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Kim T, Jung GE, Kwon M, Jung YH, Choi SH, Nam SY, Lee YS. Additional injection laryngoplasty as a salvage treatment for unilateral vocal fold paralysis. Sci Prog 2024; 107:368504241276768. [PMID: 39248181 DOI: 10.1177/00368504241276768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
OBJECTIVES Injection laryngoplasty (IL) has been widely used as an initial treatment option for unilateral vocal fold paralysis (UVFP). An additional (second) IL is considered a salvage treatment for unsatisfactory outcomes of initial IL resulting from inadequate injection or early resorption of the injection material. This study aims to evaluate the efficacy of additional IL, distinguishing between "salvage" (within 4 months) and "repeated" injections (beyond 4 months), and to analyze prognostic factors for successful outcomes. METHODS This retrospective study involved patients who received IL at Asan Medical Center from January 2014 to December 2020. Voice parameters were collected after each procedure, and those who conducted the statistical analysis were blinded to the study subjects. Among the 65 patients who underwent additional IL, 51 patients were enrolled in this study. Postinjection grade, roughness, breathiness, asthenia, strain (GRBAS) scales were used to determine satisfactory treatment outcomes. Success of the additional IL was defined as a postinjection grade of dysphonia score of 0 or 1, with a reduction in grade compared with the preinjection grade. RESULTS The mean age of the patients was 61.6 years. Out of a total of 51 patients, 37 were men participating in the study. The odds ratio represents the likelihood of success in the second IL. Improved voice outcome after the additional IL was maintained in 23 (45%) patients. Compared with the failure group, the success group had a longer injection time interval between the initial and additional injection (9.1 vs. 7.4 months, respectively, p = 0.010). The success group had a higher proportion of patients with injection intervals >6 months (73.9% vs. 42.9%, p = 0.026). Logistic regression analysis revealed an injection interval >6 months had an odds ratio of 0.265 (confidence interval: 0.080-0.874, p = 0.029). CONCLUSIONS Additional injections would benefit the patients whose voice outcomes are maintained for a longer period (>6 months) after the first injection.
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Affiliation(s)
- Taegyeong Kim
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Go Eun Jung
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minsu Kwon
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Ho Jung
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoon Se Lee
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Sabotin RP, Hoffman MR, Van Daele DJ, Stegall H, Hoffman HT. Modified sclerotherapy needle catheter as protective sheath for laser fibre passage in channelled flexible laryngoscopes. Clin Otolaryngol 2024; 49:287-290. [PMID: 38158870 DOI: 10.1111/coa.14136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/19/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Ryan P Sabotin
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Matthew R Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Douglas J Van Daele
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Helen Stegall
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Henry T Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Haddad R, Mattei A, Giovanni A. Local anesthesia with blue-dyed lidocaine for a better patient's tolerance during office-based laryngology procedures: how I do it. Eur Arch Otorhinolaryngol 2023; 280:5139-5141. [PMID: 37490180 DOI: 10.1007/s00405-023-08146-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/20/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND In-office laryngological procedures became common alternatives to general anesthesia for biopsies, injection laryngoplasties, and laser procedures. The limiting step remains the laryngeal anesthesia whose quality can influence patients' and operators' comfort. METHODS We propose to dye the lidocaine with methylene blue and do an instillation through a catheter introduced in the video-endoscope's operating channel, which permits a progressive anesthesia focused on the larynx, avoiding an unwanted pharyngeal anesthesia and any tracheal irritation. CONCLUSION Using blue-dyed lidocaine can help reduce the volume of anesthesia required for an office-based laryngology intervention, improving patients' and surgeon's comfort and reducing anesthesia's side effects.
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Affiliation(s)
- Ralph Haddad
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, AP-HM, La Conception University Hospital, Aix-Marseille University, 147 Boulevard Baille, 13385 CEDEX 5, Marseille, France.
| | - Alexia Mattei
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, AP-HM, La Conception University Hospital, Aix-Marseille University, 147 Boulevard Baille, 13385 CEDEX 5, Marseille, France
| | - Antoine Giovanni
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, AP-HM, La Conception University Hospital, Aix-Marseille University, 147 Boulevard Baille, 13385 CEDEX 5, Marseille, France
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Swaminathan R, Rosa Opatha S, Mughal Z, Prasad S. A systematic review on efficacy, safety and cost-effectiveness of office-based laryngeal biopsy. J Laryngol Otol 2023; 137:946-952. [PMID: 35766586 DOI: 10.1017/s0022215122001566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Laryngeal cancer is the second most prevalent head and neck malignancy in the USA. With recent advances in technology, this procedure is increasingly performed under local anaesthesia. This study aimed to identify the efficacy, safety and cost-effectiveness of laryngeal biopsy in out-patients by conducting a systematic review. METHOD A literature search was conducted using PubMed, Medline, Google Scholar and Embase over a 20-year period. Inclusion criteria were: studies performed on out-patient diagnostic biopsy procedures of the larynx. Exclusion criteria included all therapeutic procedures. The outcome measures were sensitivity and specificity, complication rate and cost-savings. RESULTS Thirty-five studies were included in the analysis. The sensitivity and specificity varied from 60 to 100 per cent with a low complication rate and cost savings. CONCLUSION Office-based laryngeal biopsies are increasingly used in the diagnosis of laryngeal cancers, resulting in earlier diagnosis and commencement of treatment. The barrier to undertaking this procedure is low sensitivity.
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Affiliation(s)
- R Swaminathan
- Department of Otorhinolaryngology and Head and Neck Surgery, Warwick Hospital, UK
| | - S Rosa Opatha
- Department of Otorhinolaryngology and Head and Neck Surgery, Warwick Hospital, UK
| | - Z Mughal
- Department of Otorhinolaryngology and Head and Neck Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - S Prasad
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospitals Coventry & Warwickshire NHS Trust, UK
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Fan Y, Chi X, Zhu D, Yin J, Liu Y, Su D. Non-intubated deep paralysis: a new anaesthesia strategy for vocal cord polypectomy. Perioper Med (Lond) 2023; 12:12. [PMID: 37076883 PMCID: PMC10116817 DOI: 10.1186/s13741-023-00301-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 04/13/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Vocal cord polyp is common otorhinolaryngological disease, traditionally treated by vocal cord polypectomy under a supporting laryngoscope with general anaesthesia. Although it is safe and controllable, it would cause some anaesthesia complications. Moreover, the complex process of general anaesthesia may significantly reduce surgical efficiency. Avoiding these problems remains an important issue. METHODS All patients were subjected to the standard non-intubated deep paralysis (NIDP) protocol consisting of four phases. An emergency plan was launched when NIDP cannot be implemented successfully. Patient characteristics, blood gas and monitoring data were collected during NIDP. Data concerning satisfaction, complications and duration of anaesthesia and recovery were collected to assess its effectiveness. RESULT Among 20 enrolled patients, the success rate of NIDP was 95%. Only one patient failed in completing NIDP. Blood gas analysis revealed that the partial pressure of oxygen and carbon dioxide was maintained at safe levels. Monitoring during NIDP revealed fluctuations in mean arterial pressure between 110 and 70 mmHg, and the heart rate was stable at 60-100 beats per minute. The duration of anaesthesia and postoperative recovery were 13.0 ± 2.84 and 5.47 ± 1.97 min, respectively. All patients and surgeons were satisfied with NIDP, and no complications were detected before discharge. CONCLUSION NIDP can be safely applied to patients and can replace general anaesthesia in vocal cord polypectomy. It can significantly reduce the duration of anaesthesia and postoperative recovery. No anaesthesia complications occurred without intubation, and patients and surgeons were satisfied with NIDP. TRIAL REGISTRATIONS This single-centre, prospective study was registered on clinicaltrial.gov (NCT04247412) on 30th July 2020.
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Affiliation(s)
- Yichen Fan
- Department of Anesthesiology, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoying Chi
- Department of Anesthesiology, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Danyan Zhu
- Nursing department, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiemin Yin
- Department of Anesthesiology, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yaling Liu
- Department of Anesthesiology, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Diansan Su
- Department of Anesthesiology, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Dwyer CD, Devore E, Kridgen S, Roth D, Winston J, Carroll TL. Preliminary Results on the Safety and Efficacy of Silk-Hyaluronic Acid for Treatment of Glottic Insufficiency. J Voice 2022:S0892-1997(22)00362-9. [PMID: 36529565 DOI: 10.1016/j.jvoice.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Silk-Hyaluronic Acid (Silk-HA) is a novel vocal fold augmentation material that has been used in humans since July 2020. There is a paucity of published data on Silk-HA and its longevity remains a question. This study aimed to evaluate a single surgeon's initial experience performing Silk-HA injection laryngoplasty for the treatment of glottic insufficiency. METHODS Retrospective chart review of Silk-HA injections between July 2020 and December 2021. Subject demographics, diagnoses, volume of material injected, VHI-10 data, and complications were collected. A blinded perceptual voice analysis of voice samples was performed by two voice-specialized speech-language pathologists (SLP) for a subset of unilateral vocal fold paralysis patients before and 3-months following silk-HA injection. Univariate assessment of the change in VHI-10 and perceptual voice analyses at 3-month follow up was determined. RESULTS 58 patients (43.1% female) underwent Silk-HA injection with a mean age of 64 (range 21-88). 38 subjects had unilateral paralysis (65.6%), and the remaining had scar, atrophy, paresis or a combination thereof. 49 injections were unilateral (84.5%). Mean volume of silk injected was 0.26 mL. Complications were rare, most notable though for 2 admissions for dyspnea and laryngoscopic evidence of hemi-laryngeal edema (3.4%). Mean change in CAPE-V overall severity rating was -32.9 (P<0.0001), and VHI-10 was -14.6 ± 10 (P=0.0013). 14 patients underwent a repeat silk-HA injection for ongoing glottic insufficiency (loss of augmentation vs under-augmentation). CONCLUSIONS Preliminary results for Silk-HA show potential for ongoing improvement of glottic insufficiency at 3 months from date of augmentation. Clinician and patient perception of voice outcomes showed overall improvement at three months, though longevity remains to be determined. While overall well tolerated and without serious complications in 96% of the cohort, patients should be counseled on the potential for airway edema and symptomatic dyspnea requiring steroid management and observation.
