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van den Broek EMJM, Mes SD, Heijnen BJ, Langeveld APM, van Benthem PPG, Sjögren EV. Glottic insufficiency caused by vocal fold atrophy with or without sulcus: systematic review of outcome measurements. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08751-5. [PMID: 39025974 DOI: 10.1007/s00405-024-08751-5] [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: 02/19/2024] [Accepted: 05/23/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Identifying outcome measurements instruments (OMIs) to evaluate treatment efficacy in patients with vocal fold atrophy and/or sulcus. METHODS Systematic review of records published before March 2021 by searching Pubmed and EMBASE. Included studies reported on adults (> 18 year) with dysphonia caused by glottic insufficiency due to vocal fold atrophy with or without sulcus, who were enrolled into a randomized controlled trial, a non-randomized controlled trial, a case-controlled study or a cohort study. All included studies described an intervention with at least one outcome measurement. RESULTS A total of 5456 studies were identified. After removing duplicates, screening title and abstract and full text screening of selected records, 34 publications were included in final analysis. From these 50 separate OMIs were recorded and categorized according to the ELS protocol by DeJonckere et al. (Eur Arch Otorhinolaryngol 258: 77-82, 2001). With most OMIs being used in multiple studies the total number of OMIs reported was 265. Nineteen (19) individual OMIs accounted for 80% of reports. The most frequently used OMIs according to category were: VHI and VHI-10 (subjective evaluation); G of GRBAS (perceptual evaluation); F0, Jitter and Shimmer (acoustic evaluation); MPT and MFR (aerodynamic evaluation) and glottic closure and mucosal wave (endoscopic evaluation). Of these OMIs VHI had a high percentage of significance of 90%. CONCLUSION This systematic review identifies the most used OMIs in patients with glottic incompetency due to vocal fold atrophy and/or sulcus as a step toward defining a Core Outcome Set (COS) for this population. PROSPERO REGISTRATION 238274.
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Affiliation(s)
- Emke M J M van den Broek
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands.
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center, Utrecht, The Netherlands.
| | - Stephanie D Mes
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Bas J Heijnen
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Antonius P M Langeveld
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Elisabeth V Sjögren
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
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Almothahbi A, Bukhari M, Almohizea M, Alshammari H, Alammari G, Zagzoog F. Evaluating Interventions for Sulcus Vocalis or Vocal Fold Scar: A Systematic Review and Meta-analysis. J Voice 2024:S0892-1997(23)00386-7. [PMID: 38195335 DOI: 10.1016/j.jvoice.2023.11.026] [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: 11/01/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Sulcus vocalis reflects varying degrees of vocal cord lamina propria (LP) damage. Many interventions have been discussed in the literature for addressing sulcus vocalis, but there is no universally accepted gold standard for its management. AIM We aim in our study to collectively evaluate the effectiveness of different relevant interventions in the literature used for sulcus vocalis or vocal fold scar. METHODS We searched five electronic databases to collect all relevant studies. Records were screened for eligibility. Data were extracted from the included studies independently. Our continuous outcomes were pooled in our single-arm meta-analysis as mean change (MC) and with 95% confidence interval (CI). RESULTS Our systematic review and meta-analysis included 43 studies encompassing 1302 patients. The jitter parameter indicated that laser degeneration and LP regeneration/scar degradation led to the highest improvements compared to their baseline, with pooled MC of -0.897 and -0.893, respectively. Graft interposition showed a MC of -0.848, while medialization and dissection had less pronounced changes at -0.200. Shimmer parameter results were similar, with medialization and laser degeneration leading to MC of -2.129 and -2.123, while LP regeneration/scar degradation and graft interposition showed smaller changes MC -1.530 and -1.217. For the noise-to-harmonic ratio (NHR) parameter, LP regeneration/scar degradation demonstrated MC = -0.028. In aerodynamics outcomes, graft interposition and LP regeneration/scar degradation showed the highest MCs in mean phonatory time (MPT) (4.214 and 3.467, respectively). Endoscopic outcomes for mucosal wave showed high improvements in medialization and graft interposition (MC = 10.40 and 10.18, respectively). Perceptual outcomes favored graft interposition in various parameters, while laser degeneration performed well in most categories. Graft interposition and LP regeneration/scar degradation had a high voice handicap index (VHI) (MC = -27.195 and -19.269, respectively). CONCLUSION Laser degeneration and LP regeneration/scar degradation were particularly effective in improving acoustic parameters. In aerodynamics, graft interposition and LP regeneration/scar degradation improved vocal efficiency compared to their baselines. Medialization and laser degeneration had the largest impact compared to their baseline on shimmer and MPT. Endoscopic assessments showed that medialization and graft interposition had high improvement in mucosal waves, and perceptual outcomes were generally high with graft interposition and laser degeneration.
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Affiliation(s)
- Ali Almothahbi
- Otolaryngolgy Department, King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia.
| | - Manal Bukhari
- Otolaryngolgy Department, King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Almohizea
- Otolaryngolgy Department, King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Hind Alshammari
- Otolaryngolgy Department, King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Ghada Alammari
- Otolaryngolgy Department, King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Faisal Zagzoog
- Otolaryngolgy Department, King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia
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Lechien JR, Hans S, Crevier-Buchman L. Influence of age on voice quality after transoral CO 2 laser microsurgery. J Otolaryngol Head Neck Surg 2023; 52:59. [PMID: 37697412 PMCID: PMC10496204 DOI: 10.1186/s40463-023-00664-3] [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: 07/17/2022] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE To study the post-operative evolution of voice quality of patients treated by transoral CO2 laser microsurgery (TLM) according to the age. METHODS Patients treated by type I to VI TLM and post-operative speech therapy were prospectively recruited from our hospital. The voice quality was assessed pre-, 1-, 3- 6- and 12-month posttreatment with voice handicap index (VHI), dysphonia, roughness, breathiness, asthenia, strain (GRBAS), maximal phonation time (MPT), F0, F0 standard deviation (STD), percent jitter, percent shimmer, noise-to-harmonic ratio (NHR), vocal fold vibration assessment and speech fluency. Evolution of voice outcomes was analyzed considering age of patients (< 60 vs. ≥ 60 years). RESULTS Seventy-five patients completed the evaluations. Thirty-four and forty-one patients were < 60 or ≥ 60 yo, respectively. Subjective and objective voice parameters (VHI, G, R, B), jitter and fluency significantly improved from 1- to 6-month post-TLM in < 60 yo individuals. The voice parameters improved 12-month post-TLM in the ≥ 60 yo group at the exception of VHI that improved 3-month post-TLM. There were positive associations between age and 12-month NHR, G and A parameters. CONCLUSION The post-operative evolution of voice quality parameters may vary between patients according to the age. Preoperative VHI is predictive of 12-month subjective and objective voice outcomes.
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Affiliation(s)
- Jerome R Lechien
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
- Department of Otolaryngology-Head & Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, Brussels, Belgium.
- Department of Otolaryngology, Polyclinic of Poitiers, Elsan Hospital, Poitiers, France.
- Faculty of Medicine, Department of Human Anatomy and Experimental Oncology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France.
| | - Stephane Hans
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France
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Hamilton NJI, Saccente-Kennedy B, Ambler G. The use of basic fibroblast growth factor to improve vocal function: A systematic review and meta-analysis. Clin Otolaryngol 2023; 48:725-733. [PMID: 37246756 DOI: 10.1111/coa.14073] [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: 09/13/2022] [Revised: 03/29/2023] [Accepted: 05/01/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis examines if intralaryngeal injection of basic fibroblast growth factor 2 (FGF2) can improve voice outcomes in those with vocal disability. DESIGN A Systematic review of original human studies reporting voice outcomes following intra-laryngeal injection of basic fibroblast growth factor 2 in those with vocal dysfunction. Databases searched were Medline (1946-July 2022), Embase (1947-July 2022), Cochrane database and Google Scholar. SETTING Secondary or tertiary care centres that undertook the management of voice pathology Hospital. PARTICIPANTS Inclusion criteria were original human studies reporting voice outcome measurements following intralaryngeal injection of FGF2 to treat vocal fold atrophy, vocal fold scarring, vocal fold sulcus or vocal fold palsy. Articles not written in English, studies that did not include human subjects and studies where voice outcome measures were not recorded before and after FGF2 injection were excluded from the review. MAIN OUTCOME MEASURES The primary outcome measure was maximum phonation time. Secondary outcome measures included acoustic analysis, glottic closure, mucosal wave formation, voice handicap index and GRBAS scale. RESULTS Fourteen articles were included out of a search of 1023 and one article was included from scanning reference lists. All studies had a single arm design without control groups. Conditions treated were vocal fold atrophy (n = 186), vocal cord paralysis (n = 74), vocal fold fibrosis (n = 74) and vocal fold sulcus (n = 56). A meta-analysis of six articles reporting on the use of FGF2 in patients with vocal fold atrophy showed a significant increase of mean maximum phonation time of 5.2 s (95% CI: 3.4-7.0) at 3-6 months following injection. A significant improvement in maximum phonation time, voice handicap index and glottic closure was found following injection in most studies assessed. No major adverse events were reported following injection. CONCLUSIONS To date, intralaryngeal injection of basic FGF2 appears to be safe and it may be able to improve voice outcomes in those with vocal dysfunction, especially vocal fold atrophy. Randomised controlled trials are needed to further evaluate efficacy and support the wider use of this therapy.
