Zinc sulfate therapy of vocal process granuloma

Effects of trace element dietary supplements on voice parameters and some physiological and psychological parameters related to stress

Trace elements, often used as dietary supplements, are widely accessible without prescription at pharmacies. Pronutri has pioneered Nutripuncture®, a methodology that utilizes orally consumed trace elements to elicit a physiological response akin to that of acupuncture. Pronutri has empirically observed that the user's voice becomes deeper following an exclusive ingestion procedure. Given that alterations in vocal characteristics are often linked to stress, the Pronutri researchers postulated that the pills have the capacity to promptly alleviate stress upon ingestion. Nevertheless, there is a lack of scientific substantiation about the impact of these supplements on voice (or stress) indicators. The aim of this research was to determine whether there is a consistent impact of trace element ingestion on vocal characteristics, namely the fundamental frequency of the voice, as well as other physiological and psychological stress measurements. In order to achieve this objective, we have devised a unique methodology to examine this hypothesis. This involves conducting a monocentric crossover, randomized, triple-blind, placebo-controlled trial with a sample size of 43 healthy individuals. This study demonstrates that compared to placebo tablets, consuming 10 metal traces containing tablets at once is enough to cause noticeable changes in the vocal spectrum in the direction of an improvement of the voice timbre "richness", and a decrease in the occurrence of spontaneous electrodermal activity, suggesting a stress reduction. However, there were no significant changes observed in the other parameters that were tested. These parameters include vocal measures such as voice frequency F0, standard deviation from this frequency, jitter, and shimmer. Additionally, physiological measures such as respiratory rate, oxygenation and heart rate variability parameters, as well as psychological measures such as self-assessment analogic scales of anxiety, stress, muscle tension, and nervous tension, did not show any significant changes. Ultimately, our research revealed that the ingestion of 10 trace elements pills may promptly elicit a targeted impact on both vocal spectrum and electrodermal activity. Despite the limited impact, these findings warrant more research to explore the long-term effects of trace elements on voice and stress reduction.

Vocal Fold Granuloma: Updates and Advancements in Treatment

OBJECTIVE/HYPOTHESIS

Vocal fold granulomas (VFGs) are benign outgrowths from vocal folds with varying etiologies. If untreated, VFGs can result in mass effects on the surrounding larynx, leading to dysphagia, hoarseness of voice, and possibly dyspnea. With new advancements, novel treatment options and innovative collaborations of previous treatment modalities have started to surface.

STUDY DESIGN

This review aims to provide a world review of the current risks, etiologies, and complications surrounding VFGs, as well as discuss the current and future treatment modalities surrounding VFGs.

METHODS

Four databases (PubMed, Cochrane Library, Embase, and WoS) were searched from the earliest records until February 2023 using search terms related to VFGs. Relevant articles were assessed and analyzed to provide a broad scope of the current treatment options for VFGs.

RESULTS/CONCLUSIONS

The treatment options for VFGs run both wide and deep, ranging from conservative voice therapy to laser vaporization to surgical excision. Within each modality, variations to each technique and method of administration also play a role in maximizing the effectiveness of treatment. Overall, with more higher-powered studies, the complex interplay of treatment modalities can be further untangled to determine the ideal combination treatment for various VFGs.

Comparison of PPI and combined treatment in the treatment of recurrent laryngeal contact granuloma

OBJECTIVE

To compare the therapeutic effect of PPI and combined treatment in the treatment of patients with recurrent laryngeal contact granuloma.

METHODS

The clinical data of 299 patients with recurrent laryngeal contact granuloma treated with PPI or combined treatment (PPI with glucocorticoid injection into granuloma by the thyroglossal approach) from February 2013 to June 2019 were analyzed retrospectively. Patients were divided into two subgroups: PPI and combined treatment. The cure rates, recurrence rates and cure time of the two subgroups were compared and analyzed separately. Than we can get the optimal treatment of the two treatment in the treatment of recurrent patients.

RESULTS

In recurrent patients, the cure rate (81.20%) and recurrence rate (3%) of combined treatment were superior to those of PPI (57.58%) and recurrence rate (12.12%); (P < 0.05). The cure time of PPI was longer than that of combination therapy (P < 0.001).

CONCLUSION

The therapeutic effect of combined treatment is better than that of PPI in patients with recurrence. At the same time, combined treatment is an effective treatment for recurrent granuloma and can be used as a first-line treatment for recurrent laryngeal contact granuloma.

