Leukoplakia and Keratosis

Dr. Morton Cooper reports outstanding results from using Direct Voice Rehabilitation (DVR) with Leukoplakia and Keratosis.

Dr. Cooper’s success and cures of this condition were detailed in his textbook Modern Techniques of Vocal Rehabilitation in 1973. From that time on, Dr. Cooper reports faster results because of discoveries he has made with locating the right pitch of voice, the right placement of voice, the better way to breathe right for speaking, and focusing in on the voice image and voice identity, which he finds are all key to successful voice rehabilitation.

Causes of Leukoplakia and Keratosis

Leukoplakia and keratosis of the vocal folds are premalignant lesions. The etiology remains unknown, but factors which contribute to their onset and development include smoking and voice misuse and abuse. They have competed with environmental noise during their work and/or recreational activities.

The cessation of smoking when the individual is a smoker, and/or the elimination of voice misuse and abuse when such prevails has resulted in a reduction or elimination of the lesions. Patients with these conditions who are nonsmokers and who change their voice patterns experience a disappearance of the growth(s). Individuals who smoke and who desist from smoking when the condition is made known to them also report a reduction or disappearance of the growth(s).

Smoking, as has been indicated elsewhere, has a tendency to drop the pitch of the voice to a pitch level which is too low for the individual and therefore creates laryngeal and pharyngeal tensions for the individual.

Treatments for Leukoplakia and Keratosis

Surgery has been the main approach in the past. Voice rehabilitation has not been the usual procedure prior to or following surgery. Some patients seen who have undergone surgical treatment for the removal of these lesions have experienced a return of the growths. As with benign growths (such as nodes, polyps, and contact ulcers), voice rehabilitation alone or in conjunction with surgery should be considered for leukoplakia and keratosis.

Brodnitz (1963) recommends voice rehabilitation as being helpful for leukoplakia. Peacher (1963) describes voice therapy as aiding keratosis and leukoplakia by voice therapy. Cracovaner (1965) writes that leukoplakia and hyperkeratotic lesions may be reversed by eliminating causal factors, such as smoking, alcohol, voice abuse, and chronic infection.

What applies to the benign lesions of the vocal folds is even more applicable to the premalignant lesions; the laryngologist uses his discretion as to what procedures will most benefit the patient, not only to reduce and eliminate the growth but also to provide information and guidelines which can to some extent remove and eliminate irritants that may be contributing to the condition itself.

Therapy for leukoplakia and keratosis of the vocal folds parallels that of voice therapy for the benign organic lesions of the folds. Although individuals with leukoplakia and keratosis are usually using a pitch level which is below the optimal pitch, they are not necessarily using a basal or near basal pitch level. The optimal pitch level and range must be located and established at the same time that the balanced oral and nasal resonance is mastered. A voice image almost invariably exists in these patients.

Clinical Results

Of the 17 patients seen with leukoplakia, the following conclusions may be drawn:

Of the 17 patients seen, 9 (52.9%) entered therapy.
Of the 9 patients entering therapy, 8 (88.9%) completed therapy.
Of the 8 patients completing therapy, 3 (37.5%) had long-term therapy and 5 (62.5%) had short-term therapy.
Of the 8 patients completing therapy, the results were: 4 (50%) excellent and 4 (50%) fair.
The comparison between males and females seen: 14 (82.4%) males and 3 (17.6%) females.

Of the 6 patients seen with keratosis, the following conclusions may be drawn:

Of the 6 patients seen, 5 (83.3%) entered therapy.
Of the 5 patients entering therapy, 4 (80%) completed therapy.
Of the 4 patients completing therapy, 2 (50%) had long-term therapy and 2 (50%) had short-term therapy.
Of the 4 patients completing therapy, the results were: 2 (50%) excellent, 1 (25%) good, and 1 (25%) fair.
The comparison between males and females seen: 4 or (66.7%) males and 2 (33.3%) females.