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Kryukov AI, Romanenko SG, Oteyami AB. [Epidemiological features papillomatosis of the larynx in adults: a literature review]. Vestn Otorinolaringol 2024; 89:66-70. [PMID: 38805466 DOI: 10.17116/otorino20248902166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
The literature review presents current data on the epidemiology, drug, and surgical treatment of laryngeal papillomatosis in adults. Possible prospects for further study of the prevalence and incidence of the disease and provoking factors of recurrence of the disease for the development of possible preventive measures are considered.
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Affiliation(s)
- A I Kryukov
- Pirogov Russian National Research Medical University, Moscow, Russia
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - S G Romanenko
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A B Oteyami
- Pirogov Russian National Research Medical University, Moscow, Russia
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González-Rodríguez H, Mayo-Yáñez M, Maria-Saibene A, Allevi F, Chiesa-Estomba CM, Vaira LA, Lechien JR. Indications, Efficacy, Safety, and Clinical Outcomes of 585 nm Pulsed Dye Laser in Non-Malignant Laryngeal Lesions: A Systematic Review. J Pers Med 2023; 13:1374. [PMID: 37763142 PMCID: PMC10533112 DOI: 10.3390/jpm13091374] [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: 08/16/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
The objective of this manuscript was to review the indications, efficacy, and safety of a 585 nm pulsed dye laser (PDL) in non-malignant laryngeal lesions. Following the PRISMA statement recommendations, three independent authors searched for articles published in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo, and Web of Science. A bias analysis was performed following NICE guidance tools. From the 506 identified publications, 19 observational studies met the inclusion criteria. The PDL improves vocal quality objectively and subjectively in vascular lesions (p < 0.005) and improves vocal quality in patients with dysplasia/leukoplasia without changing the natural history of the disease compared to other treatments. Reinke's edema and granulomas require an average of 1.5 PDL sessions for resolution. Treatment of recurrent respiratory papillomatosis requires multiple sessions, with complete remission achieved in 50-70% of patients. Regardless of the lesion, the tolerance of the procedure under local anesthesia is exceptional (84-97%), and the results in terms of regression and vocal quality are promising. The complication rate is minimal, and the procedure does not interfere with other treatment alternatives. There is no consensus on laser settings. The lack of consistent use in evaluating vocal outcomes, whether objective or subjective, prevents the comparability between studies. The 585 nm pulsed dye laser appears to be an effective and safe therapeutic option in patients with non-malignant laryngeal pathology. Future controlled studies are needed to compare the 585 nm pulsed dye laser with other lasers or cold instrument procedures.
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Affiliation(s)
- Henar González-Rodríguez
- Otorhinolaryngology—Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain
| | - Miguel Mayo-Yáñez
- Otorhinolaryngology—Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Research Study Group, 75000 Paris, France; (A.M.-S.); (F.A.); (C.M.C.-E.); (L.A.V.); (J.R.L.)
| | - Alberto Maria-Saibene
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Research Study Group, 75000 Paris, France; (A.M.-S.); (F.A.); (C.M.C.-E.); (L.A.V.); (J.R.L.)
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy
| | - Fabiana Allevi
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Research Study Group, 75000 Paris, France; (A.M.-S.); (F.A.); (C.M.C.-E.); (L.A.V.); (J.R.L.)
- Maxillofacial Surgery Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy
| | - Carlos M. Chiesa-Estomba
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Research Study Group, 75000 Paris, France; (A.M.-S.); (F.A.); (C.M.C.-E.); (L.A.V.); (J.R.L.)
- Otorhinolaryngology—Head and Neck Surgery Department, Hospital Universitario Donostia—Biodonostia Research Institute, 20014 Donostia, Spain
| | - Luigi A. Vaira
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Research Study Group, 75000 Paris, France; (A.M.-S.); (F.A.); (C.M.C.-E.); (L.A.V.); (J.R.L.)
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Jerome R. Lechien
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Research Study Group, 75000 Paris, France; (A.M.-S.); (F.A.); (C.M.C.-E.); (L.A.V.); (J.R.L.)