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Affiliation(s)
- Christopher D Dwyer
- Department of Surgery, Division of Otolaryngology, Brigham & Women's Hospital, Boston, Massachusetts.
| | - Elliana Devore
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Samantha Kridgen
- Department of Surgery, Division of Otolaryngology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Douglas Roth
- Department of Surgery, Division of Otolaryngology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Jennifer Winston
- Department of Surgery, Division of Otolaryngology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Thomas L Carroll
- Department of Surgery, Division of Otolaryngology, Brigham & Women's Hospital, Boston, Massachusetts
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Dynamics of lidocaine in topical anesthesia for office-based laryngeal procedures: A pilot study. Am J Otolaryngol 2022; 43:103569. [PMID: 35933964 DOI: 10.1016/j.amjoto.2022.103569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/31/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To study topical lidocaine for office-based laryngeal procedures recording onset, duration, and subjective experience of topical anesthesia. STUDY DESIGN Nine healthy volunteers were anesthetized with 4 % lidocaine endoscopically. Laryngeal sensitivity prior to and during anesthesia was recorded until normal sensation returned measured by air-puff sensory testing. Subjective experience of the process was recorded. METHODS Questionnaires regarding subjective experience were completed prior to, during, and after anesthesia. Laryngeal sensitivity via air-pulse trigger of the laryngeal adductor reflex (LAR) prior to and after 3 mL shower of 4 % lidocaine was recorded at 30 second intervals until the larynx was insensate with no LAR at 10 mmHg. Time to anesthesia was recorded and post-endoscopy questionnaire was given. Upon subjective change in sensation, sensitivity via air-pulse trigger of the LAR was recorded until baseline sensation returned. A post-anesthesia questionnaire recorded the subjective experience. RESULTS Average time to full anesthesia was 110 s (±31.2). Subjective return of sensation was noted at 10 min (±2.5), however time to return to normal LAR was 22 min (±5.8). Based on three standard deviations, 99.7 % of the population will be anesthetized at 3.4 min, report subjective change at 18.2 min and regain full sensation at 40 min. CONCLUSIONS Office-based laryngeal procedures should be performed at least 2 min following topical 4 % lidocaine with a window for manipulation of at least 16 min. Oral intake should be delayed for over 45 min to ensure complete return of sensation. The laryngeal shower of lidocaine is subjectively tolerated. LEVEL OF EVIDENCE 2C Outcomes Research.
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Schimberg AS, Heldens GTN, Klabbers TM, van Engen-Van Grunsven ACH, Verdaasdonk RM, Takes RP, Wellenstein DJ, van den Broek GB. Thermal Effects of CO 2, KTP, and Blue Lasers with a Flexible Fiber Delivery System on Vocal Folds. J Voice 2022:S0892-1997(22)00074-1. [PMID: 35418349 DOI: 10.1016/j.jvoice.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the differences in thermal effects on vocal folds between four fiber-routed lasers. METHODS In this experimental laboratory study the thermal effects of an AcuPulse Duo CO2 (CO2 AP), UltraPulse Duo CO2 (CO2 UP), KTP, and Blue laser were analyzed using a Schlieren technique on a human tissue mimicking gel model. Power, laser duration, laser fiber distance to tissue and mode (continuous wave [CW] vs pulsed [P] modes) were evaluated in varying combinations in order to compare the effects of the tested lasers and to explore the individual effect on thermal expansion and incision depth of each setting. The model was validated by comparing the results from the Schlieren model with histology of ex vivo fresh human vocal folds after laser irradiation using a selection of the same laser settings, and calculating the intraclass correlation coefficient (ICC). RESULTS One thousand ninety-eight Schlieren experiments and 56 vocal cord experiments were conducted. In comparison with CW mode, less thermal expansion occurred in P mode in all lasers, while incisions were deeper in the CO2 and more superficial in the KTP and Blue lasers. The mean thermal expansion was found to be minimally smaller, whereas incision depth was pronouncedly smaller in the KTP and Blue compared to the CO2 lasers. Duration of laser irradiation was the most important factor of influence on thermal expansion and incision depth for all lasers in both CW and P modes. The ICC for consistency between the results of the Schlieren model and the vocal cord histology was classified from fair to excellent, except for the thermal expansion of the Blue laser, which was classified as poor. CONCLUSION This study demonstrates important differences in thermal effects between CO2, KTP, and Blue lasers which can be explained by the different physical characteristics of the P modes and divergence of the fiber delivery system. The Schlieren imaging model is a good predictor of the relative thermal effects in vocal fold tissue. Our results can be used as a guidance for ENT surgeons using fiber-routed lasers, in order to achieve effective treatment of vocal fold lesions and prevention of functional impairment of vocal folds.
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Affiliation(s)
- Anouk S Schimberg
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Gijs T N Heldens
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim M Klabbers
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Rudolf M Verdaasdonk
- Department of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Ravi A, Deshpande A, Ramasubramaniam K, Aggarwal M, Goyal R. Vocal cord biopsy under local anesthesia, with flexible bronchoscope as an outpatient procedure, by "inside-out" technique. Lung India 2022; 39:34-37. [PMID: 34975050 PMCID: PMC8926225 DOI: 10.4103/lungindia.lungindia_373_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Pulmonologists commonly need to take biopsies of laryngeal lesions, either found incidentally while doing bronchoscopy for other indications or while investigating patients for hoarseness of voice and cough. Biopsy of laryngeal lesions has been conventionally done under general anesthesia to provide adequate samples and minimize risks and patient discomfort. Of late, these biopsies have been done as outpatient procedures, by flexible endoscopes, under local anesthesia. However, vocal cord biopsies are often challenging due to poor patient compliance. We have tested an innovative method, which we have called the "inside-out" method, to circumvent this problem. Objectives We aimed to analyze the feasibility, yield, and the safety of the "inside-out" technique for taking vocal cord biopsies as an outpatient procedure in awake patients. Material and Methods This was a prospective observational study. Data of 38 patients with vocal cord lesions in whom the above technique was employed were analyzed. Results The procedure had a diagnostic yield of 78.9% with a sensitivity of 96.7% and a specificity of 100% for detecting malignancy or dysplasia. There were no major complications. Conclusions The "inside-out" technique was found to be feasible and safe and with a high yield.
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Affiliation(s)
- Ajay Ravi
- Department of Respiratory Medicine, Caritas Hospital, Kottayam, Kerala, India
| | - Anurag Deshpande
- Department of Respiratory Medicine, Fortis Hospital, Noida, Uttar Pradesh, India
| | - K Ramasubramaniam
- Department of Respiratory Medicine, Jaipur Golden Hospital; Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Manish Aggarwal
- Department of Respiratory Medicine, Jaipur Golden Hospital; Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Rajiv Goyal
- Department of Respiratory Medicine, Jaipur Golden Hospital; Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
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Chang WD, Chen SH, Tsai MH, Tsou YA. Autologous Fat Injection Laryngoplasty for Unilateral Vocal Fold Paralysis. J Clin Med 2021; 10:5034. [PMID: 34768558 PMCID: PMC8584613 DOI: 10.3390/jcm10215034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Unilateral vocal palsy (UVFP) affects the voice and swallowing function and could be treated by various materials to achieve improved mucosal wave and better closure during phonation. Injection laryngoplasty is considered an exemplary method for these patients and could be injected as early as possible. We conducted a systematic review and meta-analysis for the subjective and objective outcomes of autologous fat injection laryngoplasty (AFIL) and assessed the effects for patients with UVFP. METHODS We searched studies from PubMed and EBSCO databases with PRISMA appraisal to search for articles about the effects of AFIL on UVFP. The published articles were reviewed according to our inclusion and exclusion criteria. The short- and long-term outcomes of perceptual, acoustic analysis, and quality of life were also analyzed by meta-analysis. RESULTS Eleven articles were reviewed, and seven studies were selected for meta-analysis. AFIL improves the perceptual outcome and some voice parameters in short-term and long-term results, i.e., jitter, shimmer, and maximal phonation time (MPT). It also significantly improved the voice handicap index (VHI) in the long term, suggesting an increase in quality of life. CONCLUSIONS AFIL is considered a reliable treatment method for UVFP and could even last for over 12 months.
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Affiliation(s)
- Wen-Dien Chang
- Department of Sport Performance, National Taiwan University of Sport, Taichung 404401, Taiwan;
| | - Sheng-Hwa Chen
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung 41354, Taiwan; (S.-H.C.); (M.-H.T.)
| | - Ming-Hsui Tsai
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung 41354, Taiwan; (S.-H.C.); (M.-H.T.)
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan
| | - Yung-An Tsou
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung 41354, Taiwan; (S.-H.C.); (M.-H.T.)
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan
- School of Medicine, China Medical University, Taichung 40402, Taiwan
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High-sensitivity FEES ® with the professional image enhancement technology "PIET". Eur Arch Otorhinolaryngol 2021; 279:293-298. [PMID: 34487219 PMCID: PMC8739291 DOI: 10.1007/s00405-021-07067-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/30/2021] [Indexed: 11/05/2022]
Abstract
Purpose Flexible endoscopic evaluation of swallowing (FEES®) is a standard diagnostic tool in dysphagia. The combination of FEES® and narrow band light (narrow band imaging; NBI) provides a more precise and detailed investigation method. So far, this technique could only be performed with the NBI illumination. The new version of the “professional image enhancement technique” (PIET) provides another image enhancing system. This study investigates the eligibility of PIET in the FEES® procedure. Methods Both techniques, NBI and PIET, were compared using a target system. Furthermore, the image enhancement during FEES® was performed and recorded with the two systems during daily routine. Results Performing an image enhancement during FEES® is possible with both systems PIET and NBI. On the target system, the contrast of the PIET showed a brighter and a more detailed picture. In dysphagia patients, no difference between PIET and NBI was detected. Conclusions PIET proved to be non-inferior to NBI during image enhancement FEES®. So far, image enhancement FEES® was exclusively connected to NBI. With the PIET system, an alternative endoscopy technology is available for certain indications.
