more than 50% of individuals with voice disorders have benign alterations of the vocal fold mucosa .
polyps are one of the most frequent vocal cord lesions and are the most prevalent indication for laryngeal microsurgery . like nodules ,
polyps are caused by overuse and abuse of the voice1 , although they may also occur as a result of a single traumatic incident2 
 3 .
trauma can affect the superficial vases of the lamina propria causing the liquids within to overflow , displacing the epithelial layer and inducing scarring due to the deposition of fibrin and vascular proliferation .
depending on the type of vascularization , polyps are classified as angiomatous or hemorrhagic if accompanied by vascularity or as hyaline or gelatinous in the absence of vascularization .
the clinical picture is characterized by dysphonia related to intense vocal use , and is generally well - defined and recognized by the patient . the dysphonia is constant , and may progressively worsen .
the voice presents as hoarse and breathy ; sometimes it can be rough and , infrequently , diplophonic .
a diagnosis is made by assessing the clinical history , and by perceptive analysis and observation of the phonatory system , which includes assessments of the phonatory posture adopted , articulation , and attitude .
vocal polyps can have many presentations and characteristics , and the aim of our study was to identify the characteristics of the polyps found in our population .
the objective of this study was to analyze and compare the features of polyps ( intrinsic characteristics , associated lesions , and treatment outcomes ) from patients undergoing laryngeal surgery at our hospital .
this prospective study was conducted from february 2010 to february 2011 using an electronic computerized protocol once the approval of the ethics committee had been obtained ( caee : 0286.0208.000 - 11 ) .
we used the sinpe  electronic protocol with the sinpe analyzer for data analysis5 
 6 
 7 .
the protocol - based software program is capable of storing and manipulating data on a theoretical basis .
the sinpe analyzer module is used to create reports , graphs , and statistics summarizing the main findings .
a specific protocol for laryngeal disorders among the master ent protocol available in sinpe was used for the analysis ; only patients diagnosed with vocal fold polyps were analyzed . in total ,
the inclusion criteria were as follows : a diagnosis of polyps , clinical laryngoscopy , and intraoperative confirmation of the diagnosis by anatomopathology .
exclusion criteria were as follows : a diagnosis of infiltrative processes or storage disease ( vocal polyps not identified upon anatomopathologic examination ) .
of the 245 patients who underwent surgery during the study period , 93 ( 36.61% of lesions ) with vocal polyps and an indication for microsurgery were evaluated .
these 93 patients were classified into 2 groups according to the physical and histological characteristics of the lesions : ( a ) those with angiomatous polyps ( n  =  63 , 67.75% ) and ( b ) those with gelatinous polyps ( n  =  30 , 32.25% ) .
comparisons between the 2 groups were made according to 12 anatomic and surgical parameters based on the polyp characteristics .
parameters 18 refer to the intrinsic characteristics of the polyps ( table 1 ) , parameters 9 and 10 refer to polyp - associated lesions ( table 2 ) , and parameters 11 and 12 refer to the treatment strategy ( table 3 ) .
the protocols were performed on the day before surgery after the pre - anesthetic consultation , and supplemented during the postoperative follow - up .
endolaryngeal microsurgeries were performed in the operating room of the same institution using suspension laryngoscopy ( sl ) by 3 doctors from the laryngology and voice service department . during sl ,
statistical analyses were performed using the chi - square test to compare the variables discussed above , and the significance level was set at p  <  0.05 .
all 93 patients underwent laryngeal surgery due to a diagnosis of polyps of the vocal folds during the period february 2010 to february 2011 . of these , 63 ( 64.74% ) had angiomatous and 30 ( 32.26% ) had gelatinous polyps . regarding sex , 51 were male and 42 female .
the distribution according to the 12 parameters for each type of polyp is shown in tables 4 , 5 , and 6 .
benign lesions of the vocal folds represent a significant problem for otolaryngologists because they are very common and require a multidisciplinary treatment approach .
when such lesions do not respond to drug therapy and/or speech therapy , surgery is required with the aim of increasing phonatory function or establishing a histological diagnosis by biopsy8 
 9 . in our study , we found 93 ( 36.61% ) polyps among 245 patients with vocal fold lesions who underwent laryngeal surgery during the period from february 2010 to february 2011 in our hospital .
this was the most frequent diagnosis observed in this study , which supports the reports by haas & doderlein , mossallam , and lehmann and kleinsasser , who noted that polyps were the main indication for laryngeal microsurgery10 
 11 
 12 
 13 .
angiomatous polyps were more common ( 63 patients , 64.74% ) than gelatinous polyps ( 30 patients , 32.26% ) .
in addition , we noticed a male predominance among patients with angiomatous polyps and a female predominance among those with gelatinous polyps . the chi - square test ( significance level , p  =  0.008 ) showed that the type of polyp was dependent on sex .