- Department of Otolaryngology, Polyclinique de Poitiers, Elsan Hospital, 86000 Poitiers, France
- Department of Otolaryngology—Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 91190 Paris, France
- Department of Human Anatomy and Experimental Oncology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
- Department of Otolaryngology—Head & Neck Surgery, CHU Saint-Pierre (CHU de Bruxelles), 1000 Brussels, Belgium
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Ding D, Yin G, Guo W, Huang Z. Analysis of lesion location and disease characteristics of pharyngeal and laryngeal papilloma in adult. Eur Arch Otorhinolaryngol 2023; 280:289-295. [PMID: 35939058 DOI: 10.1007/s00405-022-07575-5] [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: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Papilloma is a common benign epithelial tumor of the respiratory tract in adults. Its histological structure and immune environment vary from site to site. This study investigated the disease characteristics and prognostic differences of papillomas at various primary locations. METHODS Clinical data was collected from patients with adult glossal root and hypopharyngeal papilloma admitted to our tertiary referral center between January 2010 and December 2020, and compared with patients with laryngeal papilloma. Differences in age, sex, smoking, alcohol consumption, single or multiple lesions, surgical methods, immunohistochemical indexes, Ki-67 and p16, were analyzed in patients with different primary papilloma sites. RESULTS A total of 84 cases of glossal root papilloma, 51 cases of hypopharyngeal papilloma, and 51 cases of laryngeal papilloma were included. Differential analysis between groups showed that there were statistically significant differences in age, sex, smoking, single and multiple lesions, and surgical methods in the different primary sites. Ki-67 expression in laryngeal papilloma was higher than that in glossal root and hypopharyngeal papilloma. There was no significant difference in p16 expression in the three groups. In terms of prognosis, laryngeal papilloma is more likely to relapse than glossal root or hypopharyngeal papilloma, and the recurrence time is shorter. CONCLUSIONS As the largest clinical study of papilloma in different primary locations, this study found that the clinical characteristics and postoperative recurrence of papilloma of the glossal root and hypopharynx differ from those of papilloma of the larynx. This finding supports the current clinical experience in treating papillomas in different locations and facilitates the development of clinical treatment plans.
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Affiliation(s)
- Dong Ding
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Room 501, No. 8 Chongwenmennei Street, Dongcheng District, Beijing, China
| | - Gaofei Yin
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Room 501, No. 8 Chongwenmennei Street, Dongcheng District, Beijing, China
| | - Wei Guo
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Room 501, No. 8 Chongwenmennei Street, Dongcheng District, Beijing, China
| | - Zhigang Huang
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Room 501, No. 8 Chongwenmennei Street, Dongcheng District, Beijing, China.
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Benedict PA, Kravietz A, Achlatis E, Wang B, Zhang Y, Kidane J, Harrison T, Miller J, Drake VE, Best SR, McWhorter AJ, Lin RJ, Rosen CA, Smith LJ, Amin MR. Prospective, Multi-Center Study of the Anatomic Distribution of Recurrent Respiratory Papillomatosis. Laryngoscope 2022; 132:2403-2411. [PMID: 35129220 DOI: 10.1002/lary.30036] [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: 10/04/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS To create a model of the anatomic distribution, recurrence, and growth patterns of recurrent respiratory papillomatosis (RRP). STUDY DESIGN Prospective, multi-institutional cohort study. METHODS Adult patients with a diagnosis of RRP evaluated between August 1, 2018 and February 1, 2021 at six participating centers were invited to enroll. At each office or operating room encounter, laryngologists recorded the location and size of RRP lesions using a 22-region schematic. A generalized linear mixed effects model was used to compare region variations in lesion prevalence and recurrence. RESULTS The cohort comprised 121 patients: 74% were male, 81% had been diagnosed with adult-onset RRP, and a plurality (34%) had undergone 0 to 3 RRP interventions prior to enrollment. Across the study period, the odds of a lesion occurring in the glottis was significantly higher (odds ratio [OR]: 26.51; 95% confidence interval [CI]: 11.76-59.75, P < .001) compared with all other areas of the larynx and trachea. Within the true vocal folds, the membranous vocal folds had significantly higher odds (OR: 6.16; 95% CI: 2.66-14.30, P < .001) of lesion occurrence compared to the cartilaginous vocal folds. Despite these strong trends in lesion distribution, there were no differences in the odds of lesion recurrence, growth, or in the time to recurrence, between anatomic subsites. CONCLUSIONS RRP lesions are most likely to occur in the glottis, particularly the membranous vocal folds, compared with other regions of the larynx or trachea. However, all lesions demonstrate similar behavior with respect to recurrence, growth, and time to recurrence regardless of anatomic location. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2403-2411, 2022.