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Affiliation(s)
- Nick J I Hamilton
- UCL Division of Surgery and Interventional Sciences, Head & Neck Academic Centre, University College London, London, UK
- Department of Laryngology, Royal National Ear Nose & Throat Hospital, University College London Hospitals NHS Trust, London, UK
| | - Brian Saccente-Kennedy
- Department of Laryngology, Royal National Ear Nose & Throat Hospital, University College London Hospitals NHS Trust, London, UK
| | - Gareth Ambler
- UCL Department of Statistical Science, University College London, London, UK
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Hasegawa T, Fujita R, Komazawa D, Konomi U, Hirosaki M, Watanabe Y. Evaluation of Safety After Intracordal Basic Fibroblast Growth Factor Injection. J Voice 2023:S0892-1997(23)00100-5. [PMID: 37028950 DOI: 10.1016/j.jvoice.2023.03.007] [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: 12/27/2022] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES Although there are many reports of voice improvement with intracordal trafermin (a basic fibroblast growth factor) injections under local anesthesia, few papers have documented the safety of trafermin. Therefore, we aimed to investigate whether trafermin is safer than control drugs (triamcinolone acetonide) early after intracordal injection under local anesthesia. METHODS We conducted a retrospective review from the medical records of patients who underwent intracordal injection with trafermin and triamcinolone acetonide under local anesthesia at our institution. Early postinjective complications were defined as changes in vital signs and chief complaints early after intracordal injection. RESULTS A total of 699 and 297 patients underwent intracordal injection under local anesthesia with trafermin and triamcinolone acetonide, respectively. Of these, 227 and 130 patients had early postinjective complications with trafermin and triamcinolone acetonide, retrospectively. The most common complications occurring with trafermin was increased blood pressure in 39 cases (5.58%): 17 cases (2.43%) of blood pressure increase of ≥20 mm Hg. Other complications included pharyngeal discomfort in 37 (5.29%), lightheadedness in 33 (4.72%), and phlegm discharge in 29 (4.15%). Triamcinolone acetonide caused pharyngeal discomfort in 28 patients (9.43%), phlegm discharge in 17 patients (5.72%), lightheadedness in 12 patients (4.04%), sore throat in 11 patients (3.70%), increased blood pressure in 10 patients (3.37%): 7 cases (2.36%) of blood pressure increase of ≥20 mm Hg, and dizziness in seven patients (2.36%). Statistical analysis of the complications between trafermin and triamcinolone acetonide showed no significant differences. CONCLUSIONS The proportion of early postinjective complications from intracordal injection of trafermin is no significant difference in that of triamcinolone acetonide. The results suggest that the early postinjective complications are not due to the drug action of trafermin, but rather to complications from the intracordal injection procedures. Intracordal trafermin injection may be safe in the short term.
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Affiliation(s)
- Tomohiro Hasegawa
- Tokyo Voice Center, International University of Health and Welfare, Minato, Tokyo, Japan
| | - Retsu Fujita
- Innovation & Research Support Center, International University of Health and Welfare, Minato, Tokyo, Japan
| | | | - Ujimoto Konomi
- Voice and Dizziness Clinic Futakotamagawa Otolaryngology, Setagaya-ku, Tokyo, Japan
| | - Mayu Hirosaki
- Tokyo Voice Center, International University of Health and Welfare, Minato, Tokyo, Japan
| | - Yusuke Watanabe
- Tokyo Voice Center, International University of Health and Welfare, Minato, Tokyo, Japan.
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Hasegawa T, Komazawa D, Konomi U, Hirosaki M, Watanabe Y. Changes in serum basic fibroblast growth factor concentration following intracordal injection. Laryngoscope Investig Otolaryngol 2023; 8:478-487. [PMID: 37090871 PMCID: PMC10116976 DOI: 10.1002/lio2.1022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/15/2022] [Accepted: 02/04/2023] [Indexed: 02/23/2023] Open
Abstract
Objective Although many studies have reported improvements in voice outcomes with intracordal trafermin injection, there is a lack of data documenting its changes in serum basic fibroblast growth factor (bFGF) blood concentration. This study examined whether serum bFGF concentrations change after intracordal trafermin injection. Methods This retrospective study was conducted at Tokyo Voice Center. We investigated serum bFGF concentrations before and after injection in 40 patients who underwent intracordal trafermin injection. There were 26 males and 14 females, with an age ranging from 13 to 88 years (average 53.25 years). They were diagnosed with paralysis (15 patients), atrophy (15 patients), sulcus (8 patients), and others (2 patients: scar and functional), presenting with severe hoarseness that interfered with daily life. Results The mean pre- and post-injective serum bFGF concentration of the 40 patients was 6.689 and 4.658 pg/mL, respectively. The difference in mean serum bFGF concentration between pre- and post-injective was -2.031 pg/mL. The Pearson correlation coefficient was calculated to evaluate the correlation between dosage of trafermin and post-injective serum bFGF concentration, and a moderate correlation was found at r = 0.52. Generalized linear model regression analysis was performed for the purpose of adjusting for confounding among variables. The only variable that showed a statistically predominant association with post-injective serum bFGF concentrations was the dosage of trafermin, with an estimated regression coefficient of 0.048. Conclusion In this study, the dosage of trafermin we injected and post-injective serum bFGF concentrations were dose-dependent but the amount of changes in the serum bFGF concentration was negligible within the physiological range. Therefore, as with subcutaneous and wound administration, intracordal trafermin injections may be safe. Level of Evidence Level IV.
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Affiliation(s)
- Tomohiro Hasegawa
- Tokyo Voice Center International University of Health and Welfare Tokyo Japan
| | | | - Ujimoto Konomi
- Voice and Dizziness Clinic Futakotamagawa Otolaryngology Tokyo Japan
| | - Mayu Hirosaki
- Tokyo Voice Center International University of Health and Welfare Tokyo Japan
| | - Yuusuke Watanabe
- Tokyo Voice Center International University of Health and Welfare Tokyo Japan
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Ng WC, Lokanathan Y, Baki MM, Fauzi MB, Zainuddin AA, Azman M. Tissue Engineering as a Promising Treatment for Glottic Insufficiency: A Review on Biomolecules and Cell-Laden Hydrogel. Biomedicines 2022; 10:3082. [PMID: 36551838 PMCID: PMC9775346 DOI: 10.3390/biomedicines10123082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
Glottic insufficiency is widespread in the elderly population and occurs as a result of secondary damage or systemic disease. Tissue engineering is a viable treatment for glottic insufficiency since it aims to restore damaged nerve tissue and revitalize aging muscle. After injection into the biological system, injectable biomaterial delivers cost- and time-effectiveness while acting as a protective shield for cells and biomolecules. This article focuses on injectable biomaterials that transport cells and biomolecules in regenerated tissue, particularly adipose, muscle, and nerve tissue. We propose Wharton's Jelly mesenchymal stem cells (WJMSCs), induced pluripotent stem cells (IP-SCs), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), insulin growth factor-1 (IGF-1) and extracellular vesicle (EV) as potential cells and macromolecules to be included into biomaterials, with some particular testing to support them as a promising translational medicine for vocal fold regeneration.
