CLARK A. ROSEN, MD; LORI E. LOMBARD, PHD; THOMAS MURRY, PHD

PITTSBURGH, PENNSYLVANIA

Successful treatment of bilateral vocal fold lesions depends on the accuracy of the diagnosis. For example, the preferred treatment for vocal fold nodules is voice therapy; in contrast, treatment for a unilateral vocal fold lesion with a contralateral reactive vocal fold lesion (UVFL/RL) usually involves phonosurgery and voice therapy. Differentiation between vocal fold nodules and a UVFL/RL is often challenging. The purpose of this study was to facilitate diagnostic accuracy and improve treatment for patients with bilateral vocal fold lesions by attempting to identify distinct features of patients with either vocal fold nodules or a UVFLIRL with acoustic, aerodynamic, stroboscopic, and patient self-perception measures. The objective voice analysis, Voice Handicap Index, and laryngovideostroboscopic examinations of 85 patients with bilateral vocal fold lesions were reviewed. The results indicated that the patients with a UVFL/RL presented a diagnostic profile that was significantly different from that of patients with vocal fold nodules. Statistically significant differences were found for 1) symmetry of vocal fold vibration, 2) amplitude perturbations, 3) estimated subglottic pressure, and 4) Voice Handicap Index. These results suggest that a composite assessment of acoustic, aerodynamic, and videostroboscopic phonatory features facilitates differentiation between patients with vocal fold nodules and those with a UVFL/RL. The improved diagnostic accuracy afforded by multiparametric assessment provides a comprehensive framework for the treatment of these two distinct vocal fold disorders.