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Lerner MZ, Bourdillon AT, Dai F, Brackett A, Kohli N. Safety considerations for esophageal dilation by anesthetic type: A systematic review. Am J Otolaryngol 2021; 42:103128. [PMID: 34216877 DOI: 10.1016/j.amjoto.2021.103128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/21/2021] [Accepted: 06/13/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Esophageal dilation (ED) may be performed in the office under local anesthesia or in a procedure/operating room under general anesthesia or intravenous (IV) sedation. However, indications for type of anesthesia during these procedures have not been established. The purpose of this review is to assess outcomes of esophageal dilation performed using different types of anesthesia to assess the safety of office-based techniques. METHODS We conducted a systematic review and meta-analysis comparing the outcomes of anesthesia techniques for ED in adults. Exclusion criteria included reviews, small case series, use of stents, diagnoses with high morbidity, and rare diseases. A comprehensive literature search of the PubMed, CINAHL, and EMBASE databases was performed for articles relating to esophageal dilation. RESULTS 876 papers were identified of which 164 full text studies were assessed and 25 were included in the analysis using the PRISMA guidelines. Data regarding demographics, dilation technique, and adverse events were extracted. The DerSimonian-Laird random-effect models with inverse-variance weighting were fit to estimate the combined effects. There were no statistically significant differences among mortality, perforation, or bleeding based on anesthetic. CONCLUSIONS With office-based procedures gaining popularity in laryngology, there is a need to profile their safety. Office-based ED appears to have equivalent safety to general and IV sedation, although further research is necessary to define indications favoring office-based techniques.
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Affiliation(s)
- Michael Z Lerner
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT, United States of America
| | | | - Feng Dai
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, United States of America
| | - Alexandria Brackett
- Cushing/Whitney Medical Library, Yale School of Medicine, Yale University, New Haven, CT, United States of America
| | - Nikita Kohli
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT, United States of America
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13
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Wang J, Mao W, Fang R, Wei C, He P. Use of 532 nm Potassium Titanyl Phosphate Laser on Vocal Fold Scars Under Topical Anesthesia: A Pilot Study. Ann Otol Rhinol Laryngol 2021; 131:715-723. [PMID: 34423674 DOI: 10.1177/00034894211041819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This pilot study aims to evaluate the efficacy of 532 nm potassium titanyl phosphate (KTP) laser under topical anesthesia in patients with vocal fold scars. METHODS A series of 18 patients with vocal fold scars of varying degrees were treated. The KTP laser was used under local anesthesia in the outpatient clinic. It was set to deliver 6 W of power using a continuous output mode. Close-to-contact mode was used for laser irradiation, and contact mode was used for ablation and excision of the lesions. Some of the patients received laser scar ablation on both vocal folds; the scarred vocal fold on one side and the hypertrophic vocal fold on the other. Parameters include glottic closure, amplitude, and mucosal wave pattern were measured using laryngeal stroboscopic examination. Aerodynamic and voice evaluations were carried out using maximum phonation time (MPT), jitter, shimmer, Voice Handicap Index questionnaire (VHI-30), and GRBAS scale. RESULTS In total, 21 surgeries were performed on 18 patients. Glottic closure, amplitude, and mucosal wave pattern showed improvement 2 months postoperatively (P < .05). There was significant improvement in the postoperative scores for VHI-30, VHI-emotional sub-scale, VHI-physical sub-scale, and GRBAS (P < .05). There was no significant difference in the MPT and VHI-functional sub-scale before and after the operation (P > .05). Re-adhesion of the anterior commissure was observed in 2 patients with Type III scars. CONCLUSION The 532 nm KTP laser is an effective tool for the treatment of vocal fold scars. Further research is required to determine if serial laser applications could improve outcomes for this challenging condition. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jiajia Wang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Wenjing Mao
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Rui Fang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Chunsheng Wei
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Peijie He
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
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14
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Ryan MA, Brodsky MB, Blumin JH, Bock JM, Carroll TL, Garrett CG, Lechien JR, Ongkasuwan J, Simpson CB, Akst LM. Twenty-One for 2021: The Most Influential Papers in Laryngology Since 2000. Laryngoscope 2021; 132:406-412. [PMID: 34318936 DOI: 10.1002/lary.29781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/02/2021] [Accepted: 07/14/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify the most influential publications in laryngology since 2000. STUDY DESIGN Modified Delphi process. METHODS Samples of laryngologists drawn from editors of leading journals, organization officers, and thought leaders were invited to participate in a modified Delphi identification of influential laryngology papers. Influential was defined as follows: yielding meaningful practice changes, catalyzing further work as a foundation for an important topic, altering traditional views, or demonstrating durability over time. Quality and validity were not among the selection criteria. Each participant nominated 5 to 10 papers in Round 1. These nominations, augmented with papers from bibliometric analysis, were narrowed further in Round 2 as participants identified their top 20. The 40 papers with the most Round 2 votes were discussed by video conference and then subjected to Round 3 voting, with each participant again selecting their top 20 most influential papers. Final results were collated by the number of Round 3 votes. RESULTS Sixteen of 18 invited laryngologists participated overall (all 16 in Rounds 1 and 3; 14 in Round 2). Twenty-one papers were identified as most influential. One paper appeared on all 16 Round 3 lists; three papers with eight (50%) votes each were lasted to make the list. Eleven of these 21 focused on voice; three each related to cancer, airway, and swallowing; and one encompassed all of these clinical areas. CONCLUSIONS This list of 21 influential laryngology papers serves to focus further research, provides perspective on recent advances within the field, and is an educational resource for trainees and practicing physicians. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Marisa A Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Martin B Brodsky
- Department of Physical Medicine and Rehabilitation; Division Pulmonary and Critical Care Medicine; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Joel H Blumin
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jonathan M Bock
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Thomas L Carroll
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - C Gaelyn Garrett
- Vanderbilt Voice Center, Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Jerome R Lechien
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France.,Department of Otolaryngology, Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.,School of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, U.S.A
| | - C Blake Simpson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
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15
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Boles RW, Gao WZ, Johns MM, Daniero JJ, Grant NN, Rubin AD, Bhatt NK, Hapner ER, O'Dell K. Flexible Versus Rigid Laryngoscopy: A Prospective, Blinded Comparison of Image Quality. J Voice 2021; 37:440-443. [PMID: 33775470 DOI: 10.1016/j.jvoice.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare flexible distal-chip laryngoscopy (FDL) and rigid telescopic laryngoscopy (RTL) in image quality and diagnostic ability. STUDY DESIGN Prospective cohort study; blinded comparison. METHODS Eighteen normal adult subjects were recruited to undergo both FDL and RTL and normalized videos were recorded. Three blinded laryngologists compared the videos for color fidelity, illumination, resolution, and vascularity, and indicated superiority with FDL, RTL, or no difference. Raters also reported if an abnormality was seen and in which video it was better visualized. Videos for two subjects were repeated to assess intra-rater reliability, making 20 video comparisons across 3 raters for a total of 60 ratings. Differences in responses were analyzed via Mann-Whitney U and Pearson Χ2. Inter-rater reliability was assessed via Fleiss' kappa, and intra-rater reliability was assessed via percent agreement. RESULTS RTL was rated superior in all categories of image quality (47 vs 5 vs 8, P < 0.01; 47 vs 7 vs 6, P < 0.01; 51 vs 5 vs 4, P<0.01; 44 vs 9 vs 7, P < 0.01, respectively). An abnormality was seen 33 times with both modalities and 6 times with RTL only. When seen with both modalities, visualization was superior in RTL compared with FDL (29 vs 4, P <0.01). CONCLUSIONS There was significant superiority of RTL in all categories of image quality, with slight inter-rater agreement for color fidelity, resolution, and vascularity. RTL was also significantly better for visualization of abnormalities. These findings suggest superior image quality in RTL compared with FDL, but further research is required to determine if this difference is clinically significant.
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Affiliation(s)
- Roger W Boles
- Keck School of Medicine of USC, Los Angeles, California
| | - William Z Gao
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, District of Columbia
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Nazaneen N Grant
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical School, Washington, District of Columbia
| | - Adam D Rubin
- Lakeshore Ears, Nose, Throat Center, St. Clair Shores, Michighan
| | - Neel K Bhatt
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Edie R Hapner
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California.
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16
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Wilson A, Kimball EE, Sayce L, Luo H, Khosla SM, Rousseau B. Medialization Laryngoplasty: A Review for Speech-Language Pathologists. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:481-490. [PMID: 33524276 PMCID: PMC8632480 DOI: 10.1044/2020_jslhr-20-00344] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/18/2020] [Accepted: 11/17/2020] [Indexed: 05/26/2023]
Abstract
Purpose The purpose of this study is to familiarize speech-language-pathologists with the current state of the science regarding medialization laryngoplasty in the treatment of voice disorders, with emphasis on current evidence-based practice, voice outcomes, and future directions for research. Method A literature review was performed in PubMed and Embase using the keywords vocal fold/cord and laryngoplasty, thyroplasty, augmentation, or laryngeal framework. Articles published between 2010 and 2020 were reviewed for data about clinical applications, technical approach, voice-related outcomes, and basic science or clinical innovations with the potential to improve patient care. A synthesis of data was performed from articles meeting the outlined search criteria. Conclusions As key members in the multidisciplinary care of voice disorders, speech-language pathologists need to be informed of current research in medialization laryngoplasty, a procedure commonly used for patients with glottic insufficiency. Advances in anesthetic technique, office-based procedures, and the development of materials with increased bio-tolerability over the past decade have led to innovations in treatment and improved patient outcomes. Recent applications of computational and bioengineering approaches have the potential to provide new directions in the refinement of currently available techniques and the improvement of patient-based treatment outcomes.
