Vocal pathologies of difficult diagnosis.

The objective of this study was to review four vocal pathologies difficult to diagnose (vocal sulci, submucosal cysts, pseudocysts, and mucosal bridges) seen in the Principe de Asturias University Hospital Voice Unit (Alcalá de Henares, Madrid, Spain) over a 9-year period. This study was to show the prevalence of these pathologies out of the total number of benign vocal pathologies, basing our findings on clinical and stroboscopic criteria; and to analyze the stroboscopic-surgical correlation of the series over the last 3 1/2 years. This study was a retrospective review of the stroboscopies carried out between 1993 and 2002, of the suspected diagnoses offered by three ENT specialists. The data were based on the video archives of the unit and surgical notes. We reviewed 4206 stroboscopies, 189 (4.5%) corresponded to new cases. Within this group, we found the following distribution: 48% of vocal sulci, 42% of submucosal cysts, 10% of pseudocysts, and 0% of mucosal bridges. Seventy-nine percent showed unilateral pathology. The sulci showed the highest percentage of bilaterality (33%). The stroboscopic-surgical correlation (1999-2002) was positive in 69% of the sulci, 78% of the cysts, and 100% of the pseudocysts. In our series, 4.5% of the stroboscopies were performed on these groups of difficult diagnosis. For these pathologies, the stroboscopy is the exploratory method that offers more information and that allows us to obtain an optimal correlation between diagnostic suspicion and surgical evidence.