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A nomenclature paradigm for benign midmembranous vocal fold lesions

Authors

  • Clark A. Rosen MD, FACS,

    Corresponding author
    1. University of Pittsburgh Voice Center , Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    • University of Pittsburgh Voice Center, Department of Otolaryngology, UPMC Mercy, B-11500, Pittsburgh, PA 15219
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  • Jackie Gartner-Schmidt PhD,

    1. University of Pittsburgh Voice Center , Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Bridget Hathaway MD,

    1. University of Pittsburgh Voice Center , Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • C. Blake Simpson MD,

    1. Otolaryngology–Head and Neck Surgery , University of Texas Health Sciences Center, San Antonio, Texas
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  • Gregory N. Postma MD,

    1. Department of Otolaryngology , MCG Center for Voice and Swallowing Disorders, Georgia Health Sciences Center, Augusta, Georgia
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  • Mark Courey MD,

    1. Department of Otolaryngology, University of California San Francisco, San Francisco, California
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  • Robert T. Sataloff MD, DMA

    1. Department of Otolaryngology–Head and Neck Surgery, Drexel University, Philadelphia, Pennsylvania, U.S.A.
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  • Poster presentation at American Laryngological Association Meeting, Chicago, Illinois, U.S.A., April 27–28, 2011.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

There is a significant lack of uniform agreement regarding nomenclature for benign vocal fold lesions (BVFLs). This confusion results in difficulty for clinicians communicating with their patients and with each other. In addition, BVFL research and comparison of treatment methods are hampered by the lack of a detailed and uniform BVFL nomenclature.

Study Design:

Clinical consensus conferences were held to develop an initial BVFL nomenclature paradigm. Perceptual video analysis was performed to validate the stroboscopy component of the paradigm.

Methods:

The culmination of the consensus conferences and the video-perceptual analysis was used to evaluate the BVFL nomenclature paradigm using a retrospective review of patients with BVFL.

Results:

An initial BVFL nomenclature paradigm was proposed utilizing detailed definitions relating to vocal fold lesion morphology, stroboscopy, response to voice therapy and intraoperative findings. Video-perceptual analysis of stroboscopy demonstrated that the proposed binary stroboscopy system used in the BVFL nomenclature paradigm was valid and widely applicable. Retrospective review of 45 patients with BVFL followed to the conclusion of treatment demonstrated that slight modifications of the initial BVFL nomenclature paradigm were required. With the modified BVFL nomenclature paradigm, 96% of the patients fit into the predicted pattern and definitions of the BVFL nomenclature system.

Conclusions:

This study has validated a multidimensional BVFL nomenclature paradigm. This vocal fold nomenclature paradigm includes nine distinct vocal fold lesions: vocal fold nodules, vocal fold polyp, pseudocyst, vocal fold cyst (subepithelial or ligament), nonspecific vocal fold lesion, vocal fold fibrous mass (subepithelial or ligament), and reactive lesion.

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