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Affiliation(s)
- Azure Wilson
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA
| | - Emily E. Kimball
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
| | - Lea Sayce
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA
| | - Haoxiang Luo
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
| | - Sid M. Khosla
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, OH
- Neurosensory Disorder Center at UC Gardner Neuroscience Institute, Cincinnati, OH
| | - Bernard Rousseau
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA
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17
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Chang J, Ninan S, Liu K, Iloreta AM, Kirke D, Courey M. Enhancing Patient Experience in Office-Based Laryngology Procedures With Passive Virtual Reality. OTO Open 2021; 5:2473974X20975020. [PMID: 33474521 PMCID: PMC7797579 DOI: 10.1177/2473974x20975020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives Virtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office-based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in-office laryngotracheal procedures. Study Design Randomized controlled trial. Setting Tertiary care center. Methods Adult patients undergoing office-based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected. Results Eight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively (P = .037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively (P = .770). Average pain scores were 3.53 and 2.64, respectively (P = .434). Conclusion This pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office-based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia. Level of Evidence 1
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Affiliation(s)
- Joseph Chang
- The Permanente Medical Group, Department of Head and Neck Surgery, Kaiser Permanente Santa Clara, California, USA
| | - Sen Ninan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Katherine Liu
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alfred Marc Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Diana Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mark Courey
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
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18
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Kwon S, Choi H, Park C, Choi S, Kim E, Kim SW, Kim CS, Koo H. In vivo vocal fold augmentation using an injectable polyethylene glycol hydrogel based on click chemistry. Biomater Sci 2021; 9:108-115. [PMID: 33244544 DOI: 10.1039/d0bm01155j] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
It is important to focus on urgent needs in clinics and develop optimal materials. For successful augmentation of vocal folds, the ideal filler should be injectable through a syringe, and should stably maintain its volume for a long time without toxicity. To achieve these criteria, a click chemistry-based PEG (polyethylene glycol) hydrogel was developed and applied for vocal fold augmentation in vivo. The PEG hydrogel enables fast gelation in vivo after injection and provides long-term stability. Azide- and dibenzocyclooctyne (DBCO)-modified 4-arm PEG were cross-linked by chemical conjugation via click chemistry and yielded gelation within several minutes. After subcutaneous injection into mice and rats, the PEG hydrogel showed higher stability after 1 month compared to the traditionally used calcium hydroxyapatite-carboxymethyl cellulose (CaHA-CMC) filler. In rabbit models with vocal fold paralysis, the PEG hydrogel stably fixed the paralyzed vocal fold in 4 months and minimized the glottic gap. It was an improved therapeutic result compared to CaHA-CMC, demonstrating the potential of a click chemistry-based PEG hydrogel for vocal fold therapy.
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Affiliation(s)
- Soonmin Kwon
- Department of Medical Life Sciences, Department of Biomedicine & Health Sciences, and Catholic Photomedicine Research Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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19
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Zwakenberg MA, Halmos GB, Wedman J, van der Laan BFAM, Plaat BEC. Evaluating Laryngopharyngeal Tumor Extension Using Narrow Band Imaging Versus Conventional White Light Imaging. Laryngoscope 2021; 131:E2222-E2231. [PMID: 33393666 DOI: 10.1002/lary.29361] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE/HYPOTHESIS Comparing detection and extension of malignant tumors by flexible laryngoscopy in the outpatient setting with laryngoscopy under general anesthesia using both White Light Imaging (WLI) and Narrow Band Imaging (NBI). STUDY DESIGN Prospective study. METHODS Two hundred and thirty-three patients with laryngeal and pharyngeal lesions underwent flexible and rigid laryngoscopy, with both WLI and NBI. Extension of malignant lesions (n = 132) was compared between both techniques in detail. RESULTS Sensitivity of NBI during flexible endoscopy (92%), was comparable with that of WLI during rigid endoscopy (91%). The correlation of tumor extension between flexible and rigid laryngoscopy was high (rs = 0.852-0.893). The observed tumor extension was significantly larger when using NBI in both settings. The use of NBI during flexible laryngoscopy leads to upstaging (12%) and downstaging (2%) of the T classification. CONCLUSIONS NBI during flexible laryngoscopy could be an alternative to WLI rigid endoscopy. NBI improves visualization of tumor extension and accuracy of T staging. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2222-E2231, 2021.
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Affiliation(s)
- Manon A Zwakenberg
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Wedman
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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20
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Son HY, Kim S, Mohammad RT, Huh G, Kim H, Jeong WJ, Cha W. Real-Time Light-Guided Vocal Fold Injection: An In Vivo Feasibility Study in a Canine Model. Clin Exp Otorhinolaryngol 2020; 14:338-346. [PMID: 33332956 PMCID: PMC8373830 DOI: 10.21053/ceo.2020.02180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/01/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives The transcutaneous approach is a good option for office-based vocal fold injection (VFI). However, precise localization requires extensive experience because the needle tip is invisible in small and complex laryngeal spaces. Recently, real-time light-guided VFI (RL-VFI) was proposed as a new technique that allows simultaneous injection under precise needle localization by light guidance. Herein, we aimed to verify the feasibility of RL-VFI in an in vivo canine model and explored its clinical usefulness. Methods The device for RL-VFI comprised a light source (light-emitting diode modules [10 W] of red color [650 nm]) and injectors (1.5 inches, 23 gauge). An adult male beagle was used for the experiment. After tracheostomy, a rigid laryngoscope was inserted and suspended to expose the larynx. A flexible naso-laryngoscopy system was used to visualize the vocal folds. Results RL-VFI was performed using various transcutaneous approaches, including the cricothyroid, transthyroid, and transhyoid approaches. Light guidance helped identify the path of the needle and prevent inadvertent penetration. The location of the needle tip was accurately indicated by the light. The illuminated needle could be easily placed at the intended points in the vocal fold with real-time visual-motor feedback. Hyaluronic acid could be simultaneously injected lateral to the vocal process under light guidance without manipulation of the device. Conclusion RL-VFI was found to be safe and feasible in an in vivo canine model, providing precise localization and visual-motor feedback. The clinical application of RL-VFI is expected to improve the safety and precision of VFI.
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Affiliation(s)
- Hee Young Son
- Department of Otorhinolaryngology-Head and Neck Surgery, The Dongnam Institute of Radiological and Medical Sciences (DIRAMS), Busan, Korea
| | - Sanghoon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ramla Talib Mohammad
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Gene Huh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyojin Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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21
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Whited CW, Lubin J, Marka N, Koszewski IJ, Hoffman MR, Schoeff S, Dailey SH. Pain Experience and Tolerance of Awake In-Office Upper Airway Procedures: Influencing Factors. Laryngoscope 2020; 131:E1580-E1588. [PMID: 33196115 DOI: 10.1002/lary.29238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/21/2020] [Accepted: 10/22/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Awake, unsedated in-office upper airway procedures are performed frequently and have high completion rates, yet less is known about the patients' pain experience and potentially influencing factors. It is also unclear if patients' pain experiences become worse with repeated procedures. We identified procedure- and patient-related factors that might influence procedural completion and pain scores. STUDY DESIGN Retrospective chart review. METHODS Pre-, intra-, and post-procedure pain scores were collected prospectively for awake unsedated upper airway procedures performed at a single institution over a 5-year period. Patient factors reviewed were demographics, body mass index, psychiatric and/or pain diagnosis, and related medications. Procedure factors reviewed were procedure type, route, side, and performance of the same procedure multiple times. Patients reported their pain level before, during, and after the procedure using a standard 0 to 10 scale. Maximum pain score change (PΔmax), or the difference between highest and lowest reported pain levels, was calculated. Descriptive and multivariate analyses were performed. RESULTS Procedure completion was 98.7% for 609 first time patients and 99.0% in 60 patients undergoing 292 repeat procedures. PΔmax did not covary with age, gender, or BMI. PΔmax covaried with pain and psychiatric conditions and associated medications. PΔmax was highest for injection medialization and lowest for tracheoscopy. PΔmax decreased over time for those undergoing multiple identical procedures. CONCLUSIONS Procedures were performed with a very high completion rate and low pain scores. Age, sex, and BMI did not affect pain experience. A combination of pain and psychiatric conditions did. Injection medialization had the highest PΔmax and tracheoscopy the lowest. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1580-E1588, 2021.
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Affiliation(s)
- Chad W Whited
- Austin Voice Center, Austin Ear, Nose, and Throat Clinic, Austin, Texas, U.S.A
| | - Jonathan Lubin
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Nicholas Marka
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Ian J Koszewski
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Matthew R Hoffman
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Stephen Schoeff
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Seth H Dailey
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
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22
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Dassé R, De Monès Del Pujol E. First-line treatment of exudative vocal fold-lesions by in-office local corticosteroid injection: A literature review. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:169-175. [PMID: 33191161 DOI: 10.1016/j.anorl.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There are emerging reports of the effectiveness of in-office awake vocal-fold corticosteroid injection in the treatment of exudative vocal-fold lesions. The aim of this study was to review this therapy and specify indications, practical modalities and outcomes. STUDY DESIGN Systematic review of the literature without meta-analysis. METHODS A systematic review by PubMed search for the period January 2000 to December 2018 was carried out. RESULTS Nine articles were included, for a total of 502 lesions: nodules (46.4%), polyps (31.7%), and Reinke's edema (21.9%). Submucosal injection of low-dose triamcinolone acetonide (0.1 to 0.3mL) was transoral, transcutaneous or transnasal via flexible endoscope with operating channel. Lesion volume was significantly reduced in more than 90% of cases, with significant vocal improvement in all studies. Relapse rates ranged between 4% and 31%, with time to relapse of 1 to 40 months. CONCLUSIONS First-line treatment of exudative glottic lesions by submucosal corticosteroid injection provides at least transient significant reduction in lesion volume and vocal improvement. It is consensually reserved to moderate-sized mainly exudative lesions without fibrosis. In-office injection provides an immediate therapeutic response in case of vocal impairment, enabling surgery under general anesthesia to be postponed.
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Affiliation(s)
- R Dassé
- Service ORL et chirurgie cervico-faciale, CHU de Bordeaux-Pellegrin, place Amélie Rabat-Léon, 33000 Bordeaux, France.
| | - E De Monès Del Pujol
- Service ORL et chirurgie cervico-faciale, CHU de Bordeaux-Pellegrin, place Amélie Rabat-Léon, 33000 Bordeaux, France
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Tkaczuk A, Trivedi S, Mody MD, Steuer CE, Shin DM, Klein AM, Saba NF. Parenteral Bevacizumab for the Treatment of Severe Respiratory Papillomatosis in an Adult Population. Laryngoscope 2020; 131:E921-E928. [PMID: 33107615 DOI: 10.1002/lary.29133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/14/2020] [Accepted: 08/30/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Recurrent respiratory papillomatosis (RRP) is a rare, potentially life-threatening, disease that impacts the voice, breathing, and quality of life of patients. Frequent surgical interventions may be needed to control symptoms. We examined the safety and efficacy of utilizing parenteral bevacizumab in the management of severe RRP in adults. STUDY DESIGN This is a retrospective review of clinical management approaches in a group of patients with severe RRP defined as having a high disease burden, frequent need for debridement, and/or tracheobronchial disease. Patients were initially treated with 15 mg/kg of bevacizumab at 3-week intervals. Bevacizumab dosing and frequency was then individually titrated down. RESULTS Fourteen adults received a median of 8.5 (range 2-17) bevacizumab infusions over approximately 24 months. All had a history of laryngeal RRP with 6/14 having additional tracheobronchial lesions. Patients required a median of 4 (range 2-11) procedures in the year prior to treatment. Only 3/10 (30%) patients who continued therapy required any additional procedures. Bevacizumab administration was generally well tolerated, with four patients discontinuing therapy. Medical reasons included severe epistaxis and hypertension and thrombocytopenia in an individual with systemic lupus erythematosus. Common side effects included hypertension (grade 2), headache (grades 1-2), elevated creatinine (grades 1-2), and epistaxis (grade 3). CONCLUSIONS Intravenous bevacizumab for the primary treatment of severe RRP in adults appears clinically effective and safe. Expected and typically mild side effects related to bevacizumab were observed. Continued investigation of bevacizumab through a prospective clinical trial is warranted. LEVEL OF EVIDENCE 4. Laryngoscope, 131:E921-E928, 2021.
