The Role of Vocal Rest After Removal of Benign Lesions From Vocal Cord
Condition: Vocal Fold Polyp; Vocal Cord Dysfunction
MeSH terms: Vocal Cord Dysfunction
Study type: Interventional

Summary: 
      The accepted recommendation after removal of vocal cord lesion is voice rest.This
      recommendation leads to great tension among the patients, loss of working days and need to
      practice speech therapy.The investigators hypothesize that voice rest after surgery does not
      affect the quality of the patient's voice. The investigators will divide the patients into 2
      groups: the first group will be instructed for a postoperative voice rest and the second
      group will not. Later the investigators will compare the results and conclude whether voice
      rest had any significance.
    

Detailed description: 
      The prevailing view among laryngologists is that voice rest after laryngeal surgery is
      important to ensure a good recovery of the epithelium and lamina propria layers of the vocal
      cord. Speaking immediately after surgery leads to the formation of an irregular collagen in
      large quantities of the vocal cords - namely the creation scar tissue. The scarred vocal
      cords leads to a decrease in its elasticity, which is reflected in poor speech quality.
      Although this theory, not many works were published in the literature proving the necessity
      for voice rest after vocal cord surgery.

      Several studies have been recently published which claim that there is no need for vocal rest
      and stress the importance of a moderate voice effort straight after surgery. This need is
      based on the idea that early mobilization of tissue after surgery led to the creation of a
      healthy soft tissue architecture.

      The investigators hypothesize that there is no role for vocal rest after surgery to remove
      benign lesions from the vocal cords.

      Patients candidate for laryngeal surgery that include removal of a benign vocal cord lesion
      will be divided into two groups:

        1. Patients instructed for the conventional post operative voice rest, namely absolute
           voice rest for a week and another week of relative voice rest (speaking is allowed for
           20 minutes a day).

        2. Patients instructed to speak freely without restrictions after the surgery. those are
           the study phases: * first visit- preoperative visit.

             -  First the investigators prove by fiber optic examination that the patient suffers
                from the scourge of benign vocal cord lesion. Then the patient gets an explanation
                of the study, fill a demographic questionnaire. Next the patient fills the VHI
                (voice handicap index) questionnaire - a questionnaire which assesses the impact of
                the patient voice by 3 measures:emotional,functional and psychosocial. The
                questionnaire contains 30 questions. Any question dotted between 0-4 by the patient
                so that a higher score means more bad sound.

             -  Optical fiber testing is performed. Vocal cords including the lesion are
                photographed and video files are saved . Stroboscopic test for determining the
                quality of vibration, movement and closure of the vocal cords.The patient voice is
                recorded for future determination of the GRBAS (Grade,Roughness, breathiness,
                asthenia,strain). this index, scored by the laryngologists assesses the patient's
                voice according to five factors- grade, roughness, breathiness, asthenia,strain.
                Each parameter dotted between 0-3 so a higher score means more bad sound.The last
                test is objective. The voice recording will undergo computer analysis which
                determine the following voice objectives : fundamental frequency, jitter, shimmer,
                harmonic to noise ratio.

      Lastly the patient is randomized (by block randomization) to determine to which group the
      patient belongs.

      Patients belonging to the control group (standard post operative voice rest) receive a form
      where they annotate every day whether they kept on the instructed sound regime. This log will
      allow the investigators to track the compliance of the patients belonging to the voice rest
      group.

        -  Second visit- 3 days post operative

             -  Execute an optical fiber examination for description and evaluation of the recovery
                process of the vocal cord.

             -  Vocal cords including the lesion will be photographed and video files are saved.
                stroboscopic test for future determination of the quality of vibration, movement
                and closure of the vocal cods.

        -  Third visit- 14 days post operative

      Same examination as the second visit are performed plus:

      - The patient voice will be recorded to determine the GRBAS Index by the laryngologist.
      recording of the patient's voice for an objective voice analysis evaluation using a computer.

        -  Forth visit- 1 months post operative. Same examinations as the second visit are
           performed.

        -  Fifth visit- 3 months post operative. Same examinations as the second visit are
           performed plus patient fills VHI questionnaire.

        -  Sixth visit- 6 months post operative. Same examinations as the fifth visit are
           performed.
    

Intervention name(s): post operative voice rest; No voice rest
Intervention type(s): Behavioral; Behavioral
Intervention description(s): After surgery, a week of total silence. In the second week after surgery talking is allowed for 20 minutes a day.; No limitations regarding post operative speech. Members can talk indefinitely after surgery with no special restrictions
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The research group is the group of patients who do not keep voice rest and talk without restrictions or special instructions after surgery.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: voice rest; laryngeal surgery; glottic polyp; glottic cyst