Low-Dose LEMG-Guided Botulinum Toxin Type A Injection for Intractable Vocal Process Granulomas

OBJECTIVE

Vocal process granuloma (VPG) has a varied treatment success rate and may frustrate patients and physicians due to poor outcomes. There is still a lack of standard protocols to manage VPG. This study aimed to review the efficiency of a standardized low-dose laryngeal electromyographic (LEMG)-guided botulinum toxin A (BTA) injection in intractable vocal granulomas.

METHODS

Twenty-four patients with intractable VPG were recruited. All patients underwent percutaneous LEMG-guided BTA injection on the thyroarytenoid-lateral cricoarytenoid muscle complex in an office setting. The injecting dose was standardized to 1 U in 0.1 mL normal saline at a time. We evaluated the treatment effect by measuring the lesion size with serial laryngoscope evaluations.

RESULTS

The postinjection follow-up time varied from 3 to 23 months. Twenty-one patients (87.5%) experienced complete regression of the granuloma over 1-7 months (median 3 months). No major adverse effects were noted during the follow-up period.

CONCLUSION

For recalcitrant VPG, LEMG-guided low-dose BTA injection has the potential to be a safe, efficient, and effective treatment.

Operative and Conservative Management of Laryngeal Contact Granuloma: A Network Analysis and Systematic Review

OBJECTIVE

Laryngeal contact granuloma is a disease of benign hypertrophic granulation tissue at the medial side of vocal process. Numerous studies of conservative and surgical management have reported effectiveness, yet optimal treatment has not been standardized. We compared primary and secondary outcomes of conservative and surgical treatment using endoscopic grading, Voice Handicap Index-10 (VHI-10), maximum phonation time (MPT), and recurrence rate.

METHODS

We performed literature searches of MEDLINE, PubMed, and EMBASE from November 1985 to October 2017, with randomized controlled trials and case control studies of at least three months follow-up as the inclusion criteria. Outcomes included laryngoscopic findings, MPT, and VHI-10. Data regarding study design, outcome analysis, follow-up time, and disease remission were systematically collected.

RESULTS

A total of 1069 patients were abstracted from 19 papers. With conservative treatment, 98% of patients' laryngeal granuloma resolved within three months, and 84% for the surgical group. There was a decrease in VHI-10 of 2.69 (95% credible interval (CI) -9.52 to 3.82) and 6.48 (95% CI -15.00 to 1.94) for conservative and surgical management, respectively. MPT improvement was 1.27 s (95% CI: 2.03-5.84) for conservative treatment and 5.02 s (95% CI: 0.78-8.07) for surgical. For all 19 studies, absolute recurrence risk for control, conservative, and surgical measures were respectively 4%, 16%, and 29%.

CONCLUSIONS

Most patients treated conservatively or surgically alone responded to treatment, but conservative management was favored. VHI-10 and MPT improvement in surgical patients were noted, but only the latter was statistically significant. In regard to recurrence, conservative management had better outcome than surgical. Taken together, the results suggest that minimally symptomatic granulomas have higher response rate and lower recurrence risk when treated conservatively, while larger, symptomatic granulomas may favor surgical excision followed by medical management to reduce risk of recurrence.

Treatment of post-intubation laryngeal granulomas: systematic review and proportional meta-analysis

INTRODUCTION

Laryngeal granulomas post intubation are benign but recurrent lesions. There is no consensus for its treatment.

OBJECTIVE

To describe the effectiveness of different treatment modalities for primary or recurrent laryngeal granulomas resulting from endotracheal intubation.

METHODS

Systematic review and proportional meta-analysis. Eligibility criteria - experimental or observational studies with at least five subjects. Outcomes studied - granuloma resolution, recurrence, and time for resolution. Databases used - Pubmed, Embase, Lilacs, and Cochrane. The Stats Direct 3.0.121 program was used.

RESULTS

Six studies were selected, with 85 patients. The treatments registered were: antireflux therapy, speech therapy, anti-inflammatory drugs, steroids, antibiotics, zinc sulfate and surgery. 85 patients from six studies had primary treatment: surgery±associations (41 patients), resolution chance 75% (95% CI: 0.3-100%, I2=90%), absolute relapse risk 25% (95% CI: 0.2-71%); medical treatment (44 patients), resolution chance 86% (95% CI: 67-97%); and absolute relapse risk 14% (95% CI: 3-33%). There was no significant difference between groups. Three studies, encompassing 19 patients, analyzed secondary treatment (failure or recurrence after primary treatment); three subjects presented new recurrence. The time needed to resolve the lesions varied from immediate, after surgery, to 23 months, for inhaled steroid.