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Affiliation(s)
- Peter A Benedict
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, U.S.A
| | - Adam Kravietz
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, U.S.A
| | - Efstratios Achlatis
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, U.S.A
| | - Binhuan Wang
- Department of Population Heath, New York University Grossman School of Medicine, New York, New York, U.S.A
| | - Yan Zhang
- Department of Population Heath, New York University Grossman School of Medicine, New York, New York, U.S.A
| | - Joseph Kidane
- Department of Otolaryngology-Head and Neck Surgery, UCSF School of Medicine, University of California, San Francisco, California, U.S.A
| | - Tina Harrison
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Jonas Miller
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Virginia E Drake
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Andrew J McWhorter
- Department of Otolaryngology-Head and Neck Surgery, Our Lady of the Lake/Louisiana State University Voice Center, Baton Rouge, Louisiana, U.S.A
| | - R Jun Lin
- Department of Otolaryngology-Head and Neck Surgery, Unity Health Toronto - St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, UCSF School of Medicine, University of California, San Francisco, California, U.S.A
| | - Libby J Smith
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, U.S.A
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Yang J, Xie Z, Seyler BC. Comparing KTP and CO 2 laser excision for recurrent respiratory papillomatosis: A systematic review. Laryngoscope Investig Otolaryngol 2022; 7:970-981. [PMID: 36000042 PMCID: PMC9392380 DOI: 10.1002/lio2.871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/04/2022] [Indexed: 02/05/2023] Open
Abstract
Objective The CO2 laser and 532 nm potassium titanyl phosphate (KTP) laser have been applied to treat recurrent respiratory papillomatosis (RRP). This systematic review sought to compare outcome differences between these two methods. Data Sources Embase, Web of Science, PubMed, and the Cochrane Library. Review Methods CO2 laser and KTP laser studies were obtained by keyword searches of four authoritative medical databases. Articles were screened and retained when conforming to inclusion criteria. The primary outcome was cure rate; the secondary outcomes were recurrence, death, remission, clearance, and human papillomavirus (HPV)-detected rates, as well as laser effectiveness rates. Postoperative complications rate was the safety outcome measure. All outcomes were summarized within the CO2 and KTP groups, with results statistically compared (p < .05). Results Overall, the cure rates were 87.25% (KTP group) and 75.98% (CO2 group; p < .05). Complication rates significantly differed between the KTP (2.32%) and CO2 (17.71%) groups (p < .0001). There was a relatively higher but not significant difference in the recurrence rates between the CO2 (18.6%) and KTP (10.87%) groups (p = .1595). The CO2 group remission rate was considerably lower (38.9%) than the KTP group (88.46%, p < .0001). HPV-detected and clearance rates were only reported for the CO2 group. The bias risks were 13.1 ± 1.45 (CO2) and 13.6 ± 1.52 (KTP) for the two groups, indicating evidence was of fair quality. Conclusion Overall, KTP laser excision showed significantly better postoperative clinical outcomes than the CO2 laser, with a lower failure rate. Available fair-quality evidence suggests KTP laser excision might be better for treating RRP. Nevertheless, more high-quality randomized controlled studies are needed to compare these two surgical techniques, particularly in terms of reporting functional data such as vocal outcomes.
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Affiliation(s)
- Jimin Yang
- Department of Otolaryngology, Head and Neck SurgeryWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Zhongcheng Xie
- Department of AnatomyHengyang Medical School, University of South ChinaHengyangHunanChina
| | - Barnabas C. Seyler
- Department of EnvironmentCollege of Architecture and Environment, Sichuan UniversityChengduSichuanChina
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NBI and Laryngeal Papillomatosis: A Diagnostic Challenge: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148716. [PMID: 35886569 PMCID: PMC9317038 DOI: 10.3390/ijerph19148716] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 11/21/2022]
Abstract
Highlights Abstract Narrow-band imaging (NBI) represents a valid aid in laryngeal squamous cell carcinoma (LSCC) diagnosis for detecting vascular changes. However, LSCC and laryngeal papillomatosis (LP) show similar vascular patterns that may lead to misdiagnosis and improper treatment. This review aims to deepen this NBI limit in order to stress a careful preoperative evaluation of laryngeal lesions. The research was carried out on PubMed, Web of Science and Scopus databases using specific keywords. The topic of research was assessed by these parameters: accuracy, sensitivity, specificity, and positive and negative predictive values. This review included only five articles: they demonstrated that NBI is better than white-light endoscopy in detecting LSCC and LP. They also reported that LP is frequently mistaken for LSCC, resulting in high rates of false positives using NBI. This is the first review that emphasized this NBI limitation in distinguishing between LP and LSCC in cases of a type V pattern of intraepithelial papillary capillary loop. Although NBI application increased the rate of early cancer detection, LP reduces NBI accuracy. This drawback may lead to misdiagnosis and improper treatment. Our advice is to be careful in cases of type V pattern on NBI and to research LP epithelial and clinical features because it could be a pitfall.
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8
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Hess M, Fleischer S. [Photoangiolytic Lasers in Laryngology]. Laryngorhinootologie 2020; 99:607-612. [PMID: 32851626 DOI: 10.1055/a-1071-0410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
With photoangiolytic lasers like KTP (Potassium-Titanyl-Phosphate, 532 nm) lasers or the new "blue" laser (445 nm), even the smallest vessels and capillaries within the vocal fold can be treated without destroying the covering epithelium. This enables effective treatment of benign and malignant sub- and intraepithelial lesions of the vocal folds such as papilloma, edema, polyps, leukoplakia, dysplasia and capillary vessels while preserving the vibratory properties of the different layers of the lamina propria. Because photoangiolytic laser light can be routed through tiny glass fibers, office-based surgery with channelled flexible endoscopes are feasible as well as phonomicrosurgical operations under general anesthesia. Furthermore, the so called "blue" laser can cut tissues and thus broadens the technical armamentarium of the phonosurgeon.