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Affiliation(s)
- Wan-Chiew Ng
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Yogeswaran Lokanathan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Marina Mat Baki
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Ani Amelia Zainuddin
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mawaddah Azman
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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Motohashi R, Tokashiki R, Konomi U, Sakurai E, Saito Y, Shoji Y, Osanai A, Tsukahara K. Effectiveness of Breath-holding Pulling Exercise in Patients with Vocal Fold Atrophy. J Voice 2022:S0892-1997(22)00199-0. [PMID: 35987739 DOI: 10.1016/j.jvoice.2022.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In recent years, the incidence of vocal fold atrophy has increased among the elderly. Vocal function exercises (VFE) are performed in patients with age-related vocal fold atrophy; however, treatment could be challenging if the patient is unable to go to the hospital or in hospitals that do not have a speech pathologist. Breath-holding pulling exercises are simple and can be performed anywhere for the management of such patients. This study aimed to examine the effectiveness of breath-holding pulling exercises in patients with vocal fold atrophy. STUDY DESIGN Retrospective study METHODS: With the hands folded in front of the chest, the patients were instructed to take a deep breath, pull their hands to the left and right, and then hold their breath for 5 seconds. The physician instructed the patients to do this 10 times each morning, afternoon, and evening. Speech function, acoustic analysis, pitch range, and Voice Handicap Index-10 (VHI-10) were evaluated and compared before and 4-8 weeks after treatment. RESULTS Maximum phonation time (MPT), the primary endpoint, significantly improved after treatment from 14.2 ± 6.6 to 20.3 ± 9.3 seconds. Among the secondary endpoints, mean flow rate (207.5 ± 104.4 to 165.1 ± 66.5 mL/s), pitch range (22.9 ± 8.3 to 26.2 ± 8.1 semitones), VHI-10 (18.1 ± 7.2 to 12.5 ± 6.3 points) jitter (2.5±1.6 to 1.7±1.2%), and shimmer (5.9±3.5 to 4.8±3.3%) showed significant improvement. CONCLUSION Breath-holding pulling exercises were found to be effective in patients with vocal fold atrophy. These can be performed in hospitals with no speech pathologists, in patients who are unable to go to the hospital, and in patients who are hospitalized or unable to speak loudly. Moreover, as with conventional VFE, the training method achieves a high level of patient satisfaction.
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Affiliation(s)
- Ray Motohashi
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Ryoji Tokashiki
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan; Shinjuku Voice Clinic, Tokyo, Japan
| | - Ujimoto Konomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Eriko Sakurai
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yu Saito
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yusuke Shoji
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ayaka Osanai
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
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Ogawa M, Mukudai S, Sugiyama Y, Matsushita H, Kinoshita S, Ozawa S, Hashimoto K, Fuse S, Kaneko M, Nakanishi Y, Yoshizaki T, Sotozono C, Hirano S. The Effects of Amniotic Membrane Transplantation on Vocal Fold Regeneration. Laryngoscope 2021; 132:2017-2025. [PMID: 34951490 DOI: 10.1002/lary.29997] [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: 09/10/2021] [Revised: 12/05/2021] [Accepted: 12/10/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold (VF) scar and sulcus cause severe vocal problems, but optimal methods have not been established. Total replacement of the mucosa is required particularly for cases in which the whole lamina propria is occupied by severe fibrosis and vibratory function is totally lost. The amniotic membrane (AM) has been proven to have regenerative potential, as it contains stem cells and growth factors. The current study investigated the biocompatibility and effects of AM for regeneration of the VF mucosa. STUDY DESIGN In vitro and in vivo studies. METHODS Vocal fold fibroblasts (VFFs) from 13 Sprague-Dawley rats were seeded on AM and subjected to histology and immunohistochemistry, and gene expressions in the VFFs on AM were examined in in vitro study. Twelve New Zealand White rabbits were used in in vivo study. VFs were stripped down and were reconstructed with AM. The regenerative effects were examined 3 months later by histological examination. RESULTS In vitro study indicated VFFs survived on AM and stained positively for Ki67, vimentin, and fibronectin. Gene expressions of Has1, Has2, and Hgf were significantly increased in the VFFs on AM compared with the other groups. The in vivo study indicated AM-transplanted VFs showed a significantly higher density of hyaluronic acid and lower density of collagen compared with sham VFs. CONCLUSIONS The current preliminary study suggests biocompatibility and possible regenerative effects of AM for VFs. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Machiko Ogawa
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Otolaryngology Head and Neck Surgery, Kanazawa University, Kanazawa, Japan
| | - Shigeyuki Mukudai
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoichiro Sugiyama
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Matsushita
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shota Kinoshita
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satomi Ozawa
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiko Hashimoto
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinya Fuse
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mami Kaneko
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yosuke Nakanishi
- Department of Otolaryngology Head and Neck Surgery, Kanazawa University, Kanazawa, Japan
| | - Tomokazu Yoshizaki
- Department of Otolaryngology Head and Neck Surgery, Kanazawa University, Kanazawa, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeru Hirano
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Sueyoshi S, Umeno H, Kurita T, Fukahori M, Chitose SI. Long-term outcomes of basic fibroblast growth factor treatments in patients with vocal fold scarring, aged vocal fold, and sulcus vocalis. Auris Nasus Larynx 2021; 48:949-955. [PMID: 33640199 DOI: 10.1016/j.anl.2021.02.004] [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: 10/29/2020] [Revised: 01/25/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Fibrotic changes in the vocal fold mucosa have been observed in patients with vocal fold scarring, aged vocal fold, and sulcus vocalis, which often lead to severe voice disorders. Previous research suggests that the basic fibroblast growth factor (b FGF) improves variations in vocal fold properties [1,2]. Although clinical studies on b FGF treatments have been conducted [3,4,5], these studies only demonstrated the efficacy of this drug over a short period. The present study is the first to investigate the long-term efficacy of b FGF treatment. METHODS b FGF injections were performed in six patients from January of 2016 to December of 2017 at our institution. Patient follow-up continued for at least two years after the last injection. Three patients had vocal fold scarring, two had aged vocal fold atrophy, and one patient had sulcus vocalis. Each vocal fold was injected with 10 µg of b FGF four times. Voice and stroboscopic examinations were performed after surgery (at one month, three months, six months, one year, two years). Fundamental frequency, maximum phonation time (MPT), mean flow rate (MFR), amplitude perturbation quotient (APQ), pitch perturbation quotient (PPQ), and noise-to-harmonic ratio (NHR), and voice handicap index-10 (VHI-10) were examined and compared statistically between the pretreatment time and at each posttreatment time point. RESULTS The speaking F0 had an obvious decreasing tendency, with significant differences suggesting the increase in volume in the vocal folds. Aerodynamic parameters also showed small improvements. The most remarkable improvement was observed in the acoustic parameters, indicating that the treatment could improve the vocal fold to make vibrations symmetrically and regularly for a long period. Achievement of symmetry and regularity on vocal fold vibrations suggested the property changes had happened in the vocal folds. Consequently, the score of VHI-10 had improved, indicating high patient satisfaction with this treatment. CONCLUSION b FGF injections could be a reliable treatment option for diseases that deteriorate the property of vocal fold.
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Affiliation(s)
- Shintaro Sueyoshi
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
| | - Hirohito Umeno
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Takashi Kurita
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Mioko Fukahori
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Shun-Ichi Chitose
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
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11
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Hirano S, Sugiyama Y, Kaneko M, Mukudai S, Fuse S, Hashimoto K. Intracordal Injection of Basic Fibroblast Growth Factor in 100 Cases of Vocal Fold Atrophy and Scar. Laryngoscope 2020; 131:2059-2064. [PMID: 33107605 DOI: 10.1002/lary.29200] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold atrophy, scar, and sulcus reduce the vibratory function of the vocal fold mucosa, which causes severe refractory dysphonia. We have reported encouraging preliminary results using an intracordal injection of basic fibroblast growth factor (bFGF) and showed improvement in phonatory parameters and voice. The present study summarizes our experience with 100 cases of stiffened vocal folds that were treated with bFGF injections. STUDY DESIGN Retrospective chart review with Interstitial Review Board (IRB) approval. METHODS Local injection of bFGF was performed in 100 cases of vocal fold pathology, which included 43 cases of vocal fold atrophy, 41 cases with scar, and 16 cases with sulcus. Ten micrograms of bFGF were injected into the vocal folds under topical anesthesia 4 times in each patient. Therapeutic outcomes were examined with maximum phonation time (MPT), voice handicap index-10 (VHI-10), and GRBAS scale. RESULTS MPT, VHI-10, and GRBAS scores significantly improved in all pathology groups. An improvement on the VHI-10 greater than five points was observed in 82% of atrophy cases, 78% of scar cases, and 67% of sulcus cases. Improvement on the VHI-10 was significantly better in the atrophy group than the scar or sulcus groups. The mild/moderate cases of scar and sulcus showed better improvement than severe cases. CONCLUSIONS The current large case series indicates positive effects of intracordal injection of bFGF for improvement of voice with no severe adverse events. The effects appeared best for cases of atrophy, while the treatment of severe scar and sulcus requires further improvement. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2059-2064, 2021.
