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significant in patients with moderate dysplasia, but factors, such

as cordectomy type, abnormal amplitude of the vocal fold vi-

brations, and the existence of nonvibrating segment, placed

the patients at greater risk of recurrent disease. In patients

with severe dysplasia type of cordectomy, insufficient glottic

occlusion and abnormal amplitude of the vocal fold vibrations

carried higher risk of recurrent disease than others, but this re-

sult was not statistically significant. In this group, logistic re-

gression could not be performed for phase symmetry because

all patients had asymmetric vibrations of the vocal fold vibra-

tions. For all patients, regardless of the degree of dysplasia, ab-

normal amplitude of vocal fold vibrations (

0.01) was

a significant factor connected with recurrence. Considering

the other factors, the type of cordectomy and the existence of

vibratory segment placed the patients at greater risk of recur-

rence, but this result was not statistically significant.

Regarding the disease progression, none of the considered

factors proved to be statistically significant. Some factors

placed the patients at greater risk of progression (

Table 8

The existence of nonvibrating segment carried higher risk of

progression in group with mild and moderate dysplasia and in

all patients regardless of the degree of dysplasia. In a group

of patients with severe dysplasia, logistic regression could not

be performed for the phase symmetry because all patients had

asymmetric vibrations of the vocal fold vibrations.

DISCUSSION

In our study, there is male predominance in laryngeal dysplasia

(87.5% males). The average age of our patients was 55.63

years, and most patients were in their sixth and seventh decades

of life. There were 105 (93.7%) smokers. These facts aligned

with other studies, with slight variations; therefore, we can gen-

erally expect this demography.

2,9–11

Malignant transformation

occurred in 3.6% of the patients after 12 months of follow-up.

Most patients were from the group with severe dysplasia. Ricci

et al

observed a recurrence rate of 14.1% for all dysplasia

patients. Dispenza et al observed a recurrence rate of 13.2%

for patients with LIN1 and 29% for patients with LIN2 after

a 1-year follow-up.

Malignant transformation in those studies

ranged from 6.48%

to 16%.

9,10,12

Weller et al observed

a progression rate (according to severity) of 21% with severe

dysplasia compared with 14% for mild and moderate

dysplasia, which differed from our results.

Gamboa et al

conducted a study on stroboscopic assess-

ment of chronic laryngitis in 27 patients (eight of whom had dif-

ferent degrees of laryngeal dysplasia). Among the 15 cases with

absence of mucosal wave in the stroboscopic exploration, 60%

of the cases had severe dysplasia with squamous cell carci-

noma. The authors concluded that the stroboscopic results

were related to the pathologic results.

Atypical mucosal waves, as viewed through stroboscopy,

should travel one-half of the width of the superior surface of

the vocal fold during modal phonation. A reduced mucosal

wave and decreased amplitude during modal phonation sig-

nifies stiffness, which may result from a lesion, edema, or

scar. The vocal fold epithelium normally shows five to 10 cell

layers and a thickness of 100–200

m. Arens et al

determined

that vocal fold mucosa shows progressive thickening from nor-

mal epithelium (147

m) over the different epithelial dysplasia

grades (grade I epithelial dysplasia, 258

m; grade II epithelial

dysplasia, 301

m; and CIS, 445

m) up to early invasive car-

cinoma (974

m). This result can explain the increasing num-

ber of patients with decreased mucosal wave in the three

dysplasia groups. Colden et al

also conducted a study to deter-

mine whether stroboscopy is a reliable method for differentiat-

ing invasive glottic carcinoma from intraepithelial atypia and

determining the depth of cancer invasion. The authors exam-

ined 62 keratotic lesions (45 intraepithelial and 17 carcinomas).

The reduced amplitude of vocal fold vibration and/or mucosal

wave propagation associated with keratosis did not reliably

predict the presence of cancer or the depth of cancer invasion.

Reductions in the amplitude of vocal fold vibration and in mu-

cosal wave magnitude were noticed in intraepithelial atypia, de-

spite the fact that there was no invasion into the superficial

lamina propria. The authors concluded that the reduced epithe-

lial flexibility could be caused by voluminous keratosis without

dysplasia and that abnormalities of the superficial lamina prop-

ria could be provoked by inflammation or fibrovascular scar-

ring; for this reason, the absence of mucosal wave was not

synonymous with malignancy.

The existence of atypical vocal fold vibration patterns was

also reported in normophonic speakers.

Nonvibrating seg-

ments were associated with the existence of malignant infiltra-

tion of the vocal fold epithelium and basal membrane. In our

patients, nonvibrating segments were present in 15.1% of the

patients with mild hyperplasia, 38.5% of the patients with mod-

erate hyperplasia, and 54.5% of the patients with severe hyper-

plasia. Shaw and Deliyski

determined the presence of atypical

magnitude and symmetry of the mucosal waves in the vocal fold

vibration of normophonic speakers. In their study, mucosal

wave absence was noted in at least 21% of vocal fold vibration

TABLE 5.

Patients With Recurrent Disease, Progression of the Disease, and Developed Invasive Carcinoma After 12 Months of

Follow-Up

Recurrence (%)

Progression of the Disease (%)

Malignant Transformation (%)

Mild dysplasia

12/53 (22.6)

4/53 (7.5)

0/53 (0)

Moderate dysplasia

9/26 (34.6)

3/26 (11.5)

1/26 (3.8)

Severe dysplasia

7/33 (21.2)

3/33 (9.1)

All patients

28/112 (25)

10/112 (8.9)

4/112 (3.6)

Journal of Voice, Vol. 28, No. 2, 2014