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Affiliation(s)
| | - Susanne Fleischer
- Deutsche Stimmklinik, Hamburg.,Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
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Rey Caro EP, Rey Caro DG, Rey Caro EA. High Radiofrequency Surgery and Chromoendoscopy: A Novel Surgical Technique for the Treatment of Respiratory Papillomatosis. J Voice 2020; 35:936.e17-936.e26. [PMID: 32362579 DOI: 10.1016/j.jvoice.2020.03.021] [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: 09/12/2019] [Revised: 03/15/2020] [Accepted: 03/18/2020] [Indexed: 11/26/2022]
Abstract
Recurrent Respiratory Papillomatosis is a highly recurrent and residual disease. The use of indigo-carmine chromoendoscopy increases the early detection of nonvisible disease and reduces the possibility of leaving residual lesions. The best chances of papillomatosis being eradicated depend upon a surgical shallow epitheliolysis approach applied to patients who have never been surgically damaged before. We developed a novel surgical technique based upon the use of a time controlled High Radiofrequency (HRF) energy output. We applied a three-step bloodless HRF-surgical technique, that is, epitheliolysis, angiolysis and peeling without the aid of adjunct therapies. It acts according to differences in the water density of the tissues. We use it to remove the epithelial viral reservoir thus preserving subepithelial layers. For this purpose, we designed and manufactured a custom-made HRF electrodes set for office and O.R. use. From 2005 to 2018, 39 patients (100%) with recurrent respiratory papillomatosis participated in the present prospective work. Twenty-five (64,10%) achieved complete postsurgical remission, 6 (15,38%) were lost to follow up, and 8 (20,51%) present partial remissions. Thirty-six patients had laryngeal papillomatosis. Follow-up was possible in 30 of the 36 patients with laryngeal papillomatosis with a success remission rate of 83,33% (25 of 30). Eleven of those 36 (30,55%) entered this study without previous surgical treatment and 9 of 11 (81,81%) were cured. Indigo-carmine chromoendoscopy, a visualization solution for papillomatosis detection, together with a bloodless HRF-surgical technique proved to be effective tools to eradicate papillomatosis. Voice restoration to normal or near normal levels was achieved in all patients.
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Affiliation(s)
- Enrique P Rey Caro
- Rey Caro Voice Center, Rey Caro Ear, Nose and Throat Service, Cordoba, Argentina.
| | - Daniel G Rey Caro
- Rey Caro Voice Center, Rey Caro Ear, Nose and Throat Service, Cordoba, Argentina; Department of Otorhinolaryngology II at San Roque Hospital, National University of Córdoba, Cordoba, Argentina.
| | - Enrique A Rey Caro
- Rey Caro Voice Center, Rey Caro Ear, Nose and Throat Service, Cordoba, Argentina.
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Ballestas SA, Shelly S, Soriano RM, Klein A. Trends in recurrent respiratory papillomatosis treatment. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:109-120. [PMID: 32312478 DOI: 10.1016/j.otorri.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/23/2019] [Accepted: 11/08/2019] [Indexed: 11/27/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) consist of benign tumours along the airway caused by human papillomavirus infection. Papillomas may cause changes in phonation and obstruct the airway. The purpose of this study was to evaluate the different surgical and adjuvant therapies available for the treatment of this condition reported between 2014-2018. A PubMed search was performed for RRP treatment articles published between 2014 -2018. Forty articles that encompassed 1425 patients with RRP met the criteria. Of these, 24 articles evaluate the use of adjuvant therapies such as bevacizumab, human papillomavirus vaccine and cidofovir. There has been an increase in adjuvant therapy options for RRP in the literature in recent years. An awareness of these options highlights gaps and opportunities in the care of these patients, opens the door to new protocols to control disease and increase intersurgical intervals, and guides us towards new management paradigms in the future.
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Affiliation(s)
- Samir A Ballestas
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos
| | - Sandeep Shelly
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos
| | - Roberto M Soriano
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos
| | - Adam Klein
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos.
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Galletti F, Freni F, Gazia F, Gallo A. Vocal cord surgery and pharmacological treatment of a patient with HPV and recurrent respiratory papillomatosis. BMJ Case Rep 2019; 12:12/11/e231117. [PMID: 31732543 DOI: 10.1136/bcr-2019-231117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is caused by persistent infection of the respiratory epithelium by human papillomavirus (HPV), especially HPV 6 and 11. We present a case of surgically treated RRP. The main purpose of our protocol is to remove the lesions with a non-aggressive surgical technique and prevent recurrences with the use of cidofovir for local infiltrations in multiple sessions. We use low-power energy CO2 laser, directed towards the upper part of the vocal cord, to determine a retraction of the mucosa with consequent coverage of the epithelium of the free edge. The aim of this technique is to treat and stop the formation of synechia of the anterior commissure and the free margin of the vocal cords in the anterior commissure. After 8 years follow-up, there are no signs of recurrence of the disease. The voice had a net improvement confirming the effectiveness of the protocol.