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Affiliation(s)
- Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Otolaryngology, Kanai Hospital, Kyoto, Japan
| | - Yoichiro Sugiyama
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mami Kaneko
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Otolaryngology, Kanai Hospital, Kyoto, Japan
| | - Shigeyuki Mukudai
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinya Fuse
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiko Hashimoto
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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12
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Ban MJ, Lee SC, Park JH, Park KN, Kim HK, Lee SW. Regenerative efficacy of fibroblast growth factor for the treatment of aged vocal fold: From animal model to clinical application. Clin Otolaryngol 2020; 46:131-137. [PMID: 32558170 DOI: 10.1111/coa.13597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/03/2020] [Accepted: 06/04/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We assessed fibroblast growth factor (FGF) regenerative efficacy in an aged vocal fold rat model and confirmed it in a prospective clinical trial. DESIGN, SETTING, AND PARTICIPANTS For animal experiments, 48 Sprague-Dawley rats were divided into two groups: 24 six-month-olds (young group) and 24 twenty-four-month-olds (old group). FGF was injected once a week thrice into the left vocal fold of the old group, dividing them into two sub-groups (injected [left] and uninjected [right]). Additionally, we conducted a prospective clinical trial for 38 patients with aged atrophic vocal fold. MAIN OUTCOME MEASURES A month post-injection, excised larynx from the three groups was subjected to comparative histopathological (ratio of relative lamina propria to total vocal fold) and mRNA expression analysis (of procollagen I, hyaluronic acid synthase (HAS)-2 and matrix metalloproteinase (MMP)-2) by real-time PCR. We performed perceptual, stroboscopic, acoustic aerodynamic test and Voice Handicap Index survey prior to and 1, 6 and 12 months after FGF injection. RESULTS In rats, the relative lamina propria ratio increased after FGF injection. Procollagen I mRNA level decreased, whereas that of HAS-2 and MMP-2 increased significantly in the injected compared to the uninjected old group. Enrolled patients showed improved subjective and objective voice parameters after FGF injection, and these were maintained for a year. Potential side effects were not observed. CONCLUSIONS Animal experiments and prospective clinical trial suggest that FGF injection to vocal fold can significantly improve voice quality until one year, without complications, and is effective for aged atrophic vocal fold treatment.
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Affiliation(s)
- Myung Jin Ban
- Department of Otorhinolaryngology - Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Seung Chul Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Hong Park
- Department of Otorhinolaryngology - Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Ki Nam Park
- Department of Otorhinolaryngology - Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hee Kyung Kim
- Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seung Won Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
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Abstract
Head and neck structures govern the vital functions of breathing and swallowing. Additionally, these structures facilitate our sense of self through vocal communication, hearing, facial animation, and physical appearance. Loss of these functions can lead to loss of life or greatly affect quality of life. Regenerative medicine is a rapidly developing field that aims to repair or replace damaged cells, tissues, and organs. Although the field is largely in its nascence, regenerative medicine holds promise for improving on conventional treatments for head and neck disorders or providing therapies where no current standard exists. This review presents milestones in the research of regenerative medicine in head and neck surgery.
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Affiliation(s)
- Michael J McPhail
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Jeffrey R Janus
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - David G Lott
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Scottsdale, AZ, USA
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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Okui A, Konomi U, Kanazawa T, Komazawa D, Nakamura K, Matsushima K, Watanabe Y. Therapeutic Efficacy of Basic Fibroblast Growth Factor in Patients With Vocal Fold Atrophy. Laryngoscope 2020; 130:2847-2852. [PMID: 32034961 DOI: 10.1002/lary.28541] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/13/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS In recent years, basic fibroblast growth factor (bFGF) injection has been used in the treatment of aging-related vocal fold atrophy. This injection not only improves closure by increasing the mass of the vocal fold but also improves its viscoelasticity. However, it has been reported that fibroblasts targeted by bFGF treatment decrease in number with age. The purpose of this study was to examine the effects of local injection of bFGF on age-related vocal atrophy as well as the influence of age on phonological outcomes. STUDY DESIGN Retrospective chart review. METHODS Fifty-three patients with age-related vocal fold atrophy underwent single injections of bFGF in their vocal folds. Phonological outcomes were evaluated 3 and 6 months after injection by acoustic and aerodynamic measurements. RESULTS Voice Handicap Index (VHI), maximum phonation time (MPT), jitter, shimmer, and pitch range improved after injection, and the effects continued for 6 months. In those over 70 years of age, VHI and MPT showed improvement at 3 and 6 months after injection. In addition, the degree of improvement in VHI and MPT did not differ significantly between those older than 70 years and those younger than 70 years. CONCLUSIONS Regenerative treatments dependent on bFGF single injection was safe and effective for both early and late elderly patients suffering of vocal fold atrophy. LEVEL OF EVIDENCE 2c Laryngoscope, 2020.
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Affiliation(s)
- Ayako Okui
- Tokyo Voice Center, International University of Health and Welfare, Tokyo.,Graduate School of Medicine, International University of Health and Welfare Graduate School, Tokyo
| | - Ujimoto Konomi
- Tokyo Voice Center, International University of Health and Welfare, Tokyo
| | - Takeharu Kanazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo
| | - Daigo Komazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo
| | - Kazuhiro Nakamura
- Tokyo Voice Center, International University of Health and Welfare, Tokyo.,Department of Otolaryngology-Head and Neck Surgery, Nihon University, Itabashi Hospital, Tokyo
| | - Koji Matsushima
- Tokyo Voice Center, International University of Health and Welfare, Tokyo.,Department of Otolaryngology-Head and Neck Surgery, Toho University, Omori Medical Center, Tokyo, Japan
| | - Yusuke Watanabe
- Tokyo Voice Center, International University of Health and Welfare, Tokyo
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15
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16
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Goto T, Ueha R, Sato T, Fujimaki Y, Nito T, Yamasoba T. Single, high-dose local injection of bFGF improves thyroarytenoid muscle atrophy after paralysis. Laryngoscope 2019; 130:159-165. [PMID: 30810241 DOI: 10.1002/lary.27887] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/10/2019] [Accepted: 02/04/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES/HYPOTHESIS Unilateral vocal fold paralysis (UVFP) induces hoarseness due to progressive atrophy of the denervated thyroarytenoid (TA) muscle. Therefore, treatments aimed at regenerating the atrophied TA muscle are required. Basic fibroblast growth factor (bFGF) is involved in muscle development and regeneration. This study aimed to elucidate the effects of bFGF injection on atrophied TA muscle. STUDY DESIGN Animal research. METHODS A recurrent laryngeal nerve-paralysis rat model was established, and low- (200 ng) or high-dose (2,000 ng) bFGF or saline (control) was injected into the TA muscle 28 days later. The larynges were excised on day 1, 3, 7, 14, and 28 after treatment. The cross-sectional area of the TA muscle in normal and paralyzed sides was compared, and the Ki67-positive (Ki67+ ) dividing cells, paired box 7-positive (Pax7+ ) satellite cells (SCs), and myogenic differentiation-positive (MyoD+ ) myoblasts were counted. RESULTS The TA muscle area of animals administered high-dose bFGF increased with time and was significantly larger than that of the saline-injected controls 28 days after treatment (P < .05). The counts of Ki67+ and Pax7+ cells were the highest on day 1, whereas the MyoD+ myoblast count was highest on day 7. These results suggest that bFGF administration into the denervated TA muscles compensated for the atrophied TA muscles by inducing proliferation of SCs and their differentiation to myoblasts. CONCLUSIONS A single injection of high-dose bFGF augmented regeneration and differentiation of the atrophied TA muscle by enhancing proliferation and differentiation of muscle SCs, suggesting its possible clinical application in humans with UVFP. LEVEL OF EVIDENCE NA Laryngoscope, 130:159-165, 2020.