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Affiliation(s)
- Andrew Tkaczuk
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Sumita Trivedi
- Department of Hematology and Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Mayur D Mody
- Division of Medical Oncology, Department of Medicine, Emory University, Atlanta, Georgia, U.S.A
| | - Conor E Steuer
- Division of Medical Oncology, Department of Medicine, Emory University, Atlanta, Georgia, U.S.A
| | - Dong M Shin
- Division of Medical Oncology, Department of Medicine, Emory University, Atlanta, Georgia, U.S.A
| | - Adam M Klein
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Nabil F Saba
- Division of Medical Oncology, Department of Medicine, Emory University, Atlanta, Georgia, U.S.A
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Straub JM, Calamari KA, Shin TJ, Janse SA, Forrest LA, deSilva BW, Matrka LA. The safety of in-office laryngologic procedures during active antithrombotic therapy. Laryngoscope Investig Otolaryngol 2020; 5:890-894. [PMID: 33134536 PMCID: PMC7585240 DOI: 10.1002/lio2.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/08/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine whether patients undergoing in-office laryngologic procedures on antithrombotic therapy are at increased risk for treatment-related complications. METHODS Patients were those who underwent at least one in-office laryngologic procedure with any of three fellowship-trained laryngologists. Procedures were identified by current procedural terminology (CPT) code and included biopsies, excisions, laser ablations, and injections (therapeutic and augmentative). Patients were divided into two groups based on the use of antithrombotic therapy at the time of their procedure. Retrospective chart review was performed to identify any complications, with an average follow-up of 186 days. RESULTS Five hundred-sixty-four unique individuals were identified with ages ranging from 18 to 93 years old and with a relatively even distribution between females (45%) and males (55%). They underwent 647 procedures in total, 310 of which were performed while on some form of antithrombotic therapy. Sixteen procedures were associated with complications either during or after the procedure. In comparing overall complication rates, there was no significant difference between non-antithrombotic (2.4%) and antithrombotic (3.3%) cohorts (OR 1.09, 95% CI [0.46-2.60], P = .8454). CONCLUSIONS In spite of known risks in other settings, antithrombotic agents do not appear to confer increased risk of treatment-related complications during in-office laryngologic procedures, obviating the need for cessation of therapy prior to these interventions. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Jeffrey M. Straub
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Kevin A. Calamari
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Timothy J. Shin
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Sarah A. Janse
- Department of Biomedical InformaticsThe Ohio State UniversityColumbusOhioUSA
| | - Lowell A. Forrest
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Brad W. deSilva
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Laura A. Matrka
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
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Miller BJ, Abdelhamid A, Karagama Y. Applications of Office-Based 445 nm Blue Laser Transnasal Flexible Laser Surgery: A Case Series and Review of Practice. EAR, NOSE & THROAT JOURNAL 2020; 100:105S-112S. [PMID: 32970490 DOI: 10.1177/0145561320960544] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The recent introduction of 445 nm blue laser to office-based laryngology presents potential advantages. These include a desirable combination of cutting and photoangiolytic qualities and a lightweight, shock-resistant design. Despite its increasing use, current evidence is limited to experimental data and case reports. OBJECTIVES The authors present a case series and overview of office blue laser transnasal flexible laser surgery (TNFLS), considering indications, patient selection, safety, technique, and surgical outcomes. We also review the safety and relevance of TNFLS to the ongoing coronavirus pandemic. METHODS Retrospective case series and narrative review. Our primary outcome measure was preoperative and postoperative Voice Handicap Index (VHI-10) score. Complications were documented by nature and severity. RESULTS Thirty-six cases of office blue laser TNFLS were performed. A statistically significant improvement in VHI-10 score was demonstrated in cases of recurrent respiratory papillomatosis (RRP) and benign laryngeal lesions causing dysphonia (P < 0.01 and 0.045). Blue laser also proved effective in assisting office biopsy procedures. A minor and self-limiting complication was reported. CONCLUSIONS Office blue laser TNFLS is safe and effective in the treatment of RRP and a range of benign laryngeal lesions. Future research should compare the efficacy and safety of blue laser with potassium titanyl phosphate laser in office-based treatment of these conditions. Further assessment of the cutting qualities of blue laser, initially in the theater environment, is necessary to refine our understanding of future applications.
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Affiliation(s)
- Benjamin John Miller
- ENT Department, 8945Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Amr Abdelhamid
- ENT Department, 5293Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Yakubu Karagama
- ENT Department, 8945Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Kim MS, An S, Jin S, Kim T, Kwon TK. Continuous pressure measurement and serial micro-computed tomography analysis during injection laryngoplasty: A preliminary canine cadaveric study. PLoS One 2020; 15:e0239544. [PMID: 32966339 PMCID: PMC7511003 DOI: 10.1371/journal.pone.0239544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022] Open
Abstract
Injection laryngoplasty (IL) has been used to treat various types of glottal insufficiency. The precise volume and location of the injected materials impact the outcomes. However, exactly how increasing volumes of material are distributed is unknown. In fact, the amount of IL material required to medialize a vocal cord tends to be determined empirically. Thus, the goal of this study was to investigate the pattern of IL material distribution by checking serial micro–computed tomography (MCT) and pressure changes during ILs. This experimental study used 10 excised canine larynges. Experimental devices included the IL syringe, pressure sensor, infusion pump, fixed frame, and monitoring system. We injected calcium hydroxyapatite in the thyroarytenoid muscle; whenever 0.1 mL of material was injected, we obtained an MCT scan while simultaneously measuring the pressure. After the experiments, we performed histologic analyses. MCT analyses showed that materials initially expanded centrifugally and then expanded in all directions within the muscle. The pressure initially increased rapidly but then remained relatively constant until the point at which the materials expanded in multiple directions. Histologic analyses showed that the IL material tended to expand within the epimysium of the thyroarytenoid muscle. However, in some cases, the MCT revealed that there were leakages to the surrounding space with a corresponding pressure drop. If the IL material passes through the epimysium, leakage can occur in the surrounding space, which can account for the reduction in resistance during ILs.
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Affiliation(s)
- Min-Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Gyeonggi-do, Republic of Korea
| | - Seongmin An
- Department of Mechanical Engineering, Korea Polytechnic University, Siheung, Gyeonggi-do, Republic of Korea
| | - Songwan Jin
- Department of Mechanical Engineering, Korea Polytechnic University, Siheung, Gyeonggi-do, Republic of Korea
| | - Taehoen Kim
- Department of Pathology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Gyeonggi-do, Republic of Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Schimberg AS, Wellenstein DJ, Schutte HW, Honings J, van den Hoogen FJA, Marres HAM, Takes RP, van den Broek GB. Flexible Endoscopic Biopsy: Identifying Factors to Increase Accuracy in Diagnosing Benign and Malignant Laryngopharyngeal Pathology. J Voice 2020; 36:128-133. [PMID: 32434679 DOI: 10.1016/j.jvoice.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess the influence that several factors, such as the amount of obtained biopsies, difficult procedures, biopsy site and the experience of the attending physician, have on accuracy of flexible endoscopic biopsy (FEB). MATERIALS AND METHODS 203 FEB procedures for benign or malignant laryngopharyngeal lesions were prospectively included. During the procedure, three representative biopsies (macroscopically containing vital tumor tissue and not only necrosis or healthy tissue) were obtained. The accuracy of each biopsy was separately analyzed. Difficulties during the procedures leading to failure of acquiring three representative biopsies were recorded and classified into tumor, patient and procedural factors. Histological results of FEB were defined correct when consistent with clinical context, additional biopsies or Positron emission tomography-computed tomography (PET-CT) revealed equivalent pathology, or the lesion was stable or resolved in >6 months follow-up. RESULTS The first representative biopsy yielded a correct diagnosis in 65% of the cases. After the second representative biopsy, 78% was correctly diagnosed. The contribution of the third and fourth representative biopsies to accuracy was 3%. The overall accuracy of FEB was 85%. Difficult procedures were more likely to result in misdiagnosis, whereas biopsy site or experience of the attending physician did not influence results. CONCLUSIONS FEB was accurate in diagnosing laryngopharyngeal lesions when at least two representative biopsies were obtained. Accuracy of FEB could be further improved by limiting possible constraints during the procedures, for example by selecting, informing, and anesthetizing patients carefully.
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Affiliation(s)
- Anouk S Schimberg
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henrieke W Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Fleischer S, Pflug C, Hess M. Dipping and rotating: two maneuvers to achieve maximum magnification during indirect transnasal laryngoscopy. Eur Arch Otorhinolaryngol 2020; 277:1545-1549. [PMID: 32130511 PMCID: PMC7160064 DOI: 10.1007/s00405-020-05862-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/12/2020] [Indexed: 02/07/2023]
Abstract
Background Since many years, office-based flexible transnasal laryngoscopy is a common routine procedure. The development of new technical equipment such as high-definition cameras and flexible tip-chip endoscopes nowadays allows for much more precise examination than a few years ago. In contrast to rigid laryngoscopy, it is possible to move the tip of the endoscope close to the vocal folds and to other structures of interest. Nevertheless, without professional handling of the equipment, one cannot benefit from the potential of the newest technology. Method Two easily performed and very helpful maneuvers in flexible endoscopy are described. The “dipping maneuver” enables a maximum magnification of the mucosal surfaces of the endolarynx as well as the examination of the subglottal region and the trachea by positioning the tip of the endoscope very close to the vocal folds or even in the upper trachea during long transnasal inspiration. During the “rotation laryngoscopy”, the tip of the endoscope is positioned in the posterior interarytenoid region by rotating the flexible endoscope by 180° and advancing it close to the glottis. This allows a close-up examination of the anterior commissure, the inferior aspect of the vocal folds and the inside of the Morgagni’s ventricle. Before performing transnasal flexible endoscopy, we routinely apply topical anesthesia sprayed intranasally. Conclusion The described techniques of flexible endoscopy are easily performed and allow a maximum magnification of the mucosal surfaces and otherwise not visible regions of the endolarynx.