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Affiliation(s)
- Francesco Galletti
- Department of Adult and Development Age Human Pathology 'Gaetano Barresi', Unit of Otorhinolaryngology, Universita degli Studi di Messina, Messina, Italy
| | - Francesco Freni
- Department of Adult and Development Age Human Pathology 'Gaetano Barresi', Unit of Otorhinolaryngology, Universita degli Studi di Messina, Messina, Italy
| | - Francesco Gazia
- Department of Adult and Development Age Human Pathology 'Gaetano Barresi', Unit of Otorhinolaryngology, Universita degli Studi di Messina, Messina, Italy
| | - Andrea Gallo
- UOC Otorinolaringoiatria - Polo Pontino, Università degli Studi di Roma La Sapienza Facoltà di Medicina e Odontoiatria, Roma, Italy
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Prophylactic human papilloma virus vaccination in head and neck: indications and future perspectives. Curr Opin Otolaryngol Head Neck Surg 2019; 27:85-90. [PMID: 30694913 DOI: 10.1097/moo.0000000000000525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To gain the evidence-based knowledge concerning the efficacy of HPV vaccination for oropharyngeal sites and to highlight the trials and strategies for vaccine administration in HPV-dependent head and neck diseases. RECENT FINDINGS Vaccination can be provided in two injections. There is increasing anecdotal evidence that therapeutic vaccination is effective in treatment of recurrent respiratory papillomatosis. SUMMARY The availability and broadening spectrum of HPV vaccines make possible the prevention of cervical and other HPV-dependent diseases. Vaccination is now included in the national immunization programs of most industrial countries and will be used, it is hoped, in developing countries within the next few years. In developing countries, few women are screened for cervical precancerous lesions, making immunization even more important. In affluent countries and matured societies, with high coverage of cervical screening, the focus of interest will shift to other HPV-related diseases. The HPV vaccination is effective in preventing oral infection with types targeted by the vaccines.
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Tam S, Wu CF, Peng HL, Dahlstrom KR, Sturgis EM, Lairson DR. Cost of treating recurrent respiratory papillomavirus in commercially insured and medicaid patients. Laryngoscope 2019; 130:1186-1194. [PMID: 31194270 DOI: 10.1002/lary.28139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/09/2019] [Accepted: 05/28/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The study objective was to estimate the first 2 years' direct costs of treating new cases of juvenile-onset and adult-onset recurrent respiratory papillomatosis (RRP) and determine the predictors of treatment costs. METHODS Cases were patients diagnosed with RRP in commercial insurance claims in 2011-2014 and Texas Medicaid in 2008-2012 for treatment of RRP. Controls were patients without a diagnosis of HPV-related cancer or RRP, matched with cases by age, sex, geographic area, date of diagnosis of RRP, and propensity score. Total health care costs in the first 2 years after diagnosis were obtained from cases and matched controls. A generalized linear model was created to identify predictors of monthly costs. RESULTS In commercially insured patients, a total of 122 cases of juvenile-onset (<18 years old) and 1824 cases of adult-onset (≥18 years old) RRP were identified. The mean first 2 years' cost difference between cases and controls was $58,733 for juvenile-onset disease and $11,185 for adult-onset disease after model adjustments. In the Texas Medicaid population, 73 cases of juvenile-onset and 96 cases of adult-onset RRP were identified. The mean first 2 years' cost difference between cases and controls was $76,115 for juvenile-onset disease and $4,633 for adult-onset disease after model adjustments. CONCLUSION The first 2 years' medical costs difference of juvenile-onset and adult-onset RRP among commercially insured and Medicaid population were approximately $60,000 to $70,000 and $5,000 to $11,000, respectively, and should be considered in HPV vaccination promotion investment decisions. LEVEL OF EVIDENCE N/A Laryngoscope, 130:1186-1194, 2020.
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Affiliation(s)
- Samantha Tam
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chi-Fang Wu
- Department of Management, Policy, and Community Health the University of Texas Health Science Center, Houston, TX
| | - Ho-Lan Peng
- Department of Management, Policy, and Community Health the University of Texas Health Science Center, Houston, TX
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erich M Sturgis
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Epidemiology, the University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - David R Lairson
- Department of Management, Policy, and Community Health the University of Texas Health Science Center, Houston, TX
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14
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Hu L, Benedict PA, Garber D, Wang B, Amin MR, Branski RC. Laryngeal distribution of adult-onset recurrent respiratory papillomatosis: A longitudinal study. Laryngoscope 2019; 129:1993-1997. [PMID: 31059600 DOI: 10.1002/lary.27694] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/26/2018] [Accepted: 10/22/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe recurrence patterns in patients with recurrent respiratory papillomatosis (RRP) following surgical intervention. STUDY DESIGN Single-center, retrospective, longitudinal case series. METHODS Initial and follow-up laryngoscopic examinations of seven previously untreated adult-onset RRP patients were reviewed. Patients were followed longitudinally for periods ranging from 3 months to 7 years. Lesion locations were recorded using a twenty-one region laryngeal schematic, and maps were generated to illustrate the distribution of disease before and after cold-knife or potassium-titanyl-phosphate laser intervention. Univariate and multivariate analyses were employed to examine variables affecting recurrence patterns. RESULTS Across all patients, a statistically significant correlation between initial distribution and primary recurrence was observed. Seventy-five percent of new lesions were adjacent to regions with preexisting disease; 83% of new glottic lesions were adjacent to preexisting glottic lesions, and 66% of supraglottic lesions were adjacent to preexisting supraglottic regions. No statistically significant differences in recurrence rate were observed across sites. CONCLUSIONS In previously untreated patients with adult-onset recurrent respiratory papillomatosis, lesions tended to recur either in the same regions or regions adjacent to those affected at the time of initial surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1993-1997, 2019.
