 41.3 years, respectively. For each patient, subjective evaluations were performed along with aerodynamic and acoustic tests. Still images were captured from video recordings of the vocal folds to quantify the size-related morphological features of the polyps.
The researchers specifically looked at the length of the polyp base, the ratio of polyp base to vocal fold length, and the glottal gap area. These measurements were then correlated with the objective and subjective voice parameters using Pearson’s and Spearman’s tests.
Key Findings
Contrary to expectations, the study found no significant correlation between the morphological features of the VFPs and any of the voice parameters evaluated. The size of the polyp, the ratio of the polyp base to vocal fold length, and the glottal gap area did not reliably predict the patient’s perceptual voice quality, aerodynamic, or acoustic measurements.
These results indicate that the size and shape of a vocal fold polyp do not necessarily reflect the degree of voice quality impairment. Therefore, clinical decisions regarding the management of VFPs should not be overly reliant on polyp size alone.
Discussion and Implications
The findings of this study challenge commonly held assumptions about the relationship between VFP size and voice quality. For clinicians, this implies that a comprehensive evaluation of voice disorders should go beyond mere anatomical assessments. Treatment protocols might need to place greater emphasis on functional assessments, such as how the vocal folds vibrate and the patient’s subjective experience of their voice problem.
Moreover, this study highlights the complexity of voice disorders and suggests that factors other than VFP size are responsible for the perceived changes in voice quality. It could be that other factors, such as the positioning of a polyp or the specific vibratory patterns of the vocal folds, play a more significant role in voice quality alteration.
Future Research Directions
Despite providing valuable insights, several limitations of the study open up avenues for future research:
Expanding the cohort size could provide more robust data and help to identify more nuanced relationships between polyp size and voice quality.
Longitudinal studies assessing voice quality before and after polyp removal might offer insights into how voice quality can change following treatment and whether size plays a role in recovery.
Research into the biomechanics of polyp vibration and its impact on voice production could further clarify the link between polyp morphology and voice quality.
Conclusion
The study by Öcal Bülent and colleagues raises crucial questions about the influence of vocal fold polyp size on voice quality. While their research did not establish a correlation between polyp size and voice quality parameters, it underscores the need for an integrated approach to the evaluation and treatment of voice disorders. As such, clinicians should remain circumspect about relying solely on morphological characteristics when making clinical decisions regarding vocal fold polyps.
Keywords
1. Vocal fold polyps
2. Voice quality evaluation
3. Vocal fold pathology
4. Polyp size and voice
5. Dysphonia treatment
References
1. Bülent, Ö., Emel Ç. T., Gökhan, T., Elife, B., Güleser, S., & Mehmet H., K. (2020). Evaluation of Voice Quality in Patients With Vocal Fold Polyps: The Size of a Polyp Matters or Does it? Journal of Voice, 34(2), 294-299. https://doi.org/10.1016/j.jvoice.2019.04.009
2. Sulica, L., & Blitzer, A. (Eds.). (2006). Vocal Fold Paralysis. Springer-Verlag Berlin Heidelberg.
3. Sataloff, R. T. (2005). Professional Voice: The Science and Art of Clinical Care. Plural Publishing.
4. Casiano, R. R., Zaveri, V., & Lundy, D. S. (2006). Efficacy of Videostroboscopy in the Diagnosis of Voice Disorders. Otolaryngologic Clinics of North America, 39(1), 115-128.
5. Verdolini, K., Rosen, C. A., & Branski, R. C. (Eds.). (2006). Classification Manual for Voice Disorders-I. Lawrence Erlbaum Associates.