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Affiliation(s)
- Susanne Fleischer
- Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. .,Deutsche Stimmklinik (German Voice Clinic), Martinistrasse 64, 20251, Hamburg, Germany.
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Markus Hess
- Deutsche Stimmklinik (German Voice Clinic), Martinistrasse 64, 20251, Hamburg, Germany
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Choi N, Won S, Jin H, Kim HJ, Park W, Son Y. Additional Injection Laryngoplasty for Patients With Unilateral Vocal Fold Paralysis. Laryngoscope 2020; 130:2863-2868. [DOI: 10.1002/lary.28567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/12/2020] [Accepted: 01/29/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Nayeon Choi
- Department of Otorhinolaryngology–Head and Neck Surgery Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Seongjun Won
- Department of Otorhinolaryngology–Head and Neck Surgery Gyeongsang National University Hospital Jinju Republic of Korea
| | - Hokyung Jin
- Department of Otorhinolaryngology–Head and Neck Surgery Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Hack Jung Kim
- Department of Otorhinolaryngology–Head and Neck Surgery Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Woori Park
- Department of Otorhinolaryngology–Head and Neck Surgery Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Young‐Ik Son
- Department of Otorhinolaryngology–Head and Neck Surgery Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
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Schimberg AS, Klabbers TM, Wellenstein DJ, Heutink F, Honings J, van Engen-Van Grunsven I, Verdaasdonk RM, Takes RP, van den Broek GB. Optimizing Settings for Office-Based Endoscopic CO 2 Laser Surgery Using an Experimental Vocal Cord Model. Laryngoscope 2020; 130:E680-E685. [PMID: 32022931 PMCID: PMC7687150 DOI: 10.1002/lary.28518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/10/2019] [Accepted: 12/30/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES/HYPOTHESIS To provide insight in the thermal effects of individual laser settings in target tissues to optimize flexible endoscopic CO2 laser surgery treatment. STUDY DESIGN Experimental laboratory study. METHODS Thermal effects of the CO2 laser using a fiber delivery system were visualized using the color Schlieren technique in combination with a polyacrylamide gel tissue model. Variable settings were used for emission mode, power, laser fiber distance, and laser duration, which were evaluated in every possible combination. Collateral thermal expansion and incision depth were measured. To validate the model, the results were compared to histology after CO2 laser irradiation of ex vivo human vocal cords, and the intraclass correlation coefficient was calculated. Thermal damage and incision depth were measured by a blinded pathologist. RESULTS Of all parameters studied, duration of laser irradiation had the greatest effect on thermal expansion. Increased distance between laser tip and target tissue resulted in significantly reduced incision depth and increased thermal expansion. Pulsed emission modes led to increased incision depths. The intraclass correlation coefficient for consistency between the model setup and the ex vivo human vocal cords was classified as "fair." CONCLUSIONS By using high-intensity pulsed lasers at minimal distance to the target tissue, exposure times and subsequent damage to surrounding tissue can be reduced. If an evaporation technique is used, lower power in continuous wave at a larger distance to the target tissue will lead to superficial but broader thermal effects. The model setup used in this study is a valid model to investigate laser-induced thermal effects in vocal cord tissue. LEVEL OF EVIDENCE NA Laryngoscope, 130:E680-E685, 2020.
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Affiliation(s)
- Anouk S Schimberg
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim M Klabbers
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floris Heutink
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Rudolf M Verdaasdonk
- Department of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Kim D, Siegel J, Chouake RJ, Geliebter J, Zalvan CH. Implication and Management of Incidental Oropharyngeal Papillomas-A Retrospective Case Series Review. EAR, NOSE & THROAT JOURNAL 2019; 100:546-551. [PMID: 31581834 DOI: 10.1177/0145561319871228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Incidental papillomas of the pharynx can be found while examining the nasopharynx, oropharynx, and hypopharynx for other disorders of the head and neck. Purpose of the study is to explore the location, biopsy protocol, and decision to perform office-based versus operative management via potassium titanyl phosphate (KTP) laser when an oropharyngeal papilloma is discovered incidentally. METHODS A retrospective review of the senior author's patient population was performed using Current Procedural Terminology and/or International Classification of Diseases codes to identify patients who had KTP laser removal of incidental oropharyngeal papillomas. Patients were included based on the incidental nature of the papilloma and confirmed pathology report of squamous papilloma. Demographics, presenting complaint, lesion location, pathological analysis, type of intervention, and outcomes were recorded. When available, human papillomavirus (HPV) subtype was noted. RESULTS A total of 26 cases were identified, 13 females and 13 males. The median age at time of surgery was 58 years (range: 21-77). The most common presenting symptoms were difficulty swallowing and throat pain. The most common locations were the base of tongue, uvula, tonsils, and the soft palate. Of the 26 patients, 23 patients received KTP laser ablation therapy as an office-based procedure, while the remaining 3 were performed under general anesthesia in the operating room. Only 5 patients had a recorded recurrence that required reoperation. There were no operative or postoperative complications. There were 16 biopsy samples tested for HPV, where 12 were negative for HPV and 4 were positive for HPV. CONCLUSION Oropharyngeal papillomas, when present, can be found incidentally during examination of the oropharynx for other symptoms. Office-based biopsy and KTP laser is a safe and efficient means of identifying and removing most oropharyngeal papillomas.
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Affiliation(s)
- Daniel Kim
- Department of Otolaryngology, New York Medical College, Valhalla, NY, USA
| | - Justin Siegel
- Department of Otolaryngology, New York Medical College, Valhalla, NY, USA
| | - Robert J Chouake
- Department of Otolaryngology, New York Medical College, Valhalla, NY, USA
| | - Jan Geliebter
- Department of Microbiology and Immunology, 8137New York Medical College, Valhalla, NY, USA
| | - Craig H Zalvan
- Department of Otolaryngology, New York Medical College, Valhalla, NY, USA.,The Institute for Voice and Swallowing Disorders, Sleepy Hollow, NY, USA
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Schimberg AS, Wellenstein DJ, van den Broek EM, Honings J, van den Hoogen FJA, Marres HAM, Takes RP, van den Broek GB. Office-based vs. operating room-performed laryngopharyngeal surgery: a review of cost differences. Eur Arch Otorhinolaryngol 2019; 276:2963-2973. [PMID: 31486936 PMCID: PMC6811667 DOI: 10.1007/s00405-019-05617-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/24/2019] [Indexed: 02/07/2023]
Abstract
Purpose Office-based transnasal flexible endoscopic surgery under topical anesthesia has recently been developed as an alternative for transoral laryngopharyngeal surgery under general anesthesia. The aim of this study was to evaluate differences in health care costs between the two surgical settings. Methods PubMed, EMBASE and Cochrane Library were searched for studies reporting on costs of laryngopharyngeal procedures that could either be performed in the office or operating room (i.e., laser surgery, biopsies, vocal fold injection, or hypopharyngeal or esophageal dilation). Quality assessment of the included references was performed. Results Of 2953 identified studies, 13 were included. Quality assessment revealed that methodology differed significantly among the included studies. All studies reported lower costs for procedures performed in the office compared to those performed in the operating room. The variation within reported hospital and physician charges was substantial. Conclusion Office-based laryngopharyngeal procedures under topical anesthesia result in lower costs compared to similar procedures performed under general anesthesia. Electronic supplementary material The online version of this article (10.1007/s00405-019-05617-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anouk S Schimberg
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Eline M van den Broek
- Center for Health Services Research, Larner College of Medicine, University of Vermont, Burlington, USA
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
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Ali SA, Smith JD, Hogikyan ND. The White Lesion, Hyperkeratosis, and Dysplasia. Otolaryngol Clin North Am 2019; 52:703-712. [PMID: 31078307 DOI: 10.1016/j.otc.2019.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Laryngeal mucosal precursor lesions represent a challenging clinical entity. Updated classification systems allow for grade-based categorization. Multiple management options exist, with treatment decisions made jointly by physician and patient and focused on both appropriate lesion treatment and preservation of laryngeal structure and function. Traditional methods include cold steel and CO2 laser excision, with newer modalities using angiolytic lasers for lesion ablation. Both operating room-based and office-based treatment options exist, and there are advantages and disadvantages to each approach. Research is ongoing to advance the understanding of lesion biology, and to optimize prevention and treatment.
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Affiliation(s)
- S Ahmed Ali
- Department of Otolaryngology - Head & Neck Surgery, Michigan Medicine, 1904 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5312, USA
| | - Joshua D Smith
- Department of Otolaryngology - Head & Neck Surgery, Michigan Medicine, 1904 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5312, USA
| | - Norman D Hogikyan
- Department of Otolaryngology - Head & Neck Surgery, Michigan Medicine, 1904 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5312, USA.
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Uys HK, Pelser A, Attwood R, Adam S, Afrogheh A, Hille J, Loock JW. Diagnosis and staging of laryngopharyngeal tumours with flexible endoscopy: A prospective study. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2019. [DOI: 10.4102/sajo.v3i0.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Office-Based 532-Nanometer Pulsed Potassium-Titanyl-Phosphate Laser Procedures in Laryngology. Otolaryngol Clin North Am 2019; 52:537-557. [PMID: 30922560 DOI: 10.1016/j.otc.2019.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
With fiber-based lasers that may be passed via the working channel of a flexible laryngoscope, in-office laser laryngeal surgery has become possible. The potassium-titanyl-phosphate laser has several features that make it ideal for laryngeal surgery, and it is now the laser of choice for in-office management of a variety of laryngeal lesions. Its applications have expanded significantly since its introduction, with reports of new indications continuing to appear in the literature. This article provides a comprehensive review of the indications and technical details of in-office potassium-titanyl-phosphate laser laryngeal surgery, and a summary of the existing literature regarding outcomes of these procedures.