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Affiliation(s)
- Lizbeth Hu
- New York University Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York, New York, U.S.A
| | - Peter A Benedict
- New York University Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York, New York, U.S.A
| | - David Garber
- New York University Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York, New York, U.S.A
| | - Binhuan Wang
- Department of Population Heath, Division of Biostatistics, New York University School of Medicine, New York, New York, U.S.A
| | - Milan R Amin
- New York University Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York, New York, U.S.A
| | - Ryan C Branski
- New York University Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York, New York, U.S.A
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15
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Creelan BC, Ahmad MU, Kaszuba FJ, Khalil FK, Welsh AW, Ozdemirli M, Grant NN, Subramaniam DS. Clinical Activity of Nivolumab for Human Papilloma Virus-Related Juvenile-Onset Recurrent Respiratory Papillomatosis. Oncologist 2019; 24:829-835. [PMID: 30842242 DOI: 10.1634/theoncologist.2018-0505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 02/08/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Juvenile-onset recurrent respiratory papillomatosis (JO-RRP) is a human papilloma virus-mediated progressive benign neoplasm that affects children and young adults. Primary management consists of regular surgical debulking to maintain airway patency and vocal function. Like condyloma acuminata, JO-RRP is associated with immune dysregulation, and T cells isolated from papillomas express an anergic phenotype. Therefore, we hypothesized that programmed death protein 1 axis inhibition could stabilize tumor growth. MATERIALS AND METHODS We treated two patients with refractory JO-RRP using nivolumab, with the primary objective of assessing clinical activity. We explored baseline papilloma features using immunohistochemistry and comprehensive genomic profiling. RESULTS Both patients experienced symptomatic improvement, and interval laryngoscopies revealed a reduction in papillomatosis burden. One patient has not required subsequent surgical debridement for almost 2 years. On pathologic examination of pretreatment papillomas from both cases, infiltrating T cells were evident in the papilloma stroma, and papilloma programmed death ligand 1 expression was absent. Papilloma mutational load ranged between three and six mutations per megabase for each case. From on-treatment biopsy tissue, a higher amount of intraepithelial T cells and programmed death ligand 1 expression were detected in the papilloma. CONCLUSION Nivolumab appears to have promising activity in JO-RRP, and further clinical investigation with more patients in clinical trials is warranted. IMPLICATIONS FOR PRACTICE To the authors' knowledge, this article is the first report describing clinical activity with a programed cell death-1 (PD-1) inhibitor to treat a rare but detrimental type of respiratory tract epithelial neoplasm that afflicts young adults. Two patients were treated, and tumor features, such as mutational load, were examined with the intent to stimulate future hypotheses for translational research. The safety and activity of PD-1 inhibitors in this population still need to be corroborated in clinical trials and should not yet be adopted into clinical practice.
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Affiliation(s)
- Ben C Creelan
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - M Usman Ahmad
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Frank J Kaszuba
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Farah K Khalil
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | | | - Metin Ozdemirli
- Department of Pathology, Georgetown Lombardi Comprehensive Cancer Center, MedStar Georgetown University Medical Center, Washington, D.C., USA
| | - Nazaneen N Grant
- Department of Otolaryngology, Georgetown Lombardi Comprehensive Cancer Center, MedStar Georgetown University Medical Center, Washington, D.C., USA
| | - Deepa S Subramaniam
- Division of Hematology/Oncology, Georgetown Lombardi Comprehensive Cancer Center, MedStar Georgetown University Medical Center, Washington, D.C., USA
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16
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Parker LA, Kunduk M, Blouin D, Adkins L, McWhorter AJ. Voice Outcomes Following Multiple Surgeries for Recurrent Respiratory Papillomatosis. J Voice 2019; 34:791-798. [PMID: 30795926 DOI: 10.1016/j.jvoice.2019.02.004] [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: 12/12/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Recurrent Respiratory Papillomatosis (RRP) is a rare disease caused by the human papilloma virus that presents as warty, exophytic growths in the upper airway. RRP in the larynx can lead to severe airway obstruction and voice changes. It is clinically known that patients with RRP frequently experience dysphonia. The purpose of this study was to assess the impact of multiple surgical treatments on RRP patients' voice outcomes, and to determine whether a higher number of repeated surgeries lead to decreased voice quality. METHODS A retrospective cohort study was conducted of adult RRP patients (n = 23) who underwent multiple surgeries. Group 1 included patients (n = 11) who had <5 surgeries (range 2-4 surgeries) and Group 2 included patients (n = 12) who had ≥5 surgeries (range 5-50+ surgeries). Voice recordings were selected from the following clinic visits: initial office visit (initial presurgery), first postsurgery, and the last clinic encounter(s) with no immediate planned surgery. Blinded auditory-perceptual ratings along with cepstral and spectral acoustic measures assessed voice severity. RESULTS There was significant improvement from the initial presurgery visit compared to each postoperative visit over time for all voice outcome measures for both Group 1 and Group 2. The results of the study indicated that the number of surgeries did not significantly affect mean postoperative voice outcomes, and there were no significant differences between patient groups for voice quality over time. CONCLUSIONS The results of this study suggest that RRP patients' voice quality may not suffer cumulative negative effects when using modern tissue-sparing surgical techniques.