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Affiliation(s)
- Takao Goto
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoko Fujimaki
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Takaharu Nito
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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17
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Hu HC, Hung YT, Lin SY, Tung TH, Chang SY. Office-Based Autologous Fat Injection Laryngoplasty for Glottic Insufficiency in Patients Under 50 Years Old. J Voice 2018; 33:747-750. [PMID: 29678440 DOI: 10.1016/j.jvoice.2018.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 03/13/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to determine the outcomes of office-based autologous fat injection laryngoplasty in the treatment of patients under 50 years old with glottic insufficiency but without neurological problems or acquired organic lesions in the vocal fold. METHODS We conducted a retrospective chart review of consecutive patients under 50 years of age who underwent office-based autologous fat injection laryngoplasty for glottic insufficiency. None of the patients presented neurological problems or acquired organic lesions in the vocal fold. Videolaryngostroboscopic data, objective voice assessment, perceptual measurements of vocal quality, and subjective ratings of voice quality were evaluated before and after treatment. RESULTS The 23 patients (7 men and 16 women) in this study presented significant improvements in phonatory function in terms of maximum phonation time, jitter, grade, asthenia, and Voice Handicap Index-10 (VHI-10) values at 3 months. Significant improvements in terms of jitter, noise-to-harmonic ratio, grade, roughness, breathiness, asthenia, and the VHI-10 values were also observed at 6 months. CONCLUSIONS Glottic insufficiency in younger patients without neurological problems or acquired organic lesions in the vocal fold can be treated effectively using office-based autologous fat injection laryngoplasty. Significant improvements in phonatory function were observed even 6 months after surgery.
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Affiliation(s)
- Hao-Chun Hu
- Department of Otorhinolaryngology-Head and Neck Surgery, Fu Jen Catholic University Hospital, New Taipei, Taiwan; Voice Center, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Yi-Ting Hung
- Voice Center, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shu-Yi Lin
- Voice Center, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan; Department of Public Health, Fu Jen Catholic University, New Taipei, Taiwan
| | - Shyue-Yih Chang
- Voice Center, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan; Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan.
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18
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Affiliation(s)
- Cara Sauder
- Department of Speech and Hearing Sciences, University of Washington
Seattle, WA
| | - Albert L. Merati
- Department of Otolaryngology - Head & Neck Surgery, University of Washington School of Medicine
Seattle, WA
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19
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Kaneko M, Tsuji T, Kishimoto Y, Sugiyama Y, Nakamura T, Hirano S. Regenerative Effects of Basic Fibroblast Growth Factor on Restoration of Thyroarytenoid Muscle Atrophy Caused by Recurrent Laryngeal Nerve Transection. J Voice 2017; 32:645-651. [PMID: 29111336 DOI: 10.1016/j.jvoice.2017.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Vocal fold atrophy following unilateral vocal fold paralysis is caused by atrophy of the thyroarytenoid (TA) muscle and remains a challenge. Medialization procedures are popular treatment options; however, hoarseness often remains due to the reduction in mass or tension of the TA muscle. Therefore, in addition to medialization procedures, TA muscle reinnervation is desirable. In vivo studies have shown the potential for basic fibroblast growth factor (bFGF) to affect muscular and nerve regeneration. The present study aimed to examine the regenerative effects of bFGF on restoration of TA muscle atrophy caused by recurrent laryngeal nerve transection. STUDY DESIGN Prospective animal experiments with controls. METHODS TA muscle atrophy was induced by unilateral transection of the recurrent laryngeal nerve. One month after transection, different doses (200 ng, 100 ng, 10 ng) of bFGF in 50 µL were repeatedly injected into the TA muscle four times with an interval of 1 week between injections. Saline only was injected in the sham group. Larynges were harvested for histologic and immunohistochemical examination 4 weeks after the final injection. RESULTS The cross-sectional TA muscle area was significantly larger in the bFGF-treated groups compared with the sham-treated groups. Immunohistochemistry indicated that bFGF significantly increases the number of neuromuscular junctions and satellite cells in the TA muscle. CONCLUSIONS These results suggest that local application of bFGF to the TA muscle may improve TA muscle atrophy caused by recurrent laryngeal nerve paralysis. Furthermore, bFGF may have regenerative effects on both nerves and muscles.
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Affiliation(s)
- Mami Kaneko
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuya Tsuji
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoichiro Sugiyama
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tatsuo Nakamura
- Department of Regeneration Science and Engineering, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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20
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Kanazawa T, Kurakami K, Kashima K, Konomi U, Komazawa D, Nakamura K, Matsushima K, Akagi Y, Misawa K, Nishino H, Watanabe Y. Injection of basic fibroblast growth factor for unilateral vocal cord paralysis . Acta Otolaryngol 2017; 137:962-967. [PMID: 28434284 DOI: 10.1080/00016489.2017.1314550] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Unilateral vocal cord paralysis (UVCP) not only induces severe dysphonia, but aspiration as well. Although laryngeal framework surgery is usually performed to treat this condition, the procedure is not tolerated by some patients. In the previous study, basic fibroblast growth factor (bFGF) injections for vocal cord scarring and sulcus have been reported to provide favorable outcomes while being minimally invasive. In this study, the authors retrospectively investigated phonological outcomes after bFGF injection in patients with UVCP. METHODS This study was registered in University hospital Medical Information Network - Clinical Trials Registry (UMIN000019347). Nineteen patients with unilateral cord paralysis were treated with bFGF injection. The treatment regimen involved a single injection of 50 μg of bFGF into the muscle layer. More than six months after the injection, aerodynamic and acoustic outcomes were examined. RESULTS The voice handicap index, maximum phonation time, mean airflow rate, and pitch range improved significantly after injection of bFGF. No sex-related differences were observed in any phonological parameter. CONCLUSION bFGF injection, an easy method and suitable as an office procedure, significantly improved the hoarseness caused by UVCP. It is expected to be widely adopted and effective adjunctive drugs, and procedures are anticipated to be developed.
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Affiliation(s)
- Takeharu Kanazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Kazuya Kurakami
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Yamagata University, Faculty of Medicine, Yamagata, Japan
| | - Kazutaka Kashima
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ujimoto Konomi
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Daigo Komazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Kazuhiro Nakamura
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Koji Matsushima
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Yusuke Akagi
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology, Okayama Medical Center, Okayama, Japan
| | - Kiyoshi Misawa
- Department of Otolaryngology-Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroshi Nishino
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Yusuke Watanabe
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
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21
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Suzuki H, Makiyama K, Hirai R, Matsuzaki H, Furusaka T, Oshima T. Efficacy of a Single Dose of Basic Fibroblast Growth Factor: Clinical Observation for 1 Year. J Voice 2016; 30:761.e11-761.e17. [DOI: 10.1016/j.jvoice.2015.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/29/2015] [Indexed: 11/28/2022]
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22
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Suzuki R, Kawai Y, Tsuji T, Hiwatashi N, Kishimoto Y, Tateya I, Nakamura T, Hirano S. Prevention of vocal fold scarring by local application of basic fibroblast growth factor in a rat vocal fold injury model. Laryngoscope 2016; 127:E67-E74. [DOI: 10.1002/lary.26138] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/01/2016] [Accepted: 05/23/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Ryo Suzuki
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Yoshitaka Kawai
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Takuya Tsuji
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Nao Hiwatashi
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Ichiro Tateya
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Tatsuo Nakamura
- Department of Bioartificial Organs; Institute for Frontier Medical Science; Kyoto University Kyoto Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery; Kyoto Prefectural University of Medicine; Kyoto Japan
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23
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Stemple JC, Andreatta RD, Seward TS, Angadi V, Dietrich M, McMullen CA. Enhancement of aging rat laryngeal muscles with endogenous growth factor treatment. Physiol Rep 2016; 4:e12798. [PMID: 27207784 PMCID: PMC4886166 DOI: 10.14814/phy2.12798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/18/2016] [Accepted: 04/23/2016] [Indexed: 01/03/2023] Open
Abstract
Clinical evidence suggests that laryngeal muscle dysfunction is associated with human aging. Studies in animal models have reported morphological changes consistent with denervation in laryngeal muscles with age. Life-long laryngeal muscle activity relies on cytoskeletal integrity and nerve-muscle communication at the neuromuscular junction (NMJ). It is thought that neurotrophins enhance neuromuscular transmission by increasing neurotransmitter release. We hypothesized that treatment with neurotrophin 4 (NTF4) would modify the morphology and functional innervation of aging rat laryngeal muscles. Fifty-six Fischer 344xBrown Norway rats (6- and 30-mo age groups) were used to evaluate to determine if NTF4, given systemically (n = 32) or directly (n = 24), would improve the morphology and functional innervation of aging rat thyroarytenoid muscles. Results demonstrate the ability of rat laryngeal muscles to remodel in response to neurotrophin application. Changes were demonstrated in fiber size, glycolytic capacity, mitochondrial, tyrosine kinase receptors (Trk), NMJ content, and denervation in aging rat thyroarytenoid muscles. This study suggests that growth factors may have therapeutic potential to ameliorate aging-related laryngeal muscle dysfunction.
