الفهرس 
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Abstract
The vocal fold is a multilayered vibrator structure which gives the vocal folds their mechanical properties. These structures oscillate during the production of sound. According to cover-body complex theory layers structure can be classified into 3 sections:-
1. Cover: epithetlium + superficial layer of lamina propria
2.Transition portion: intermediate and deep layers of lamina propria.
3. Body(core): vocalis muscle. Benign superficial lesions of the vocal folds like polyp arise from the epithelium and the superficial layer of the lamina propria. Vocal abuse and misuse lead to excessive mechanical stress and trauma in the membranous portion of the vocal fold resulting in wound formation. Wound healing leads to remodeling of the superficial layer of the lamina propria. This tissue remodeling leads to formation of benign vocal fold lesions. Vocal fold polyps vary greatly in shape, size and color. Some are sessile, circumscribed or even pedunculated . Others are broad-based and more diffuse affecting varying portions of the vocal folds. The polyp is usually reddish lesion that has a sharp margin and is clearly different from surrounding tissue .vocal fold polyps occur usually due to phonotrauma, polyps aren’t precancerous or cancerous lesions. They are important purely because of their effect on the voice. polyps mostly arise at midportions of one or both vocal folds. Polyps generally cause dysphonia which results from irregularities in vocal fold closure as well as irregularities in vibration, both the result of the bulk and location of the
polyps. Vocal fold polyps are usually unilateral, although they can cause contact swelling on the contralateral side.
Most commonly, vocal fold polyps must be removed surgically by means of microlaryngeal phonosurgery. The lesion is carefully dissected from the vocal ligament and cover, and then it is excised by cold instrumentation technique (microflap or Truncation techniques) or Laser microlaryngeal phonsurgery.
The general principles for microlaryngeal phonosurgery:
Preservation of normal tissue. Good visualization.
Avoidance of injury to the intermediate and deep layers of the lamina propriaThe aim of this work was to study the effect of antireflux therapy ,in the form of PPI and sodium alginate, on the voice outcome after phonomicrosurgery for vocal fold polyps by dividing patients into two groups one recieved antireflux therapy ,in the form of PPI and sodium alginate postoperatively and the other group didn’t receive it (without antireflux therapy).In the two groups of 12 patients each from our study there was a statistically significant improvement regarding laryngeal evaluation, grades of dysphonia, the acoustic and aerodynamic parameters i.e. jitter (p = 0.001), shimmer (p = 0.02) and maximum phonation time (p = 0.001) and AFF (p = 0.04) in the group in which proton pump inhibitor and gaviscon advance were taken postoperative (group A). while in group B there is no Statistically significant difference in Average fundamental frequency.AFF, Jitter, Shimmer (p value above 0.05 ),but there were stastically significant difference in HNR (p = 0.05) and Maximal phonation time(MPT) (p value 0.008).In conclusion, the intake of combination of proton pump inhibitor and gaviscon advance liquid is beneficial if taken after phonomicrosurgery for vocal fold polyp to overcome the acidic and non acidic components of the reflux with statistically significant results, Therefore, we recommend the intake of proton pump inhibitors with sodium alginate in the form of gaviscon advance liquid after phononomicrosurgery of vocal fold polyp to enhance voice outcomes. For our knowledge this is the first prospective study about the effect of combined administration of PPIs and sodium alginate (in the form of gaviscon advance) postoperatively after phonomicrosurgery for patients with vocal fold polyps. We hope this study to be the core for further studies in the future on a larger numbers of patients and for a prolonged time of follow