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Affiliation(s)
- Lindsey A Parker
- Louisiana State University, Department of Communication Sciences & Disorders, Baton Rouge, Louisiana; Our Lady of the Lake Voice Center, Baton Rouge, Louisiana
| | - Melda Kunduk
- Louisiana State University, Department of Communication Sciences & Disorders, Baton Rouge, Louisiana; Our Lady of the Lake Voice Center, Baton Rouge, Louisiana; Louisiana State University Health Sciences Center, School of Medicine, Department of Otolaryngology Head & Neck Surgery, New Orleans, Louisiana.
| | - David Blouin
- Louisiana State University, Department of Experimental Statistics, Baton Rouge, Louisiana
| | - Lacey Adkins
- Our Lady of the Lake Voice Center, Baton Rouge, Louisiana; Louisiana State University Health Sciences Center, School of Medicine, Department of Otolaryngology Head & Neck Surgery, New Orleans, Louisiana
| | - Andrew J McWhorter
- Our Lady of the Lake Voice Center, Baton Rouge, Louisiana; Louisiana State University Health Sciences Center, School of Medicine, Department of Otolaryngology Head & Neck Surgery, New Orleans, Louisiana
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17
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Bowles PF, Liu A, Harries ML. CO 2 laser "Ablation Suction" technique for treatment of laryngeal recurrent respiratory papillomatosis. Clin Otolaryngol 2019; 44:884-885. [PMID: 30615261 DOI: 10.1111/coa.13278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/07/2018] [Accepted: 12/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Alison Liu
- ENT Department, BSUH NHS Trust, Brighton, UK
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18
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Hess MM, Fleischer S, Ernstberger M. New 445 nm blue laser for laryngeal surgery combines photoangiolytic and cutting properties. Eur Arch Otorhinolaryngol 2018; 275:1557-1567. [DOI: 10.1007/s00405-018-4974-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
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19
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Ivancic R, Iqbal H, deSilva B, Pan Q, Matrka L. Current and future management of recurrent respiratory papillomatosis. Laryngoscope Investig Otolaryngol 2018; 3:22-34. [PMID: 29492465 PMCID: PMC5824106 DOI: 10.1002/lio2.132] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/17/2017] [Accepted: 11/11/2017] [Indexed: 01/01/2023] Open
Abstract
Objectives Recurrent respiratory papillomatosis (RRP) is a chronic disease of the respiratory tract that occurs in both children and adults. It is caused by the human papillomavirus (HPV), in particular low‐risk HPV6 and HPV11, and aggressiveness varies among patients. RRP remains a chronic disease that is difficult to manage. This review provides perspectives on current and future management of RRP. Results The current standard of care is surgical excision, with adjuvant therapies as needed. Surgical management of RRP has evolved with the introduction of microdebriders and photoangiolytic lasers; the latter can now be used in the office setting. Numerous adjuvant pharmacologic therapies have been utilized with some success. Also, exciting preliminary data show that HPV vaccines may prolong the time to recurrence in the RRP population. There is also optimism that wide‐spread HPV vaccination could reduce RRP incidence indirectly by preventing vertical HPV transmission to newborns. Conclusion To date, the biology of RRP is not well understood, although it has been noted to become more aggressive in the setting of immune suppression. Additional research is needed to better understand immune system dysfunction in RRP such that immunomodulatory approaches may be developed for RRP management. Level of Evidence 4
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Affiliation(s)
- Ryan Ivancic
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center Columbus Ohio U.S.A
| | - Hassan Iqbal
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center Columbus Ohio U.S.A
| | - Brad deSilva
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Quintin Pan
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center Columbus Ohio U.S.A.,Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio U.S.A
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20
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Benedict PA, Ruiz R, Yoo M, Verma A, Ahmed OH, Wang B, Dion GR, Voigt A, Merati A, Rosen CA, Amin MR, Branski RC. Laryngeal distribution of recurrent respiratory papillomatosis in a previously untreated cohort. Laryngoscope 2017; 128:138-143. [DOI: 10.1002/lary.26742] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/18/2017] [Accepted: 05/22/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Peter A. Benedict
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York
| | - Ryan Ruiz
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York
| | - MiJin Yoo
- Department of Otolaryngology-Head and Neck Surgery; University of Washington School of Medicine; Seattle Washington
| | - Avanti Verma
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York
| | - Omar H. Ahmed
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York
| | - Binhuan Wang
- Department of Population Heath, Division of Biostatistics; New York University School of Medicine; New York New York
| | - Gregory R. Dion
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York
- Department of Otolaryngology-Head and Neck Surgery; Brooke Army Medical Center; Fort Sam Houston Texas
| | - Andrew Voigt
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York
| | - Albert Merati
- Department of Otolaryngology-Head and Neck Surgery; University of Washington School of Medicine; Seattle Washington
| | - Clark A. Rosen
