Journal article
An Exploration of the Risk Factors, Severity, and Sequelae of Vocal Fold Hemorrhage in a Population of Voice Patients Before and After Diagnosis
Journal of voice
05 Aug 2023
PMID: 37550112
Abstract
Vocal fold hemorrhage (VFH) is the rupture (usually acute) of a blood vessel within the true vocal fold. The long-term sequelae of VFH on the mucosal wave (MW) and glottic gap (GG) on videostroboscopy remain understudied. The primary objective of this study was to investigate the short-term and long-term consequences of VFH through measured and rated analysis of the mucosal wave and glottic gap.
The presence of VFH and its extent (limited/moderate vs. extensive VFH) were identified. The primary outcome of this study was mucosal wave, which was assessed on an ordinal scale by three blinded raters pre- and post-hemorrhage. Only patients who had undergone strobovideolaryngoscopy before sustaining VFH were included. Mucosal wave and glottic gap also were measured using image pixel analysis using the open-access tool, ImageJ (NIH, Bethesda, MD).
Twenty-three subjects were included in this study (mean age 39.78 ± 15.54). Intra-rater reliability for MW ratings was 81.48% ± 6.150% (minimum 77.78%) for all evaluators (κ = 0.519 [0.267-0.772], P < 0.001). Inter-rater reliability analysis revealed 75.56% agreement between evaluators (κ = 0.524 [0.425 - 0.623], P < 0.001). MWMeasured extrapolated from ImageJ methodology correlated significantly with MWRated (n = 70, r = 0.448, p < 0.001). ΔMWMeasured from baseline to follow-up evaluation were compared for both the initial follow-up visit (FU1) and the second follow-up visit (FU2) [-4.135 ± 31.01 vs. 36.50± 39.97, p =0.025]. Hence, ΔMWMeasured was significantly better by FU2 than FU1, with the larger positive change from baseline representing a greater improvement in the measured mucosal wave. Additionally, there were significant differences in ΔMWRated between those with limited/moderate VFH and those with extensive VFH at FU1. Duration of absolute voice rest correlated significantly with time to VFH resolution. Long-term change in mucosal wave after hemorrhage was assessed using both ΔMWMeasured and MWRated. Based on ΔMWRater, 35.0% of subjects demonstrated ongoing and worse mucosal wave restriction compared to baseline at their most recent follow-up visit. Based on ΔMWMeasured, 50.0% of subjects showed ongoing and worse mucosal wave restriction compared to baseline at their most recent follow-up visit.
Overall long-term restrictions in MW after hemorrhage were present in 35.0% of subjects based on ratings and 50.0% of patients based on the measured MW using ImageJ, demonstrating the importance of ongoing study into this pathology and how to prevent it, especially in PVU and professional singers. Patients presenting with extensive hemorrhage were at risk for more prominent, detectable changes in mucosal wave compared to those with limited/moderate hemorrhage in the short-term, defined by a mean FU time of three months, but not long-term, characterized by a mean FU time six months or greater. Whether the severity of VFH is a true indicator of mucosal wave alterations requires additional study, as does the reliability and validity of ImageJ mucosal wave and glottic gap measurement techniques.
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3 citations in Scopus
Details
- Title
- An Exploration of the Risk Factors, Severity, and Sequelae of Vocal Fold Hemorrhage in a Population of Voice Patients Before and After Diagnosis
- Creators
- Parastou Azadeh Ranjbar - Drexel UniversityPhilip Maxwell - Drexel UniversityAlexander Barna - Drexel UniversityBailey Balouch - Drexel UniversityMary Hawkshaw - Drexel UniversityAhmad Issa Al Omari - Department of Otolaryngology-Head and Neck Surgery Drexel University College of Medicine Jordan University of Science and TechnologyKaren Lyons - Drexel UniversityGhiath Alnouri - Drexel UniversityRobert T. Sataloff - Drexel University
- Publication Details
- Journal of voice
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine; Otolaryngology (and Head and Neck Surgery)
- Scopus ID
- 2-s2.0-85167828448
- Other Identifier
- 991021901009904721