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Affiliation(s)
- Joseph C Stemple
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
| | - Richard D Andreatta
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
| | - Tanya S Seward
- Department of Physiology, University of Kentucky, Lexington, Kentucky
| | - Vrushali Angadi
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
| | - Maria Dietrich
- Department of Communication Science and Disorders, University of Missouri, Columbia, Missouri
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Ohno S, Hirano S, Yasumoto A, Ikeda H, Takebayashi S, Miura M. Outcome of regenerative therapy for age-related vocal fold atrophy with basic fibroblast growth factor. Laryngoscope 2016; 126:1844-8. [DOI: 10.1002/lary.25578] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/14/2015] [Accepted: 07/20/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Satoshi Ohno
- Department of Otolaryngology; Head and Neck Surgery, Kokura Memorial Hospital; Fukuoka Japan
- Department of Otolaryngology; Japanese Red Cross Wakayama Medical Center; Wakayama Japan
| | - Shigeru Hirano
- Department of Otolaryngology; Head and Neck Surgery, Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Akiyoshi Yasumoto
- Department of Otolaryngology; Head and Neck Surgery, Kokura Memorial Hospital; Fukuoka Japan
- Department of Otolaryngology; Japanese Red Cross Wakayama Medical Center; Wakayama Japan
| | - Hiroki Ikeda
- Department of Otolaryngology; Japanese Red Cross Wakayama Medical Center; Wakayama Japan
| | - Shinji Takebayashi
- Department of Otolaryngology; Japanese Red Cross Wakayama Medical Center; Wakayama Japan
| | - Makoto Miura
- Department of Otolaryngology; Japanese Red Cross Wakayama Medical Center; Wakayama Japan
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Fishman JM, Long J, Gugatschka M, De Coppi P, Hirano S, Hertegard S, Thibeault SL, Birchall MA. Stem cell approaches for vocal fold regeneration. Laryngoscope 2016; 126:1865-70. [PMID: 26774977 DOI: 10.1002/lary.25820] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/20/2015] [Accepted: 11/13/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS Current interventions in the management of vocal fold (VF) dysfunction focus on conservative and surgical approaches. However, the complex structure and precise biomechanical properties of the human VF mean that these strategies have their limitations in clinical practice and in some cases offer inadequate levels of success. Regenerative medicine is an exciting development in this field and has the potential to further enhance VF recovery beyond conventional treatments. Our aim in this review is to discuss advances in the field of regenerative medicine; that is, advances in the process of replacing, engineering, or regenerating the VF through utilization of stem cells, with the intention of restoring normal VF structure and function. DATA SOURCES English literature (1946-2015) review. METHODS We conducted a systematic review of MEDLINE for cases and studies of VF tissue engineering utilizing stem cells. RESULTS The three main approaches by which regenerative medicine is currently applied to VF regeneration include cell therapy, scaffold development, and utilization of growth factors. CONCLUSION Exciting advances have been made in stem cell biology in recent years, including use of induced pluripotent stem cells. We expect such advances to be translated into the field in the forthcoming years. Laryngoscope, 126:1865-1870, 2016.
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Affiliation(s)
- Jonathan M Fishman
- UCL Institute of Child Health, London, United Kingdom.,UCL Ear Institute and Royal National Throat, Nose and Ear Hospital and, London, United Kingdom
| | - Jenny Long
- UCL Institute of Child Health, London, United Kingdom
| | - Markus Gugatschka
- Department of Phoniatrics, ENT University Hospital Graz, Medical University Graz, Graz, Austria
| | | | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Stellan Hertegard
- Department of Otorhinolaryngology, Karolinska Institutet Clintec, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, Madison, Wisconsin, U.S.A
| | - Martin A Birchall
- UCL Ear Institute and Royal National Throat, Nose and Ear Hospital and, London, United Kingdom
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Nunes QM, Li Y, Sun C, Kinnunen TK, Fernig DG. Fibroblast growth factors as tissue repair and regeneration therapeutics. PeerJ 2016; 4:e1535. [PMID: 26793421 PMCID: PMC4715458 DOI: 10.7717/peerj.1535] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/05/2015] [Indexed: 12/25/2022] Open
Abstract
Cell communication is central to the integration of cell function required for the development and homeostasis of multicellular animals. Proteins are an important currency of cell communication, acting locally (auto-, juxta-, or paracrine) or systemically (endocrine). The fibroblast growth factor (FGF) family contributes to the regulation of virtually all aspects of development and organogenesis, and after birth to tissue maintenance, as well as particular aspects of organism physiology. In the West, oncology has been the focus of translation of FGF research, whereas in China and to an extent Japan a major focus has been to use FGFs in repair and regeneration settings. These differences have their roots in research history and aims. The Chinese drive into biotechnology and the delivery of engineered clinical grade FGFs by a major Chinese research group were important enablers in this respect. The Chinese language clinical literature is not widely accessible. To put this into context, we provide the essential molecular and functional background to the FGF communication system covering FGF ligands, the heparan sulfate and Klotho co-receptors and FGF receptor (FGFR) tyrosine kinases. We then summarise a selection of clinical reports that demonstrate the efficacy of engineered recombinant FGF ligands in treating a wide range of conditions that require tissue repair/regeneration. Alongside, the functional reasons why application of exogenous FGF ligands does not lead to cancers are described. Together, this highlights that the FGF ligands represent a major opportunity for clinical translation that has been largely overlooked in the West.
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Affiliation(s)
- Quentin M. Nunes
- Department of Molecular and Clinical Cancer Medicine, NIHR Liverpool Pancreas Biomedical Research Unit, University of Liverpool, Liverpool, United Kingdom
| | - Yong Li
- Department of Biochemistry, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Changye Sun
- Department of Biochemistry, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Tarja K. Kinnunen
- Department of Biology, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - David G. Fernig
- Department of Biochemistry, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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27
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Sardesai MG, Merati AL, Hu A, Birkent H. Impact of patient-related factors on the outcomes of office-based injection laryngoplasty. Laryngoscope 2015; 126:1806-9. [PMID: 26597519 DOI: 10.1002/lary.25764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 08/31/2015] [Accepted: 10/02/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS In-office percutaneous injection laryngoplasty (IL) is a common treatment for glottal insufficiency. The objective of this prospective study was to determine if voice outcomes from IL are affected by age, gender, or initial disease severity. STUDY DESIGN Prospective case series. METHODS Consecutive adult patients undergoing awake injection laryngoplasty were recruited from a subspecialty laryngology clinic. Voice Handicap Index (VHI-30); Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V); and Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) Dysphonia Scale were evaluated prior to and 2 months after injection. Patients who had more severe disease were defined as those patients with greater initial perception of handicap, with a VHI score greater than 60. RESULTS Thirty-five subjects were enrolled, and 27 (16 male; mean age 61.6 ± 13.2 years) had complete data. No impact from age or gender was seen on outcomes from IL as measured by VHI-30 (P = 0.397 for age; P = 0.764 for gender), CAPE-V (P = 0.675 for age, P = 0.975 for gender), or GRBAS (P = 0.213 for age, P = 0.983 for gender). Patients with poorer initial VHI tended to have more significant improvement (P = 0.002), which may represent a ceiling effect. CONCLUSIONS In this prospective clinical study, age and gender did not affect outcome in IL. Patients with more severe disease appeared to have greater improvement. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1806-1809, 2016.