- University of Pittsburgh Voice Center, Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
| | - Milan R. Amin
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York
| | - Ryan C. Branski
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York
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21
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Cui W, Xu W, Yang Q, Hu R. Clinical features and surgical treatment for Chinese juvenile onset current respiratory papillomatosis (JORRP). Eur Arch Otorhinolaryngol 2016; 274:925-929. [PMID: 27637752 DOI: 10.1007/s00405-016-4298-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
Abstract
Juvenile onset current respiratory papillomatosis (JORRP), which is the commonest benign laryngeal disease in children, has not been well investigated. This study aimed at further evaluating the clinical features and surgery for such children with JORRP. Patients diagnosed as JORRP in our department from January 2011 to June 2014 were enrolled, and the demographic and clinical data were collected. All the patients were followed up after surgery, and the recurrences were recorded. A total of 124 patients were included and categorized into low recurrence (<4/year, n = 97) and high recurrence (≥4/year, n = 27) groups based on the recurrence at diagnosis, respectively. The demographic characteristics were comparable in two groups. There were more patients in high recurrence group who had dyspnea II-III, abnormal chest X-ray findings and severe illness, and needed electrocardiscope monitoring (P < 0.05). Patients who had dyspnea II (P = 0.008) and severe illness (P = 0.002) needed electrocardiscope monitoring (P = 0.014) in high recurrence group were more prone to have recurrence after surgery. Multivariate logistic regression analysis proved that high recurrence at diagnosis was an independent risk factor for recurrence after surgery in JORRP [95 %CI OR 17.342 (1.266, 237.608), P = 0.033]. The recurrence at diagnosis could be used as a prognostic factor for JORRP after surgery, which could help to improve the therapeutic efficacy in such children.
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Affiliation(s)
- Weixin Cui
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.,Ministry of Education, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, 100730, China
| | - Wen Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China. .,Ministry of Education, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, 100730, China.
| | - Qingwen Yang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.,Ministry of Education, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, 100730, China
| | - Rong Hu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.,Ministry of Education, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, 100730, China
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22
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Kono T, Yabe H, Uno K, Saito K, Ogawa K. Multidimensional vocal assessment after laser treatment for recurrent respiratory papillomatosis. Laryngoscope 2016; 127:679-684. [PMID: 27515839 DOI: 10.1002/lary.26210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/29/2016] [Accepted: 06/29/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Recurrent respiratory papillomatosis (RRP) is a benign epithelial tumor that exhibits a high frequency of recurrence. This study assesses the vocal function after laser treatment for RRP, particularly in relation to the frequency of surgery. STUDY DESIGN Retrospective study. METHODS Thirty RRP patients who underwent laser surgery that controlled the tumor were included. Preoperative and postoperative Grade, Roughness, Breathiness, Asthenia, and Strain Scale, videostroboscopic findings, aerodynamic and acoustic parameters, and self-assessment questionnaires were measured and compared with an age- and sex-matched control group. Subsequently, to evaluate the association between postoperative voice quality and the number of surgeries, the patients were divided into three groups (group 1: single surgery, group 2: 2-5 surgeries, group3: >6 surgeries), and comparative multidimensional vocal assessments were performed. RESULTS The mean number of surgeries was 3.4 (range, 1-8). Although all patients exhibited poorer vocal function than the control group preoperatively, they showed improvement in postoperative subjective and objective parameters. However, four patients who underwent one surgery with relatively aggressive ablation exhibited vocal cord scarring and deteriorated objective parameters. All remaining patients showed voice quality that was on par with the control group. Subgroup analysis proved no association between post-therapeutic voice quality and the patient characteristics, including preoperative staging and the number of surgical treatments performed. CONCLUSIONS RRP patients can achieve a close to normal voice with high satisfaction even after recurrent surgical treatment when ablation of a subepithelial lesion using sufficient laser energy is adequate. LEVEL OF EVIDENCE 3b Laryngoscope, 127:679-684, 2017.
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Affiliation(s)
- Takeyuki Kono
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Haruna Yabe
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kosuke Uno
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koichiro Saito
- Department of Otolaryngology-Head and Neck Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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23
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Economics, epidemiology and outcomes. The Journal of Laryngology & Otology 2016; 130:605. [PMID: 27329238 DOI: 10.1017/s0022215116008355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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