Pathological sulcus vocalis: treatment approaches and voice outcomes in 36 patients

Abstract

Purpose: This is a retrospective study to evaluate the results of surgical treatment of patients with pathological sulcus vocalis.

Methods: Thirty-six patients with pathological sulcus underwent surgery and in 33 cases were performed additional injection laryngoplasty. The pre- and postoperative evaluation of patients included the GRBAS scale, stroboscopic, and objective acoustic voice assessment. The Voice Handicap Index questionnaire (VHI-30) was also used and the scores were obtained from 33 patients.

Results: The stroboscopic evaluation showed significant improvement of amplitude, mucosal wave, and glottal closure after treatment (p < 0.001). The VHI-30 scores decreased considerably indicating improvement due to the treatment for all aspects measured by VHI (p < 0.05, or p < 0.01). In all domains of GRBAS scale, the differences between preoperative and postoperative assessment were statistically significant (p < 0.001). We observed a significant change in Shim and APQ parameters (p < 0.05). Improvement was also observed in the sAPQ parameter, but it was not statistically significant (p = 0.051). For the remaining acoustic parameters, no changes were observed.

Conclusions: The surgical procedure with supplementary injection laryngoplasty of the vocal folds is a good treatment option for pathological sulcus vocalis. The post-treatment self-assessment indicates the significant improvement in VHI, just as perceptual-acoustic evaluation of voice does. Patients with pathological sulcus frequently present with amplitude disturbances, what explains their significant improvement after treatment.

Keywords: Hyaluronic acid; Injection laryngoplasty; Microlaryngoscopy; Sulcus glottidis; Sulcus vocalis.

Fig. 1

Bilateral sulcus type 2 (LVS)

Fig. 2

Bilateral sulcus type 3 (LVS)

Fig. 3

a Sulcus type 3 of the left vocal fold (LVS). b Same patient (intraoperative view)