Phonotraumatic Lesions

Abstract

It has been documented using Multidimensional Personality Questionnaire 7 and Maudsley Personality Inventory 8 studies that patients with vocal nodules tend to be extroverts with greater social activity, aggression and impulse. Most children with nodules tend to be screamers, incessant and loud talkers. 3 In a study by Nerurkar et al it was found that people with type A personality were more likely to develop vocal pathologies. 9 Laryngopharyngeal reflux (LPR) has emerged as a major contributing factor to the development of nodules. This association is well documented on the basis of ambulatory, three-site pharyngoesophageal pH monitoring as well as barium esophagography. 10 The baseline inflammation resulting from episodes of LPR adds to the stress of vocal folds during overuse and misuse. 3 Preponderance of nodules in patients with congenital microwebs has also been documented. 11,12 Immunohistochemical studies have shown that fibronectin, a glycoprotein present in the extracellular matrix, is increased in the SLP of patients with nodules. 13 Gray et al., in a study of nodules of human vocal folds, showed important disarrangement of the BMZ where the overall thickness appeared markedly increased. The anchoring fibers were oriented in multiple directions and were not always linking the lamina densa to the lamina propria. In addition, some of them seemed partially formed, truncated, and rudimentary, incapable of forming secure attachment. 14 Allergy may also contribute to nodule formation along with other risk factors like vocal abuse and reflux. 15 The pathophysiology of vocal nodules relies on the mid-membranous vocal fold experiencing maximal shearing and collision forces resulting in localized vascular congestion with edema. Eventually, hyalinization of Reinke's space with BMZ injury