the male predominance of angiomatous polyps ( 65.08% ) is consistent with the findings reported in the literature3 
 14 
 15 , but there was no male predominance of gelatinous polyps . instead ,
these were more common in women ( 66.67% ) , which is a similar finding to that obtained by dailey , who reported a female incidence of 62% among patients with gelatinous polyps16 .
in addition , female patients with increased vocal fold mass have a lower pitch , which has a greater impact on the social life of these patients than is the case with male patients .
regarding size , the statistical analysis demonstrated that the polyp size was dependent on type .
most angiomatous polyps were of medium size ( 68.25% ) whereas most gelatinous polyps were small ( 56.67% ) ( p  =  0.001 ) .
angiomatous polyps were also found most frequently in the middle third of the vocal fold ( 51.43% ) , whereas the gelatinous polyps tended to be found in the middle and posterior thirds of the fold ( 36.67% each ) ( p  =  0.02 ) .
thus , the position of the polyp in the vocal fold was also dependent on type . in our study ,
both angiomatous and gelatinous polyps were predominantly found on the right vocal fold ( p  =  0.009 ) , and so there is also a relationship between polyp type and its location on the vocal fold .
reported similar findings14 , whereas sakae et al.17 reported that polyps were found in the left vocal fold in 53% of cases .
the presence of msa occurred in 47.61% of patients with angiomatous polyps , in comparison with 20% of patients with gelatinous polyps ( p  =  0.02 ) .
there was thus also a correlation between polyp type and the presence of msa ( greater in angiomatous polyps ) . in sakae et al .
reaction nodular lesions were found in 41.26% of the patients with angiomatous polyps and 43.33% of the patients with gelatinous polyps .
there was no statistical difference between the two groups ( p  =  0.97 ) .
in eckley et al . 's study14 , 37% of patients had reaction lesions , confirming the suspicion that the impact of the polyp on the healthy vocal fold can cause long - term alterations in the epithelial layer of the contralateral vocal fold14 
 18 . regarding the msa ,
stria were the most frequently encountered lesions ( 49.9% ) in angiomatous polyps , whereas varicosity was predominant in gelatinous polyps ( 66.66% ) . in eckley et al .
's study14 , stria were the most frequently encountered msa ( 70% ) . in our study , the patients underwent larynx surgery with sl , which led to considerable improvement in voice quality and the remission of other symptoms .
the surgical technique most commonly used for angiomatous polyps is to grab the polyp and resect it with a microscissors ( 57.14% ) . for gelatinous polyps ,
the main surgical technique is to create a medial microflap and then resect it with a microscissors ( 60% ) .
all of the patients underwent speech therapy with optimal developments in most cases ( 88.89 and 93.33% for those with angiomatous and gelatinous polyps , respectively ) .
there is a consensus regarding the use of postoperative speech therapy and appropriate follow - up and successful outcome9 .
there was a male predominance among patients with angiomatous polyps , and a female predominance among those with gelatinous polyps .
there was also a correlation between the size of the polyp , and its position and location in the vocal fold and the presence of msa .
different surgical techniques were used , but the postoperative results were similar and satisfactory once the therapy was complete .
 summary 
 introduction :  dysphonia is the main symptom of lesions that affect the vocal tract . many of those lesions may require surgical treatment . polyps are one of the most common forms of vocal cord lesions and the most prevalent indication for laryngeal microsurgery . 
 there are different types of polyps , and their different characteristics can indicate different prognosis and treatments . 
 
 aim :  to conduct a comparative study of polypoid lesions ( angiomatous and gelatinous ) in patients undergoing laryngeal microsurgery via an electronic protocol . 
 
 method :  we prospectively evaluated 93 patients diagnosed with vocal fold polyps ; the polyps were classified as angiomatous or gelatinous . 
 
 results :  in total , 93 patients undergoing laryngeal microsurgery were diagnosed with vocal fold polyps . of these , 
 63 ( 64.74% ) had angiomatous and 30 ( 32.26% ) gelatinous polyps . 
 most patients with angiomatous polyps were men ; their polyps were frequently of medium size , positioned in the middle third of the vocal fold , and accompanied by minimal structural alterations ( msa ) . in contrast , the majority of patients with gelatinous polyps were women ; their polyps were smaller , positioned in the middle and posterior third of the vocal fold , and were not accompanied by msa . 
 both types of polyps were more frequently located on the right vocal fold . 
 
 conclusion :  angiomatous polyps were more frequently encountered than gelatinous polyps . in addition , correlations between polyp type and sex , polyp size , position , location , and the presence of msa were observed . 
 different surgical techniques were used , but the postoperative results were similar and satisfactory after speech therapy . 
Introduction
Methods
Results
Discussion
Conclusion