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Naunheim MR, Woo P. Topical anesthetic techniques in office-based laryngeal surgery: A comparison of patient preferences. Laryngoscope 2019; 130:166-170. [PMID: 30835852 DOI: 10.1002/lary.27894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/25/2019] [Accepted: 02/05/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Multiple topical anesthesia techniques exist for office-based laryngeal surgery. Our objective was to assess patient and surgeon satisfaction for three different techniques. STUDY DESIGN Cohort study. METHODS All consecutive patients presenting to an outpatient laryngology office for awake surgical procedures were enrolled. Patients were anesthetized with local anesthesia (2 cubic centimeters of 4% lidocaine) in one of three ways: 1) nebulizer, 2) flexible cannula through a channeled laryngoscope, or 3) transtracheal instillation. Demographics, procedure times, and surgeon satisfaction were recorded. A validated 11-item patient satisfaction questionnaire (Iowa Satisfaction with Anesthesia Survey) was administered after the procedure to calculate an overall satisfaction score (-3[worst] to 3[best]). Descriptive and correlative statistics were performed. RESULTS One hundred consecutive patients were included (37 females, 73 males), with relatively equal numbers between groups (32 nebulizer, 35 cannula, 33 transtracheal). Seven procedures were aborted (4 nebulizer, 2 cannula, 1 transtracheal) due to movement, anxiety, or technical issues. Three patients did not adequately complete the survey. Of the 90 remaining patients, patient satisfaction was highest with the transtracheal technique (2.04) versus cannula (1.46) or nebulizer (1.45), and this was statistically significant (P = 0.0167). This difference was driven by decreased pain and nausea scores in the transtracheal group. Surgeon satisfaction was lower with nebulizer and higher with transtracheal injection (P = 0.0081). There was a correlation between surgeon satisfaction and patient satisfaction (P < 0.0001). CONCLUSION Transtracheal instillation was favored by both patients and the surgeon. Choice of local anesthetic techniques may impact patient preferences and surgical success. This may serve as a basis for optimizing anesthetic care in office-based laryngeal surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 130:166-170, 2020.
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Affiliation(s)
- Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Peak Woo
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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Ricci Maccarini A, Stacchini M, Mozzanica F, Schindler A, Basile E, DE Rossi G, Woo P, Remacle M, Magnani M. Efficacy of trans-nasal fiberendoscopic injection laryngoplasty with centrifuged autologous fat in the treatment of glottic insufficiency due to unilateral vocal fold paralysis. ACTA ACUST UNITED AC 2019; 38:204-213. [PMID: 29984796 DOI: 10.14639/0392-100x-2012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/11/2018] [Indexed: 11/23/2022]
Abstract
SUMMARY The objective of this work is to evaluate the safety, feasibility and efficacy of trans-nasal fiberendoscopic injection laryngoplasty (IL) with centrifuged autologous fat, performed under local anaesthesia, in the treatment of glottic insufficiency due to unilateral vocal fold paralysis (UVFP). It is a within-subject study with follow-up 1 week after phonosurgery and after 6 months. A total of 22 patients with chronic dysphonia caused by glottic insufficiency due to UVFP were enrolled. Each patient underwent trans-nasal IL with centrifuged autologous fat through flexible operative endoscope under local anaesthesia and was evaluated before and twice (1 week and 6 months) after phonosurgery, using a multidimensional set of investigations. The assessment protocol included videolaryngostroboscopy, perceptual evaluation of dysphonia, maximum phonation time and patient's self-assessment on voice-related quality of life (QOL) with the Voice Handicap Index-10 and the comparative self-assessment on vocal fatigue and voice quality pre-post treatment. Trans-nasal IL with centrifuged autologous fat was performed in all 22 patients and there were no complications in any case. Significant improvements in videolaryngostroboscopic findings, perceptual evaluation of dysphonia, maximum phonation time and QoL self-assessment were reported after 1 week and were maintained at 6 months. In one patient, the result after 6 months was not satisfactory and this patient then underwent a medialization laryngoplasty (thyroplasty type I) with satisfactory long-term results. In conclusion, trans-nasal fiberendoscopic IL with centrifuged autologous fat seems to be a safe, feasible and efficacious phonosurgical procedure for treatment of glottic insufficiency due to unilateral vocal fold paralysis.
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Affiliation(s)
| | - M Stacchini
- ENT Department, M. Bufalini Hospital, Cesena, Italy
| | - F Mozzanica
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | - A Schindler
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | - E Basile
- ENT Clinic, University of Messina, Messina, Italy
| | - G DE Rossi
- Medical Center of Phoniatrics and Phonosurgery, Padua, Italy
| | - P Woo
- Clinical Professor, Department Of Otolaryngology Head and Neck Surgery, Icahn School of Medicine, New York, USA
| | - M Remacle
- Department of Otorhinolaryngology Head and Neck Surgery, Centre Hospitalier Luxemburg, Luxemburg
| | - M Magnani
- ENT Department, M. Bufalini Hospital, Cesena, Italy
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Gulka CP, Brown JE, Giordano JE, Hickey JE, Montero MP, Hoang A, Carroll TL. A novel silk-based vocal fold augmentation material: 6-month evaluation in a canine model. Laryngoscope 2018; 129:1856-1862. [DOI: 10.1002/lary.27618] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/03/2018] [Accepted: 09/17/2018] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | | | | | | | - Thomas L. Carroll
- Department of Otolaryngology; Brigham and Women's Hospital; Boston Massachusetts U.S.A
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Pearson JJ, Ortiz AS, Montelongo S, Simpson CB, Guda T, Dion GR. Quantification of injection force mechanics during injection laryngoplasty. Laryngoscope 2018; 129:1060-1066. [DOI: 10.1002/lary.27486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Joseph J. Pearson
- Department of Biomedical EngineeringUniversity of Texas at San Antonio San Antonio
| | - Alexandra S. Ortiz
- Department of Otolaryngology–Head and Neck SurgeryBrooke Army Medical Center Fort Sam Houston
| | - Sergio Montelongo
- Department of Biomedical EngineeringUniversity of Texas at San Antonio San Antonio
| | - C. Blake Simpson
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Health Science Center at San Antonio San Antonio Texas U.S.A
| | - Teja Guda
- Department of Biomedical EngineeringUniversity of Texas at San Antonio San Antonio
| | - Gregory R. Dion
- Department of Otolaryngology–Head and Neck SurgeryBrooke Army Medical Center Fort Sam Houston
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M. Dominguez L, Villarreal R, Simpson CB. Voice Outcomes of Lipoinjection Versus Medialization Laryngoplasty for Nonparalytic Glottic Insufficiency. Laryngoscope 2018; 129:1164-1168. [DOI: 10.1002/lary.27573] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Laura M. Dominguez
- Department of Otolaryngology, UT Health San Antonio San Antonio Texas U.S.A
| | | | - C. Blake Simpson
- Department of Otolaryngology, UT Health San Antonio San Antonio Texas U.S.A
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Topical Anesthesia for Endoscopic Office-based Procedures of the Upper Aerodigestive Tract. J Voice 2018; 33:732-746. [PMID: 30017430 DOI: 10.1016/j.jvoice.2018.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/09/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Over the last two decades, an increase in office-based procedures under topical anesthesia in laryngology and head and neck oncology has occurred. Adequate anesthesia in the nasal cavity, pharynx, and larynx is essential for successful performance of these procedures. Our goal is to provide an objective summary on the available local anesthetics, methods of application, local secondary effects, efficacy, and complications. MATERIAL AND METHODS A descriptive review of literature on topical anesthesia for office-based procedures in laryngology and head and neck oncology was performed. RESULTS Lidocaine is the most applied and investigated topical anesthetic. Topical anesthesia results in decreased sensory function without impairing motor function of the pharynx and larynx. For the nasal cavity, cotton pledgets soaked in anesthetic spray and decongestant, or anesthetic gel, are effective. For the pharynx, anesthetic spray is the most frequently used and effective method. For the larynx, applying local anesthesia through a catheter through the working channel of the endoscope or anesthetic injection through the cricothyroid membrane is effective. Studies comparing the most effective application methods for each anatomical site are lacking. Complications of topical lidocaine administration are rare. CONCLUSIONS By properly applying topical anesthesia to the upper aerodigestive tract, several surgical procedures in laryngology and head and neck oncology can be performed in the outpatient clinic under topical anesthesia instead of the operating room under general anesthesia. Lidocaine is the most investigated anesthetic, with adequate efficacy and few complications. Studies that determine the most effective application methods are still wanting.
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Wellenstein DJ, Schutte HW, Takes RP, Honings J, Marres HA, Burns JA, van den Broek GB. Office-Based Procedures for the Diagnosis and Treatment of Laryngeal Pathology. J Voice 2018; 32:502-513. [DOI: 10.1016/j.jvoice.2017.07.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/07/2017] [Accepted: 07/25/2017] [Indexed: 12/17/2022]
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Parab SR, Khan MM. Does the Angle of Rigid Endoscope Makes a Difference in Videolaryngoscopy. Indian J Otolaryngol Head Neck Surg 2018; 71:605-609. [PMID: 31742028 DOI: 10.1007/s12070-018-1433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/18/2018] [Indexed: 11/26/2022] Open
Abstract
Authors describe the technique of office based rigid video laryngoscopy with 0° endoscope and compare with technique of 70° 4 mm videolaryngoscopy. (1) To compare and assess the efficacy of techniques of 0° and 70° office based video laryngoscopy for examining laryngopharyngeal disorders at Ear Nose Throat (ENT) Out Patient Department level. (2) To assess whether the degree of angle of the rigid endoscope makes any difference in the visualisation in videolaryngoscopy. Prospective non randomised double blinded study of direct videolaryngoscopies using 0° and 70° 4 mm rigid endoscope (Karl Storz, Germany) done at M.I.M.E.R. Medical College and Sushrut ENT Hospital, Talegaon-D, Pune, India, during the period of October 2016 to February 2017. Patients with predominant complaints of change of voice and foreign body sensation in throat were subjected for Videolaryngoscopy by 0° and 70° 4 mm Endoscope. 375 patients were examined with both the techniques. After the end of the procedure, the patient preference or discomfort with any of the techniques was enquired. The unlabelled endoscopic recording of both techniques was visualised by the second author to compare and evaluate the 0° videolaryngoscopy with 70° in terms of extent of visualisation. The time taken for each technique was recorded. The data of all patients has been analysed in terms of patient and surgeon grading. On statistical analysis, both the techniques with 0° as well as 70° rigid endoscope videolaryngoscopy were found to be comparable. Our study concludes that both the endoscopes are equally efficient in comparable laryngeal visualization. Hence, the degree of angulation of the rigid endoscope makes no difference in videolaryngoscopy. With little practice, 0° videolaryngoscopy may be extended for routine use in laryngological examination. Level of Evidence Level 4.