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Affiliation(s)
- Maya G Sardesai
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Albert L Merati
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Amanda Hu
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Hakan Birkent
- Department of Otolaryngology-Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
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Pitman MJ, Cabin JA, Iacob CE. Small Intestinal Submucosa Implantation for the Possible Treatment of Vocal Fold Scar, Sulcus, and Superficial Lamina Propria Atrophy. Ann Otol Rhinol Laryngol 2015; 125:137-44. [DOI: 10.1177/0003489415601685] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: Evaluate the histologic effects of grafting porcine-derived small intestinal submucosa (SIS) into the vocal fold superficial lamina propria (SLP) layer for the potential treatment of vocal fold scar, sulcus and superficial lamina propria atrophy. Methods: Small intestinal submucosa was implanted into the right vocal fold SLP of 6 mongrel dogs. The left vocal fold served as a sham surgical control. At 2, 4, and 6 weeks postoperative, bilateral vocal fold specimens were evaluated histologically. Results: At 2 and 4 weeks, respectively, SIS-implanted vocal folds demonstrated moderate and mild inflammation and acute and chronic inflammation. At 6 weeks, inflammation was minimal and chronic. The 6-week specimens showed copious amounts of newly generated hyaluronic acid (HA) within the graft. There was no reactive fibrosis at 6 weeks. Conclusions: In the canine model, SIS appears safe for SLP grafting. Inflammation is similar to that of sham surgery. Small intestinal submucosa results in newly generated HA without concomitant fibrosis. Small intestinal submucosa has potential to be used in treatment of disorders with SLP, including vocal fold scar, sulcus, and atrophy. Studies evaluating the effect of SIS implantation on vocal fold function, as well as the ultimate fate of the graft, are required.
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Affiliation(s)
- Michael J. Pitman
- Otolaryngology- HNS, The Voice and Swallowing Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Jonathan A. Cabin
- Otolaryngology-Head & Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Codrin E. Iacob
- Department of Pathology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
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29
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Multidimensional Analysis on the Effect of Vocal Function Exercises on Aged Vocal Fold Atrophy. J Voice 2015; 29:638-44. [DOI: 10.1016/j.jvoice.2014.10.017] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/28/2014] [Indexed: 11/20/2022]
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30
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Kanazawa T, Komazawa D, Indo K, Akagi Y, Lee Y, Nakamura K, Matsushima K, Kunieda C, Misawa K, Nishino H, Watanabe Y. Single injection of basic fibroblast growth factor to treat severe vocal fold lesions and vocal fold paralysis. Laryngoscope 2015; 125:E338-44. [PMID: 25953726 PMCID: PMC6718003 DOI: 10.1002/lary.25315] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/26/2015] [Accepted: 03/16/2015] [Indexed: 11/08/2022]
Abstract
Objectives/Hypothesis Severe vocal fold lesions such as vocal fold sulcus, scars, and atrophy induce a communication disorder due to severe hoarseness, but a treatment has not been established. Basic fibroblast growth factor (bFGF) therapies by either four‐time repeated local injections or regenerative surgery for vocal fold scar and sulcus have previously been reported, and favorable outcomes have been observed. In this study, we modified bFGF therapy using a single of bFGF injection, which may potentially be used in office procedures. Study Design Retrospective chart review. Methods Five cases of vocal fold sulcus, six cases of scars, seven cases of paralysis, and 17 cases of atrophy were treated by a local injection of bFGF. The injection regimen involved injecting 50 µg of bFGF dissolved in 0.5 mL saline only once into the superficial lamina propria using a 23‐gauge injection needle. Two months to 3 months after the injection, phonological outcomes were evaluated. Results The maximum phonation time (MPT), mean airflow rate, pitch range, speech fundamental frequency, jitter, and voice handicap index improved significantly after the bFGF injection. Furthermore, improvement in the MPT was significantly greater in patients with (in increasing order) vocal fold atrophy, scar, and paralysis. The improvement in the MPT among all patients was significantly correlated with age; the MPT improved more greatly in younger patients. Conclusions Regenerative treatments by bFGF injection—even a single injection—effectively improve vocal function in vocal fold lesions. Level of Evidence 4 Laryngoscope, 125:E338–E344, 2015
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Affiliation(s)
- Takeharu Kanazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Daigo Komazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Kanako Indo
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otolaryngology, Kagawa University, School of Medicine, Miki, Japan
| | - Yusuke Akagi
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otolaryngology-Head and Neck Surgery, Okayama Medical Center, Okayama, Japan
| | - Yogaku Lee
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Kazuhiro Nakamura
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tokyo Medical University, Hachioji Medical Center, Hachioji, Japan
| | - Koji Matsushima
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otolaryngology-Head and Neck Surgery, Toho University, Omori Medical Center, Tokyo, Japan
| | - Chikako Kunieda
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otorhinolaryngology, Hashima City Hospital, Hashima, Japan
| | - Kiyoshi Misawa
- Department of Otolaryngology-Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroshi Nishino
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Yusuke Watanabe
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
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Abstract
Aging is marked by changes that affect organs and resident stem cell function. Shorting of telomeres, DNA damage, oxidative stress, deregulation of genes and proteins, impaired cell-cell communication, and an altered systemic environment cause the eventual demise of cells. At the same time, reparative activities also decline. It is intriguing to correlate aging with the decline of regenerative abilities. Animal models with strong regenerative capabilities imply that aging processes might not be affecting regeneration. In this review, we selectively present age-dependent changes in stem/progenitor cells that are vital for tissue homeostasis and repair. In addition, the aging effect on regeneration following injury in organs such as lung, skeletal muscle, heart, nervous system, cochlear hair, lens, and liver are discussed. These tissues are also known for diseases such as heart attack, stroke, cognitive impairment, cataract, and hearing loss that occur mostly during aging in humans. Conclusively, vertebrate regeneration declines with age with the loss of stem/progenitor cell function. Future studies on improving the function of stem cells, along with studies in fish and amphibians where regeneration does not decline with age, will undoubtedly provide insights into both processes.
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Affiliation(s)
- Konstantinos Sousounis
- Department of Biology and Center for Tissue Regeneration and Engineering, University of Dayton, Dayton, Ohio, USA
| | - Joelle A Baddour
- Department of Chemical and Materials Engineering and Center for Tissue Regeneration and Engineering, University of Dayton, Dayton, Ohio, USA
| | - Panagiotis A Tsonis
- Department of Biology and Center for Tissue Regeneration and Engineering, University of Dayton, Dayton, Ohio, USA.
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34
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Toyomura F, Tokashiki R, Hiramatsu H, Tsukahara K, Motohashi R, Sakurai E, Nomoto M, Suzuki M. Day surgery for vocal fold lesions using a double-bent 60-mm Cathelin needle. Eur Arch Otorhinolaryngol 2014; 271:3095-9. [PMID: 25178415 DOI: 10.1007/s00405-014-3257-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
Day surgery for vocal cord lesions overcomes the disadvantages of laryngomicrosurgery under general anesthesia. We present our experience with treatment of vocal fold lesions using a long double-bend Cathelin needle that can access all parts of the vocal cords. A 23G, 60-mm-long Cathelin needle was bent twice by 45(o) at a distance of 1 and 2 cm from the tip, and was attached to a syringe. Under topical anesthesia and nasal endoscopy of the laryngopharynx, the needle was inserted percutaneously perpendicular to the skin, the direction of insertion being altered when the bends in the needle reached the skin surface. This allows the tip of the needle to access all parts of the glottis, allowing the performance of procedures such as biopsies, excision of lesions, and injection into the vocal folds. Between January 2011 and December 2013, we used this technique to perform vocal fold procedures in 566 patients presenting for treatment of spasmodic dysphonia (412 cases, 73 %) and other vocal fold lesions. Only minor complications, such as hematoma (3 patients, 0.5 %) and slight bleeding from the puncture site in the epiglottic vallecula (all patients, 100 %), which ceased spontaneously within 10 min, were seen. Erroneous puncture occurred in three patients (0.5 %) and the puncture had to be repeated in 38 patients (6.7 %). The procedure was completed successfully in all cases (100 %). Surgery for vocal fold lesions under topical anesthesia using our double-bend Cathelin needle technique is simple, safe, and useful.
