Observational Study of Clinical, Endoscopic and Voice Characteristics in Patients with Vocal Cord Lesions Presenting with Persistent Hoarseness

Abstract

Background: Persistent hoarseness is a common otorhinolaryngological complaint and may result from a variety of structural vocal cord lesions. Clinical examination alone may not adequately reflect the functional impact of these lesions; therefore, endoscopic findings, perceptual voice assessment, acoustic parameters, and patient-reported voice handicap provide a more comprehensive evaluation.

Aim: To evaluate the clinical, endoscopic, and voice characteristics of patients with vocal cord lesions presenting with persistent hoarseness.

Material and Methods: This hospital-based prospective observational study included 85 patients with persistent hoarseness and an identifiable vocal cord lesion. Detailed clinical history and endoscopic evaluation were performed. Lesions were assessed for type, laterality, mucosal wave, glottic closure, surface characteristics, and supraglottic hyperfunction. Voice evaluation included the GRBAS scale, Voice Handicap Index-10 (VHI-10), fundamental frequency, jitter, shimmer, harmonics-to-noise ratio (HNR), maximum phonation time (MPT), and S/Z ratio. Data were analyzed using IBM SPSS version 24.0, with p<0.05 considered statistically significant.

Results: The mean age was 44.36±12.48 years, and 61.18% were males. Vocal nodules were the most common lesion (25.88%), followed by polyps (21.18%) and cysts (11.76%). Bilateral involvement was frequent in nodules (81.82%) and Reinke’s edema (88.89%) (p<0.001). Reduced or absent mucosal wave varied significantly among lesion types (p=0.004). Moderate dysphonia was present in 43.53% of patients. With increasing dysphonia severity, jitter, shimmer, S/Z ratio, and VHI-10 scores increased significantly, whereas HNR and MPT decreased (all p<0.001). VHI-10 correlated positively with GRBAS grade (r=0.69, p<0.001).

Conclusion: Vocal cord lesions produced distinct endoscopic and voice abnormalities. Combined clinical, endoscopic, perceptual, acoustic, aerodynamic, and VHI-10 assessment provided a comprehensive evaluation of persistent hoarseness.