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Affiliation(s)
| | - Mubarak M Khan
- Consultant Sushrut Hospital and Dr. Khan's ENT Research Center, Talegaon D, Pune, India
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Grant N, Wong RJ, Kraus DH, Schoder H, Branski RC. Positron-emission tomography enhancement after vocal fold injection medialization. EAR, NOSE & THROAT JOURNAL 2018. [PMID: 28636732 DOI: 10.1177/014556131709600621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The potential for the misinterpretation of positron-emission tomography (PET) scans in the context of a possible malignancy has been confirmed in a case report showing increased 18F-fluorodeoxyglucose (FDG) uptake after unilateral vocal fold augmentation medialization. We sought to expand these findings by investigating FDG uptake in a larger cohort of patients via a retrospective chart review. We examined the records of 15 adults-8 men and 7 women-who had undergone vocal fold augmentation for unilateral vocal fold paralysis and at least one subsequent PET scan. The differences in PET standard uptake value (SUV) between the injected and noninjected vocal folds were assessed via the Wilcoxon signed-rank test. A Spearman rank correlation coefficient was then used to estimate the relationship between differences in PET uptake and the length of time between the injection and the follow-up PET scan. The mean SUV of the injected vocal folds was 3.70, and the mean in the noninjected folds was 2.97. The difference did not achieve statistical significance (p = 0.34). In addition, the rank correlation coefficient with regard to the association between the difference in PET uptake and the duration between injection and PET was -0.24, suggesting an inverse relationship. However, the correlation coefficient did not differ significantly from zero (p = 0.34). We conclude that PET uptake after vocal fold augmentation medialization is variable and that it can increase substantially. This information should be considered in the context of the diagnostic accuracy of malignancy on PET.
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Affiliation(s)
- Nazaneen Grant
- Department of Otolaryngology, New York University School of Medicine, New York, NY, USA
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Bensoussan Y, Anderson J. In-office laryngeal procedures (IOLP) in Canada: current safety practices and procedural care. J Otolaryngol Head Neck Surg 2018; 47:23. [PMID: 29615125 PMCID: PMC5883580 DOI: 10.1186/s40463-018-0270-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The advent of chip tip technology combined with advanced endoscopy has revolutionized the field of laryngology in the past decade. Procedures such as transnasal esophagoscopy, site-specific steroid injections, injection laryngoplasty and laryngeal laser treatment can now be performed in the office setting under local anaesthesia. Although In-Office Laryngeal Procedures (IOLPs) have become standard-of-care in many American and several Canadian centers, there are no guidelines regulating the practice of these procedures. The goal of this report was to evaluate the current method of IOLP delivery in Canada. METHODS An electronic survey was dispersed to 22 practicing Canadian laryngologists to assess safety and procedural care measures undertaken when performing IOLP. The survey consisted of 37 questions divided into 6 categories; 1) Demographic data 2) Facilities 3) Staff/personnel 4) Patient screening/monitoring 5) Procedure and emergency equipment 6) Reporting of adverse events. RESULTS Data was collected for 16/22 laryngologists (72.7% response rate). Only 1 respondent did not perform IOLP. All performed injection augmentation laryngoplasty. Most performed laryngeal biopsies, intramuscular injection and/or electromyography guided injection for the treatment of spasmodic dysphonia and glottic/subglottic steroid injections. Only 4 respondents performed in-office KTP laser. Significant variation was found in procedural processes including intra procedural monitoring, anticoagulation screening, access to emergency equipment and documentation. CONCLUSION Our survey demonstrates that the delivery of IOLP in Canada varies considerably. The construct of IOLP practice guidelines based on the evidence with consistent documentation would promote safe, efficient and quality care for patient with voice disorders.
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Affiliation(s)
- Yael Bensoussan
- Department of Otolaryngology Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.
| | - Jennifer Anderson
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, St-Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
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Marcus S, Timen M, Dion GR, Fritz MA, Branski RC, Amin MR. Cost Analysis of Channeled, Distal Chip Laryngoscope for In-office Laryngopharyngeal Biopsies. J Voice 2018; 33:575-579. [PMID: 29472150 DOI: 10.1016/j.jvoice.2018.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/16/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Given that financial considerations play an increasingly prominent role in clinical decision-making, we sought (1) to determine the cost-effectiveness of in-office biopsy for the patient, the provider, and the health-care system, and (2) to determine the diagnostic accuracy of in-office biopsy. STUDY DESIGN Retrospective, financial analyses were performed. METHODS Patients who underwent in-office (Current Procedural Terminology Code 31576) or operative biopsy (CPT Code 31535) for laryngopharyngeal lesions were included. Two financial analyses were performed: (1) the average cost of operating room (OR) versus in-office biopsy was calculated, and (2) a break-even analysis was calculated to determine the cost-effectiveness of in-office biopsy for the provider. In addition, the diagnostic accuracy of in-office biopsies and need for additional biopsies or procedures was recorded. RESULTS Of the 48 patients included in the current study, 28 underwent in-office biopsy. A pathologic sample was obtained in 26 of 28 (92.9%) biopsies performed in the office. Of these patients, 16 avoided subsequent OR procedures. The average per patient cost was $7000 and $11,000 for in-office and OR biopsy, respectively. Break-even analysis demonstrated that the provider could achieve a profit 2 years after purchase of the necessary equipment. CONCLUSION In-office laryngopharyngeal biopsies are accurate and, overall, more cost-effective than OR biopsies. Purchase of the channeled, distal chip laryngoscope and biopsy forceps to perform in-office biopsies can be profitable for a provider with a videolaryngoscopy tower. In-office biopsy should be considered the initial diagnostic tool for suspected laryngopharyngeal malignancies noted on videolaryngoscopy.
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Affiliation(s)
- Sonya Marcus
- Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York
| | - Micah Timen
- Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York
| | - Gregory R Dion
- Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York
| | - Mark A Fritz
- Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York
| | - Ryan C Branski
- Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York.
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York
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Hoffman HT, Stegall H, Wingler T, Blitzer A. Steering Sheath for 2-Nostril Transnasal Office Laryngoscopy. Ann Otol Rhinol Laryngol 2017; 127:99-104. [PMID: 29199444 DOI: 10.1177/0003489417745091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim was to study the feasibility of performing office-based laryngeal procedures employing a flexible hollow steerable sheath placed contralateral to the nostril through which a standard flexible video endoscope is placed. METHODS The study design included simulation of transnasal endoscopic laryngeal procedures evaluating the use of a flexible steering sheath in laboratory and clinic settings. Transnasal laryngeal procedures were performed in an otolaryngology office setting employing an airway-management-trainer mannequin and then repeated in a human cadaver lab with standard transnasal flexible video laryngoscopy. Video documentation assessed use of a lever-manipulated deflecting ureteral access sheath with an inner diameter of 2.97 mm, an outer diameter of 4.95 mm, and a length of 45 cm. Simulated transnasal laryngoscopy procedures deployed devices through the deflecting sheath to mimic vocal fold needle injection, biopsy with forceps, balloon dilation, and laser treatment to identify strengths and shortcomings to the technology and technique. RESULTS Simulation was successful in appropriately directing instrumentation for all procedures tested. Shortcomings included limitations in steering capacity, greater length to the sheath than desirable for laryngeal procedures, and the need for additional assistants to perform procedures. CONCLUSION Steering sheath technology is applicable to enhance in-office transnasal laryngoscopy procedures.
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Affiliation(s)
- Henry T Hoffman
- 1 Department of Otolaryngology, University of Iowa, Iowa City, Iowa, USA
| | - Helen Stegall
- 1 Department of Otolaryngology, University of Iowa, Iowa City, Iowa, USA
| | | | - Andrew Blitzer
- 3 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Roosevelt Hospital, New York, New York, USA.,4 New York Center for Voice and Swallowing Disorders, New York, New York, USA.,5 Department of Neurology, Ichan School of Medicine at Mount Sinai, New York, New York, USA
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Dominguez LM, Brown RJ, Simpson CB. Treatment Outcomes of In-Office KTP Ablation of Vocal Fold Granulomas. Ann Otol Rhinol Laryngol 2017; 126:829-834. [DOI: 10.1177/0003489417738790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Laura M. Dominguez
- Department of Otolaryngology, UT Health Science Center San Antonio, San Antonio, Texas, USA
| | - Raymond J. Brown
- Department of Otolaryngology, UT Health Science Center San Antonio, San Antonio, Texas, USA
| | - C. Blake Simpson
- Department of Otolaryngology, UT Health Science Center San Antonio, San Antonio, Texas, USA
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Evaluation of clinical value of videokymography for diagnosis and treatment of voice disorders. Eur Arch Otorhinolaryngol 2017; 274:3941-3949. [PMID: 28856469 DOI: 10.1007/s00405-017-4726-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
Abstract
This study aimed at determining the clinical value of videokymography (VKG) as an additional tool for the assessment of voice disorders. 105 subjects with voice disorders were examined by an experienced laryngologist. A questionnaire was used to specify diagnosis, diagnostic confidence, and treatment recommendations before and after VKG. The first part of questionnaire was filled by the laryngologist for each patient after routine ear-nose-throat evaluation, including stroboscopy, the second part after the subsequent VKG examination. In 31% of subjects VKG confirmed the stroboscopic diagnosis, in 44% it made the diagnosis more accurate, in 20% there was adjustment of the treatment, and in 5% it was not found diagnostically useful. After VKG the diagnostic confidence increased in 68% of the subjects. VKG may help clinicians to take some important treatment decisions and may be recommended to be performed in patients, where clinicians are uncertain about diagnosis and treatment.
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