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Affiliation(s)
- Fumimasa Toyomura
- Department of Otolaryngology, Tokyo Medical University, 1-6-7 Nishishinjuku Shinjuku-ku, Tokyo, Japan,
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Mizuta M, Hirano S, Hiwatashi N, Kobayashi T, Tateya I, Kanemaru SI, Nakamura T, Ito J. Effect of AST on age-associated changes of vocal folds in a rat model. Laryngoscope 2014; 124:E411-7. [PMID: 24764173 DOI: 10.1002/lary.24733] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/18/2014] [Accepted: 03/17/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Reactive oxygen species (ROS) are associated with aging. Astaxanthin (AST) is a strong antioxidant and has been reported to prevent various ROS-induced diseases. In the current study, we investigated the effect of AST on age-associated histological and mRNA changes of vocal folds. STUDY DESIGN Prospective animal experiment with control. METHODS Six-month-old Sprague-Dawley rats were fed on a normal powder diet with 0.01% (w/w) AST (aged AST-treated group) or without AST (aged sham-treated group). After 12 months of feeding, the larynges were harvested for histology, immunohistochemical detection of 4-hydroxy-2-nonenal (4-HNE), and quantitative real-time polymerase chain reaction for basic fibroblast growth factor (bFGF) and hepatocyte growth factor (HGF). Thirteen-week-old rats were used as a young control group (young group). RESULTS The expression of 4-HNE, an oxidative stress marker, significantly increased in the two aged groups compared with the young group. Histological examination showed that the deposition of hyaluronic acid in the lamina propria (LP) was significantly reduced in the aged sham-treated group compared with the young group, but no significant difference was observed between the aged AST-treated group and the young group. There were no significant differences in the mRNA expression of bFGF and HGF between the aged AST-treated group and the young group, although the expression of these genes was significantly reduced in the aged sham-treated group as compared with the young group. CONCLUSIONS These results suggest that AST has the potential to attenuate age-associated changes of vocal folds.
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Affiliation(s)
- Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto
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Suárez-González D, Lee JS, Diggs A, Lu Y, Nemke B, Markel M, Hollister SJ, Murphy WL. Controlled multiple growth factor delivery from bone tissue engineering scaffolds via designed affinity. Tissue Eng Part A 2013; 20:2077-87. [PMID: 24350567 DOI: 10.1089/ten.tea.2013.0358] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
It is known that angiogenesis plays an important role in bone regeneration and that release of angiogenic and osteogenic growth factors can enhance bone formation. Multiple growth factors play key roles in processes that lead to tissue formation/regeneration during natural tissue development and repair. Therefore, treatments aiming to mimic tissue regeneration can benefit from multiple growth factor release, and there remains a need for simple clinically relevant approaches for dual growth factor release. We hypothesized that mineral coatings could be used as a platform for controlled incorporation and release of multiple growth factors. Specifically, mineral-coated scaffolds were "dip coated" in multiple growth factor solutions, and growth factor binding and release were dictated by the growth factor-mineral binding affinity. Beta tricalcium phosphate (β-TCP) scaffolds were fabricated using indirect solid-free form fabrication techniques and coated with a thin conformal mineral layer. Mineral-coated β-TCP scaffolds were sequentially dipped in recombinant human vascular endothelial growth factor (rhVEGF) and a modular bone morphogenetic peptide, a mineral-binding version of bone morphogenetic protein 2 (BMP2), solutions to allow for the incorporation of each growth factor. The dual release profile showed sustained release of both growth factors for over more than 60 days. Scaffolds releasing either rhVEGF alone or the combination of growth factors showed an increase in blood vessel ingrowth in a dose-dependent manner in a sheep intramuscular implantation model. This approach demonstrates a "modular design" approach, in which a controllable biologics carrier is integrated into a structural scaffold as a thin surface coating.
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Affiliation(s)
- Darilis Suárez-González
- 1 Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison , Madison, Wisconsin
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Nagai H, Nishiyama K, Seino Y, Kimura Y, Tabata Y, Okamoto M. Fascia implantation with fibroblast growth factor on vocal fold paralysis. Am J Otolaryngol 2013; 34:331-6. [PMID: 23517569 DOI: 10.1016/j.amjoto.2013.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/28/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this prospective study was to determine the effect of autologous transplantation of fascia into the vocal fold (ATFV) with controlled release of basic fibroblast growth factor (bFGF) on unilateral vocal fold paralysis (UVFP) in a rat model. MATERIALS AND METHODS Unilateral recurrent laryngeal nerve (RLN) section was performed on 15 rats. Ten rats received an autologous fascia implant and gelatin hydrogel with or without bFGF (1 μg) to their larynxes (fascia only, "fascia group"; bFGF + fascia, "fascia + bFGF group"), while the rest underwent RLN transection ("RLN section group"). Four months later, evaluation of the laryngeal glottal gap and histological analysis were performed. RESULTS The glottal gap was significantly reduced in the fascia + bFGF group, and fat volume increased significantly relative to the RLN section. The volume of the remaining fascia in the bFGF + fascia group was significantly greater than that of the fascia group. CONCLUSIONS ATFV with controlled release of bFGF may compensate for diminished laryngeal volume in UVFP by reducing resorption of the implanted fascia and increasing fat volume. Our findings suggest that this modality may represent an attractive option for treating UVFP.
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Hirano S, Mizuta M, Kaneko M, Tateya I, Kanemaru SI, Ito J. Regenerative phonosurgical treatments for vocal fold scar and sulcus with basic fibroblast growth factor. Laryngoscope 2013; 123:2749-55. [PMID: 23553343 DOI: 10.1002/lary.24092] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 02/19/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold scar and sulcus are still challenges. Basic fibroblast growth factor (bFGF) has proven to be effective to resolve scar tissue in animal models. This study reports the efficacy of regenerative treatments using bFGF on vocal fold scar and sulcus in human cases. STUDY DESIGN Retrospective chart review. METHODS Fifteen cases (7 scar; 8 sulcus) were treated by either local injection of bFGF (n = 6) or regenerative surgery using bFGF (n = 9). Injection regimen was to locally apply 10 micrograms of bFGF in 0.5 mL saline into each vocal fold under topical anesthesia repeatedly (4 times with intervals of 1 week between each injection). The regenerative surgical procedure consisted of the dissection of scar tissue and the implant of gelatin sponge with bFGF. Follow-up periods ranged from 6 months to 24 months. RESULTS Maximum Phonation Time (MPT); Voice Handicap Index (VHI)-10; and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale were assessed in both groups. The injection group showed significant improvement on VHI-10 and GRBAS. The regenerative surgery group showed significant improvement in all parameters. Jitter and shimmer were evaluated in the surgery group, and the results indicated improvement in six and five cases of nine cases, respectively. No major adverse effects were observed in both treatment groups. CONCLUSIONS Regenerative treatments using bFGF has shown to be effective for improvement of vocal function in scar and sulcus.
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Affiliation(s)
- Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Peterson JR, Watts CR, Morris JA, Shelton JM, Cooper BG. Laryngeal aging and acoustic changes in male rat ultrasonic vocalizations. Dev Psychobiol 2012; 55:818-28. [DOI: 10.1002/dev.21072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 06/26/2012] [Indexed: 11/07/2022]
Affiliation(s)
- Jennifer R. Peterson
- Department of Psychology; Texas Christian University; TCU Box 298920 Fort Worth, TX 76129
| | - Christopher R. Watts
- Department of Communication Sciences and Disorders; Texas Christian University; Fort Worth TX 76129
| | - Jesse A. Morris
- Division of Cardiology; Department of Internal Medicine; UT Southwestern Medical Center Dallas, TX 75390
| | - John M. Shelton
- Division of Cardiology; Department of Internal Medicine; UT Southwestern Medical Center Dallas, TX 75390
| | - Brenton G. Cooper
- Department of Psychology; Texas Christian University; TCU Box 298920 Fort Worth, TX 76129
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