[Phoniatric surgery and conservative treatment of vocal cord hematoma].
BACKGROUND
Functional-traumatic lesions of the vocal fold include mucous stranding, "nodular" lesions, polyps, cysts, contact hyperplasia and haematoma of the vocal fold. An acute voice overuse may result in bleeding (haematoma) within the vocal fold. This may be in the form of petechial bleeding, or a genuine haematoma develops within the tissues of the vocal fold. Haematoma may also arise as a consequence of prolonged cough, forceful vomiting, lifting of a heavy weight, various effortful activities, etc. Haematoma is usually located close to the vocal fold free edge and therefore disturbs the glottic closure during phonation. The treatment is adapted to the size and localization of haematoma, as well as to the time elapsed from onset of the lesion. Phonosurgery can be used in therapy, as well as corticosteroid treatment.


METHODS
A series of 102 vocal fold haematomas has been treated by phonosurgery (39) and conservative therapy (63). Phonosurgical interventions were performed by an indirect approach, by use of microstroboscopy (28 patients) and videostroboscopy (11 causes). Conservative treatment consisted of corticosteroid therapy.


RESULTS
During a 10-year period 1550 phonosurgical operations were performed for benign lesions of the vocal fold, including 39 haematomas (2.5%). It was established that recovery of vibration pattern was significantly faster in the surgery group in comparison to the group of patients treated conservatively. All surgical patients were operated within the first several days after the onset of symptoms.


CONCLUSIONS
In case of a vocal fold haematoma, it is very important to establish the diagnosis as soon as possible in order to start with the therapy early enough. Within the first several days after the onset (the best within 24-48 hours) a phonosurgical treatment is indicated, preferably by the use of indirect videostroboscopy. If the treatment is started later we use corticoids. However, the results are inferior as compared to surgery. We did not perform direct microlaryngoscopy in these cases, for a lack of function monitoring and possible local trauma to the tissues. In the majority of cases the voice therapy is required as well.
Milutinović
Z
Z
Department of Otorhinolaryngology, Maxillofacial and Cervical Pathology, Zemun Clinical and Hospital Centre, Belgrade.
D006406:Hematoma / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007818:Laryngeal Diseases / Q000188:drug therapy / Q000601:surgery; D014827:Vocal Cords