CONCLUSION

There is no evidence of high quality that proves the efficacy of any treatment for laryngeal granulomas resulting from endotracheal intubation.

Surgical Treatment Outcomes of Vocal Process Granuloma After Endotracheal Intubation

INTRODUCTION

The objective of this study was to review the clinical characteristics and surgical treatment outcomes of the vocal process granuloma after the endotracheal intubation.

METHODS

A retrospective chart review was performed at Chonnam National University Hwasun Hospital from January 2008 to December 2015.

RESULTS

Twenty-one vocal process granulomas after endotracheal intubation were diagnosed in 13 patients. The most common symptom was hoarseness. Among 13 patients, bilateral vocal process granulomas were in 8 patients. For the remaining 5 patients, their unilateral vocal process granulomas were all left-sided. All the cases of vocal process granulomas after the endotracheal intubation were treated by laryngoscope microsurgery under general anesthesia. Recurrence of vocal process granulomas was identified in 1 lesion.

CONCLUSION

This study suggests that surgery for vocal process granuloma after endotracheal intubation is a good treatment option for a rapid resolution of lesions and the associated symptoms, along with having low recurrence rates.

Laryngeal Granuloma - Benefit in Treatment with Zinc Supplementation?

Laryngeal granulomas present as contact and postintubation ulcers and granulomas. Essentially, a contact granuloma is a pseudotumor of the lateral wall of the posterior glottis. The most common etiological factor is voice abuse, with predisponing factors such as reflux disease. Postintubation ulcers and granulomas, although of different etiology, according to all the other traits belong to this clinical entity. The therapy of choice is conservative treatment. Surgical laser excision is indicated for resistant cases and those whose size is causing respiratory distress. Treatment of laryngeal granulomas with zinc supplementation is reported in the literature as one of the forms of conservative treatment, and we wanted to consider it in this review. Zinc is an essential mineral that plays a vital role in many biochemical reactions and is considered very important for wound healing.

Vocal process granulomas: a systematic review of treatment

OBJECTIVES

Vocal process granulomas (VPGs) are benign laryngeal lesions with controversial treatment and a tendency to recur. There are several treatment options with unpredictable results, high recurrence rates, and disappointing long-term outcome. The aims of this article are to focus on evidence-based current treatment strategies for primary lesions and recurrences.

DATA SOURCES

The data came from a systematic review of the literature.

METHODS

Main outcome measures were recurrence rate, reduction, and/or complete resolution. Inclusion criteria included English literature, randomized and nonrandomized trials, prospective and retrospective studies, and primary and recurrent cases. Exclusion criteria included case reports, teaching reviews, and papers not focusing on treatment.

RESULTS

The time frame of the included studies was from 1997 to 2012. There are 6 different treatment options (single or combined) for VPG. Antireflux medication is the mainstay treatment and when combined with lifestyle changes and voice therapy results in the lowest recurrence rate. "Bloodless" in-office or in-theater laser techniques appear to have lower recurrence rates when compared to traditional cold steel microlaryngoscopy techniques, especially for recurrences.

CONCLUSIONS

There is level 2A evidence that antireflux treatment is the main treatment strategy for vocal process granulomas with surgery reserved only for failures of medical treatment or airway obstruction or when diagnosis is in doubt.

Prognostic factors for prediction of follow-up outcome of contact granuloma

Although the frequent spontaneous resolution of contact granuloma is reported, the prognostic factor that can predict the possibility of resolution is not clear. We retrospectively analyzed the hospital records and laryngoscopic photos of 52 patients who were diagnosed with contact granuloma between May 2003 and June 2012. The reflux finding score and the shape of the granuloma were analyzed based on the initial laryngoscopy images; additionally, age, gender, chief complaint, and the side afflicted were also analyzed. Of the 52 patients, 40 who were treated conservatively were analyzed. Their mean age was 57.6 years and the mean follow-up period was 28.6 weeks. There was male predominance (87.5%), and the left side was more commonly afflicted (60.0%). Factors significantly associated with resolution included width/height ratio (P = 0.012) and gender (P = 0.048), but not reflux finding score (P = 0.713) or etiology (P = 0.382). So with this data, resolution of contact granuloma is highly probable in cases where the granuloma has a narrow base and the gender is female.

Diagnostic and therapeutic pitfalls in benign vocal fold diseases

More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis.