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Alwan M, Phyland DJ, Smith JA, Paddle PM. Systemic Effects and Absorption of Subepithelial Dexamethasone Vocal Fold Injections. Laryngoscope 2024. [PMID: 39400353 DOI: 10.1002/lary.31824] [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: 08/11/2024] [Revised: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 10/15/2024]
Abstract
OBJECTIVE/HYPOTHESIS To compare the systemic changes following two office-based procedures-subepithelial vocal fold steroid injections (VFSI) and vocal fold augmentation (VFA), and to characterize the magnitude and chronicity of the effects observed. STUDY DESIGN Prospective, controlled before-after comparative study. METHODS Patients prospectively underwent VFSI with 0.8-2 mg of dexamethasone or VFA. Serum cortisol, white cell count (WCC), and C-reactive protein (CRP) were measured at day 0 (pre-procedure), 1 and 7. Salivary cortisol was measured at baseline and daily for 7 days post-procedure. RESULTS Fourteen patients underwent VFSI and 36 VFA. At baseline serum cortisol measured 304.6 ± 116.6 nmol/L and fell significantly to 48.1 ± 41.8 nmol/L 1 day following dexamethasone injection (p = 0.001) and recovered by day 7 to 303.7 ± 78.7 nmol/L. Salivary cortisol demonstrated a similar pattern with significant recovery demonstrated by day 3 (p = 0.001). White cell counts were affected by the systemic absorption of exogenous steroid and normalized by day 7. Patients who underwent VFA demonstrated no significant change in their serum or salivary cortisol and no significant change in their WCC. No significant changes in CRP or patient's physiological parameters were observed in either procedure. CONCLUSION Our findings demonstrate systemic absorption of dexamethasone following VFSI, with acute hypothalamic-pituitary-adrenal (HPA) axis suppression which normalizes day 3 post-procedurally. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Mostafa Alwan
- Department of Otolaryngology, Monash Health, Melbourne, Victoria, Australia
| | - Debra J Phyland
- Department of Otolaryngology, Monash Health, Melbourne, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Nursing & Health Sciences, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Julian A Smith
- Department of Surgery, Faculty of Medicine, Nursing & Health Sciences, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Paul M Paddle
- Department of Otolaryngology, Monash Health, Melbourne, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Nursing & Health Sciences, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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Hamdan AL, Hosri J, Daou CAZ, Ghzayel L, Hadi J, Saab MB, Kasti M, Mourad M. Office-Based Steroid Injection for Benign Lesions of the Vocal Folds: Case Series and Review of the Literature. J Voice 2024:S0892-1997(24)00095-X. [PMID: 38762397 DOI: 10.1016/j.jvoice.2024.03.023] [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: 03/06/2024] [Accepted: 03/19/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVES To present the authors' experience on intralesional steroid injection (ILSI) for benign lesions of the vocal folds and a review of the literature. STUDY DESIGN Retrospective chart review. METHODS The medical records of patients with vocal folds nodules, polyps, Reinke's edema, laryngitis/localized edema, and vocal fold granuloma who underwent ILSI were reviewed. Disease regression was assessed by reviewing the video recordings of laryngeal endoscopy before and after surgery. Subjective and objective voice outcome measures were compared before and after office-based ILSI. RESULTS Forty-seven patients with 81 lesions were included. The most common lesion treated was Reinke's edema followed by vocal fold nodules. All patients who presented for follow-up (n = 37) had partial or complete regression of their disease. When stratified by disease type, vocal fold polyps showed the highest percentage of complete regression (66.7%) followed by vocal fold nodules (65%). The mean voice handicap index-10 (VHI-10) score of the study group dropped from 16.63 ± 6.95 to 6.21 ± 6.09 points (P < 0.001). Patients with vocal fold polyps had the highest drop in the mean VHI-10 score by 16.66 ± 4.73 (P = 0.026). There was no significant difference in the mean acoustic and aerodynamic parameters before and after office-based steroid injection. CONCLUSIONS ILSI is an effective treatment modality for benign lesions of the vocal folds leading to partial or complete disease regression and self-reported improvement in voice quality.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Jad Hosri
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christophe Abi Zeid Daou
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lana Ghzayel
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jaafar Hadi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mounir Bou Saab
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maher Kasti
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marc Mourad
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Cruz DRD, Zheng A, Debele T, Larson P, Dion GR, Park YC. Drug delivery systems for wound healing treatment of upper airway injury. Expert Opin Drug Deliv 2024; 21:573-591. [PMID: 38588553 PMCID: PMC11208077 DOI: 10.1080/17425247.2024.2340653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/04/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Endotracheal intubation is a common procedure to maintain an open airway with risks for traumatic injury. Pathological changes resulting from intubation can cause upper airway complications, including vocal fold scarring, laryngotracheal stenosis, and granulomas and present with symptoms such as dysphonia, dysphagia, and dyspnea. Current intubation-related laryngotracheal injury treatment approaches lack standardized guidelines, relying on individual clinician experience, and surgical and medical interventions have limitations and carry risks. AREAS COVERED The clinical and preclinical therapeutics for wound healing in the upper airway are described. This review discusses the current developments on local drug delivery systems in the upper airway utilizing particle-based delivery systems, including nanoparticles and microparticles, and bulk-based delivery systems, encompassing hydrogels and polymer-based approaches. EXPERT OPINION Complex laryngotracheal diseases pose challenges for effective treatment, struggling due to the intricate anatomy, limited access, and recurrence. Symptomatic management often requires invasive surgical procedures or medications that are unable to achieve lasting effects. Recent advances in nanotechnology and biocompatible materials provide potential solutions, enabling precise drug delivery, personalization, and extended treatment efficacy. Combining these technologies could lead to groundbreaking treatments for upper airways diseases, significantly improving patients' quality of life. Research and innovation in this field are crucial for further advancements.
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Affiliation(s)
- Denzel Ryan D. Cruz
- Medical Scientist Training Program, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Avery Zheng
- Chemical Engineering Program, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Tilahun Debele
- Chemical Engineering Program, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Peter Larson
- Department of Otolaryngology – Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Gregory R. Dion
- Department of Otolaryngology – Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Yoonjee C. Park
- Chemical Engineering Program, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH, USA
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Woo P, Murry T. Platelet Rich Plasma (PRP) Treatment in Recalcitrant, Bilateral Phono-traumatic Lesions. J Voice 2024:S0892-1997(24)00033-X. [PMID: 38461100 DOI: 10.1016/j.jvoice.2024.02.012] [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: 12/31/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE Mature vocal fold nodules and fibrous phono-traumatic lesions that have failed standard voice therapy can be challenging. Autologous platelet-rich plasma (PRP) is rich in growth factors and easily obtained from a simple blood draw. Growth factor injection into the vocal folds may reverse the scar and inflammation in recalcitrant, bilateral phono-traumatic lesions such as mature vocal fold nodules. This study reports the short-term (3months) voice results after PRP injection in 11 subjects with recalcitrant, bilateral phono-traumatic lesions that have failed voice therapy. MATERIALS AND METHODS Serial autologous PRP injections were used to treat 11 patients with recalcitrant, bilateral phono-traumatic lesions in an office setting. All had prior conservative voice therapy or surgery and were deemed failures. Pre and post-treatment video stroboscopy, Voice Handicap Index (VHI-10), and Cepstral Spectral Index of Dysphonia (CSID) before and after treatment (3months) were tabulated and compared. An expert rater blinded to the treatment condition rated the stroboscopy and voice results. RESULTS At 3months postinjection, 9 of the 11 patients reported improved VHI-10 and noted sustained voice improvement after PRP injections. Median VHI-10 changed from 20 to 13 (P < 0.05 paired t test). The CSID scores changed from 17 to 5 (NS P > 0.05, paired t test). Nine of 11 patients reported improved vocal effort and stamina. Stroboscopy ratings were better after treatment than before treatment in 7 of the 11 subjects. CONCLUSION Short-term improvements in voice may occur in patients with recalcitrant, bilateral phono-traumatic lesions following PRP injection. PRP injections into the vocal folds may be a new treatment for nonsurgical intervention in patients with recalcitrant, bilateral phono-traumatic lesions. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Peak Woo
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Thomas Murry
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Loma Linda Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California
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Hashimoto K, Kaneko M, Kinoshita S, Ozawa S, Mukudai S, Sugiyama Y, Hirano S. Effects of Repeated Intracordal Glucocorticoid Injection on the Histology and Gene Expression of Rat Vocal Folds. J Voice 2023; 37:822-828. [PMID: 34284926 DOI: 10.1016/j.jvoice.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Local injection of glucocorticoids (GCs) into the vocal folds has been used for treating the vocal fold lesions. While the positive effects on vocal fold nodules, polyps, or scarring have been clinically reported, some concern remains around the potential adverse effects such as vocal fold atrophy, and the mechanisms remain unclear. The present study examined the histology and gene expression of locally injected GC into the vocal folds in rats. METHODS Thirteen-week-old male Sprague-Dawley rats were used in the experiments. Triamcinolone acetonide (TAA) or saline were administered repeatedly to the right vocal folds at a weekly interval, and rats were euthanized one week after the last administration for histological examination. Genetic examination was assessed hyaluronic acid (HA) metabolism at 1 or 3 days after a single TAA injection by quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS The group which underwent four TAA injections showed a significant decrease in HA in the lamina propria (LP), thickness of the LP and total cell numbers of the LP compared with the saline group. In contrast, there was no significant difference in the area of collagen accumulation and the thyroarytenoid muscle, although there was a tendency of atrophy of the muscle. After single injection of TAA, qRT-PCR showed a significant decrease in the expression of HA synthases, Has2 and Has3. CONCLUSIONS The current animal study first demonstrates that repeated intracordal injection of GCs may lead to atrophy of vocal folds caused by decrease of deposition of HA in the LP and decrease of gene expression of Has.
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Affiliation(s)
- Keiko Hashimoto
- 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.
| | - 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
| | - 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
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Gartling G, Nakamura R, Sayce L, Zimmerman Z, Slater A, Wilson A, Bing R, Branski RC, Rousseau B. Acute In Vitro and In Vivo Effects of Dexamethasone in the Vocal Folds: a Pilot Study. Laryngoscope 2023; 133:2264-2270. [PMID: 36317801 PMCID: PMC10149570 DOI: 10.1002/lary.30461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Glucocorticoids (GC)s are commonly employed to treat vocal fold (VF) pathologies. However, VF atrophy has been associated with intracordal GC injections. Dexamethasone-induced skeletal muscle atrophy is well-documented in other tissues and believed to be mediated by increased muscle proteolysis via upregulation of Muscle Ring Finger (MuRF)-1 and Atrogin-1. Mechanisms of dexamethasone-mediated VF atrophy have not been described. This pilot study employed in vitro and in vivo models to investigate the effects of dexamethasone on VF epithelium, thyroarytenoid (TA) muscle, and TA-derived myoblasts. We hypothesized that dexamethasone will increase atrophy-associated gene expression in TA muscle and myoblasts and decrease TA muscle fiber size and epithelial thickness. STUDY DESIGN In vitro, pre-clinical. METHODS TA myoblasts were isolated from a female Sprague-Dawley rat and treated with 1 μM dexamethasone for 24-h. In vivo, 15 New Zealand white rabbits were randomly assigned to three treatment groups: (1) bilateral intracordal injection of 40 μL dexamethasone (10 mg/ml; n = 5), (2) volume-matched saline (n = 5), and (3) untreated controls (n = 5). Larynges were harvested 7-days post-injection. Across in vivo and in vitro experimentation, MuRF-1 and Atrogin-1 mRNA expression were measured via RT-qPCR. TA muscle fiber cross-sectional area (CSA) and epithelial thickness were also quantified in vivo. RESULTS Dexamethasone increased MuRF-1 gene expression in TA myoblasts. Dexamethasone injection, however, did not alter atrophy-associated gene expression, TA CSA, or epithelial thickness in vivo. CONCLUSION Dexamethasone increased atrogene expression in TA myoblasts, providing foundational insight into GC induced atrophic gene transcription. Repeated dexamethasone injections may be required to elicit atrophy in vivo. LEVEL OF EVIDENCE NA Laryngoscope, 133:2264-2270, 2023.
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Affiliation(s)
- Gary Gartling
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Ryosuke Nakamura
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY
| | - Lea Sayce
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Zachary Zimmerman
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Alysha Slater
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Azure Wilson
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Renjie Bing
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY
| | - Ryan C. Branski
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY
- Department of Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, NY
| | - Bernard Rousseau
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Doisy College of Health Sciences, Saint Louis University, St. Louis, MO
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Nakamura R, Bing R, Gartling GJ, Garabedian MJ, Branski RC. Glucocorticoid Dose Dependency on Gene Expression in Vocal Fold Fibroblasts and Macrophages. Laryngoscope 2023; 133:1169-1175. [PMID: 36779842 PMCID: PMC9925845 DOI: 10.1002/lary.30330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/22/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Glucocorticoids (GCs) modulate multiple cellular activities including inflammatory and fibrotic responses. Outcomes of GC treatment for laryngeal disease vary, affording opportunity to optimize treatment. In the current study, three clinically employed GCs were evaluated to identify optimal in vitro concentrations at which GCs mediate favorable anti-inflammatory and fibrotic effects in multiple cell types. We hypothesize a therapeutic window will emerge as a foundation for optimized therapeutic strategies for patients with laryngeal disease. STUDY DESIGN In vitro. METHODS Human vocal fold fibroblasts and human macrophages derived from THP-1 monocytes were treated with 0.03-1000 nM dexamethasone, 0.3-10,000 nM methylprednisolone, and 0.3-10,000 nM triamcinolone in combination with interferon-γ, tumor necrosis factor-α, or interleukin-4. Real-time polymerase chain reaction was performed to analyze inflammatory (CXCL10, CXCl11, PTGS2, TNF, IL1B) and fibrotic (CCN2, LOX, TGM2) genes, and TSC22D3, a target gene of GC signaling. EC50 and IC50 to alter inflammatory and fibrotic gene expression was calculated. RESULTS Interferon-γ and tumor necrosis factor-α increased inflammatory gene expression in both cell types; this response was reduced by GCs. Interleukin-4 increased LOX and TGM2 expression in macrophages; this response was also reduced by GCs. GCs induced TSC22D3 and CCN2 expression independent of cytokine treatment. EC50 for each GC to upregulate CCN2 was higher than the IC50 to downregulate other genes. CONCLUSION Lower concentrations of GCs repressed inflammatory gene expression and only moderately induced genes involved in fibrosis. These data warrant consideration as a foundation for optimized clinical care paradigms to reduce inflammation and mitigate fibrosis. LEVEL OF EVIDENCE NA Laryngoscope, 133:1169-1175, 2023.
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Affiliation(s)
- Ryosuke Nakamura
- Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY
| | - Renjie Bing
- Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY
| | - Gary J. Gartling
- Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY
| | | | - Ryan C. Branski
- Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY
- Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, NY
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Hamdan AL, Ghanem A, Abi Zeid Daou C, Hosri J, Feghali PAR, Jabbour C, Alam E. The Added Value of Steroid Injection Following Office-based Blue Laser Therapy of Benign Lesions of the Vocal Folds; Short-Term Effect in a Cohort of 43 Patients. J Voice 2023:S0892-1997(23)00067-X. [PMID: 36925408 DOI: 10.1016/j.jvoice.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES To investigate the added value of steroid injection following office-based blue laser therapy of benign lesions of the vocal folds. STUDY DESIGN Retrospective cohort analysis. METHODS The medical records and video-recordings of patients with benign lesions of the vocal folds who underwent office-based blue laser therapy in a tertiary referral center between February 2020 and October 2022 were reviewed. Patients were divided into two subgroups, those who underwent office-based blue laser therapy alone (n = 23) and those who underwent office-based blue laser therapy with steroid injection (n = 19). Disease regression and voice outcome measures included Voice Handicap Index-10 score, perceptual voice evaluation using the GRB grading, jitter, shimmer, noise to harmonic ratio, voice turbulence index, and maximum phonation time were reviewed. RESULTS A total of 42 patients were included. The mean age was 54.7 ± 10.1 years. Lesions included polyps (n = 21), Reinke's edema (n = 19), and cysts (n = 2). There was partial or complete disease regression in all patients who presented for follow-up (n = 37). In patients who underwent blue laser therapy alone (n = 19), 42.1% had complete regression and 57.9% had partial regression. In those who underwent blue laser therapy followed by steroid injection (n = 18), 77.7% had complete disease regression and 22.3% had partial regression. The difference in disease regression between the two subgroups was statistically significant (P = 0.027). The decrease in the mean Voice Handicap Index-10 score was also statistically significant with a higher mean being noted in the subgroup who underwent blue laser therapy followed by steroid injection (-10.5 ± 6.9 vs. -17.3 ± 11.8, P = 0.031). There was no significant difference in the decrease in the perceptual evaluation scores nor in the decrease in jitter, shimmer, noise to harmonic ratio, and voice turbulence index between the two subgroups. There was also no significant increase in the maximum phonation time. CONCLUSION Steroid injection after blue laser therapy improves disease regression and voice outcome of laser therapy.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon.
| | - Anthony Ghanem
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Christophe Abi Zeid Daou
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Jad Hosri
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Patrick Abou Raji Feghali
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Christopher Jabbour
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Elie Alam
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
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Elsaeed A, Afsah O, Nawka T, Caffier P, Baz H. Treatment of Vocal Fold Nodules: Transnasal Steroid Injection Versus Microlaryngoscopic Phonomicrosurgery. J Voice 2023:S0892-1997(23)00038-3. [PMID: 36882331 DOI: 10.1016/j.jvoice.2023.02.003] [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: 12/09/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES Vocal fold nodules (VFNs) are bilateral, mid-membranous, swellings of the vocal folds. Intralesional steroid injection was successfully tried in the management of benign vocal fold lesions including nodules. The aim of the present study was to compare treatment outcomes of vocal fold steroid injection (VFSI) and surgery in patients with VFNs in terms of lesion regression, subjective, and objective voice parameters. STUDY DESIGN Nonrandomized controlled clinical trial. METHODS This bicenter interventional study was conducted on 32 patients with VFNs, in the age range of 16-63 years. Sixteen patients underwent transnasal VFSI under local anesthesia (the injection group), and 16 underwent surgical excision of the nodules under general anesthesia (the surgery group). Prior to intervention and at the follow-up visit, participants were subjected to videolaryngoscopic examination with evaluation of nodules' sizes as well as subjective voice assessment by auditory perceptual assessment (APA) of voice and the international nine-item Voice Handicap Index (VHI-9i). Objective voice assessments including the measurements of cepstral peak prominence, jitter, shimmer, harmonic to noise ratio, and maximum phonation time were also administered. RESULTS The size of vocal fold nodules was significantly decreased postintervention in both studied groups. There was a decrease in the VHI-9i score, a decrease in the values of jitter and shimmer, together with an increase in the values of cepstral peak prominence and maximum phonation time after interventions indicating improvement of subjective and objective voice outcomes in both groups. CONCLUSION Office-based transnasal VFSI is a safe and tolerable therapy option for VFNs. Voice outcomes of VFSI were comparable to surgery, hereby VFSI can be considered a promising therapy for VFNs and could be used as an alternative to surgery in selected cases.
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Affiliation(s)
- Asser Elsaeed
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Omayma Afsah
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Tadeus Nawka
- Department of Audiology and Phoniatrics, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Philipp Caffier
- Department of Audiology and Phoniatrics, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Hemmat Baz
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Nozawa M, Kanazawa T, Kurakami K, Kashima K, Okui A, Hasegawa T, Hirosaki M, Kamitomai M, Igarashi T, Ito M, Watanabe Y. Age-dependent treatment effect of vocal fold steroid injection for benign vocal fold lesions. Laryngoscope Investig Otolaryngol 2023; 8:177-184. [PMID: 36846402 PMCID: PMC9948573 DOI: 10.1002/lio2.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/06/2022] [Indexed: 01/03/2023] Open
Abstract
Objective Benign vocal fold lesions (BVFLs) cause voice disorders and impair social life. Recently, office-based vocal fold steroid injection (VFSI) has gained attention as a minimally invasive treatment for BVFLs. This study aimed to analyze the age-dependent treatment effect of VFSI and to clarify the indications for treatment. Methods In this retrospective cohort study, a total of 83 patients with BVFLs were treated with a similar regimen of VFSI. Three or four months after the injection, age-dependent phonological functions were evaluated. The differences between pre- and post-treatment findings were analyzed using the Wilcoxon matched-pair signed-rank test, and the correlation between patient age and improvement rates were determined by Pearson's correlation coefficient. Results Improvement in voice handicap index (VHI), which was the primary endpoint, was observed. Subjective and objective voice quality measurements also showed significant improvements. Subgroup analyses revealed that there was no age-related difference in the improvement of voice quality and that there was no improvement in aerodynamic effect in patients over 45 years of age. Conclusion This study clarified the age-dependent treatment effect of VFSI and provided the important suggestion of establishing indication criteria for BVFLs. The study results provided clarity on the indication criteria of VFSI and served as an important indicator for tailoring treatment to patients' needs. Level of Evidence 4.
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Affiliation(s)
- Miki Nozawa
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck Surgery, School of MedicineJichi Medical UniversityShimotsukeJapan
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineJichi Medical UniversityShimotsukeJapan
| | - Takeharu Kanazawa
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck Surgery, School of MedicineJichi Medical UniversityShimotsukeJapan
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineJichi Medical UniversityShimotsukeJapan
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| | - Kazuya Kurakami
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
- Department of Otolaryngology Head and Neck Surgery, Faculty of MedicineYamagata UniversityYamagataJapan
| | - Kazutaka Kashima
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
- Department of Otolaryngology, Head and Neck SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Ayako Okui
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
- Department of Otorhinolaryngology, Head and Neck Surgery, School of MedicineKeio UniversityTokyoJapan
| | - Tomohiro Hasegawa
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck Surgery, School of MedicineJichi Medical UniversityShimotsukeJapan
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineJichi Medical UniversityShimotsukeJapan
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| | - Mayu Hirosaki
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| | - Manami Kamitomai
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| | - Takeshi Igarashi
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck Surgery, School of MedicineJichi Medical UniversityShimotsukeJapan
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineJichi Medical UniversityShimotsukeJapan
| | - Makoto Ito
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineJichi Medical UniversityShimotsukeJapan
| | - Yusuke Watanabe
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
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11
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Takahashi S, Kanazawa T, Hasegawa T, Hirosaki M, Komazawa D, Konomi U, Nimura Y, Sakaguchi Y, Nozawa M, Yamauchi T, Watanabe Y. Comparison of therapeutic effects of steroid injection by benign vocal fold lesion type. Acta Otolaryngol 2021; 141:1005-1013. [PMID: 34751085 DOI: 10.1080/00016489.2021.1995895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Benign vocal fold lesions (BVFLs) can cause voice changes, including reduced loudness and pitch range. In recent times, with progression in endoscopic technology, office-based vocal fold steroid injection (VFSI) has been used as an alternative therapy for BVFLs. AIMS/OBJECTIVES In this study, we analyzed the efficacy and safety of VFSI to investigate the mechanism underlying its therapeutic effects and determine the conditions in which VFSI will be most effective. MATERIALS AND METHODS In this retrospective cohort study, we included 40 condition-matched patients (8 patients per lesion) with chorditis, vocal nodules, vocal polyps, Reinke's edema (RE), or vocal scars who received similar regimens of steroid injection using a commercial preparation of triamcinolone acetonide. Their phonological outcomes were evaluated 2 or 3 months after the injection. RESULTS Significant improvements were observed in Voice Handicap Index scores, results of laboratory voice evaluation, and voice quality measured using the Grade, Roughness, Breathiness, Asthenia, Strain scale in all participants. In subgroup analysis, VFSI was highly effective against chorditis and vocal nodules, but less effective against RE and vocal scars. CONCLUSIONS Single-dose VFSI is valuable as an alternative to voice rehabilitation and laryngo-microsurgery, but higher concentrations or repeated injections are required for intractable lesions.
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Affiliation(s)
- Satoka Takahashi
- Department of Otolaryngology – Head and Neck Surgery, Division of Laryngeal Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Takeharu Kanazawa
- Department of Otolaryngology – Head and Neck Surgery, Division of Laryngeal Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Tomohiro Hasegawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Mayu Hirosaki
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Daigo Komazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- AKASAKA Voice Health Center, Tokyo, Japan
| | - Ujimoto Konomi
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Voice and Dizziness Clinic Futakotamagawa Otolaryngology, Tokyo, Japan
| | | | - Yu Sakaguchi
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Miki Nozawa
- Department of Otolaryngology – Head and Neck Surgery, Division of Laryngeal Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tomohiko Yamauchi
- Department of Otolaryngology – Head and Neck Surgery, Division of Laryngeal Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yusuke Watanabe
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
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12
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Resolution of a vocal fold polyp treated with Chinese herbal medicine: One case report with literature review. J Herb Med 2021. [DOI: 10.1016/j.hermed.2021.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Wu CH, Lo WC, Liao LJ, Kao YC, Wang CT. Vocal Fold Steroid Injection for Benign Vocal Lesions in Professional Voice Users. J Voice 2021; 37:472.e1-472.e6. [PMID: 33707029 DOI: 10.1016/j.jvoice.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Current treatments for benign vocal lesions consist mainly voice therapy and phonomicrosurgery. However, these options are not always suitable for professional voice users because of their tight performance schedule and limited time for voice rest. This study investigated vocal fold steroid injection (VFSI) as an alternative treatment. STUDY DESIGN Matched case series. METHODS We retrospectively enrolled 28 professional voice users (i.e., singers, actors and news anchors) who received VFSI for vocal nodules and polyps in an office setting of a tertiary teaching hospital. Outcomes were evaluated using videolaryngostroboscopy (VLS), the 10-item Voice Handicap Index (VHI-10), maximum phonation time, and acoustic and perceptual analyses before and 1 month after VFSI. Study results were compared with 56 patients of nonprofessional voice users (i.e., routine or high occupational vocal demands), matched in a 1:2 ratio by age, sex, and treatment date. RESULTS After VFSI, VLS revealed substantial lesion resolution in 82% professional voice users. One professional voice user developed a self-limited vocal fold hematoma after VFSI. VHI-10 scores in the professional group decreased from 21 to 14 points, compared with 23 to 16 points in the non-professional group, demonstrating a significant within-group effect (P < 0.01, GEE) and a nonsignificant between-group effect (P = 0.86). Other outcomes also improved significantly after VFSI (P < 0.05), without significant differences between the two groups. CONCLUSION VFSI can be an effective and safe alternative treatment for professional voice users with benign vocal lesions.
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Affiliation(s)
- Chien-Hao Wu
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan; Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Yi-Chia Kao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan; Department of Special Education, University Of Taipei, Taipei, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan; Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan; Department of Special Education, University Of Taipei, Taipei, Taiwan.
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14
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Zhang R, Li J, Nie Q, Wu M, Jia Y. Short-term outcome of transcutaneous glucocorticoid injection for laryngeal contact granuloma in females. Eur Arch Otorhinolaryngol 2021; 278:1499-1504. [PMID: 33439338 DOI: 10.1007/s00405-020-06595-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the short-term efficacy of transcutaneous glucocorticoid injection for laryngeal contact granuloma in females. METHODS A total of 14 female patients with laryngeal contact granuloma treated in our outpatient department from November 2017 to January 2020 were included in the study. Inspiratory-phase laryngoscopy images were collected before treatment and 1 month after each injection, and the lesion size was measured and evaluated with ImageJ software. RESULTS Two patients achieved complete remission after one injection, with a percent reduction of 100%. After two injections, 4 patients achieved complete remission, with a percent reduction ranging from 96% to 100%. After 3 injections, 4 patients achieved complete remission (including one patient with bilateral lesions), and the percent reduction ranged from 95% to 100%. Three patients achieved incomplete remission, with a percent reduction of 46%, 55%, and 81%, respectively. In one case, there was no remission, and the granuloma increased in size after treatment. CONCLUSION In women with laryngeal contact granuloma, transcutaneous glucocorticoid injection therapy can quickly resolve the granuloma in a short period.
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Affiliation(s)
- Ran Zhang
- Department of Otolaryngology Head and Neck Surgery, Sixth Medical Center of PLA General Hospital; College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital; National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Jinrang Li
- Department of Otolaryngology Head and Neck Surgery, Sixth Medical Center of PLA General Hospital; College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital; National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.
| | - Qian Nie
- Department of Otolaryngology Head and Neck Surgery, Sixth Medical Center of PLA General Hospital; College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital; National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Mukun Wu
- Department of Otolaryngology Head and Neck Surgery, Sixth Medical Center of PLA General Hospital; College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital; National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Yuanyuan Jia
- Department of Otolaryngology Head and Neck Surgery, Sixth Medical Center of PLA General Hospital; College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital; National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
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15
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Dassé R, De Monès Del Pujol E. First-line treatment of exudative vocal fold-lesions by in-office local corticosteroid injection: A literature review. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:169-175. [PMID: 33191161 DOI: 10.1016/j.anorl.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There are emerging reports of the effectiveness of in-office awake vocal-fold corticosteroid injection in the treatment of exudative vocal-fold lesions. The aim of this study was to review this therapy and specify indications, practical modalities and outcomes. STUDY DESIGN Systematic review of the literature without meta-analysis. METHODS A systematic review by PubMed search for the period January 2000 to December 2018 was carried out. RESULTS Nine articles were included, for a total of 502 lesions: nodules (46.4%), polyps (31.7%), and Reinke's edema (21.9%). Submucosal injection of low-dose triamcinolone acetonide (0.1 to 0.3mL) was transoral, transcutaneous or transnasal via flexible endoscope with operating channel. Lesion volume was significantly reduced in more than 90% of cases, with significant vocal improvement in all studies. Relapse rates ranged between 4% and 31%, with time to relapse of 1 to 40 months. CONCLUSIONS First-line treatment of exudative glottic lesions by submucosal corticosteroid injection provides at least transient significant reduction in lesion volume and vocal improvement. It is consensually reserved to moderate-sized mainly exudative lesions without fibrosis. In-office injection provides an immediate therapeutic response in case of vocal impairment, enabling surgery under general anesthesia to be postponed.
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Affiliation(s)
- R Dassé
- Service ORL et chirurgie cervico-faciale, CHU de Bordeaux-Pellegrin, place Amélie Rabat-Léon, 33000 Bordeaux, France.
| | - E De Monès Del Pujol
- Service ORL et chirurgie cervico-faciale, CHU de Bordeaux-Pellegrin, place Amélie Rabat-Léon, 33000 Bordeaux, France
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16
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Lin FC, Chien HY, Chen SH, Kao YC, Cheng PW, Wang CT. Voice Therapy for Benign Voice Disorders in the Elderly: A Randomized Controlled Trial Comparing Telepractice and Conventional Face-to-Face Therapy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2132-2140. [PMID: 32579859 DOI: 10.1044/2020_jslhr-19-00364] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Previous studies have reported that voice therapy via telepractice is useful for patients with nodules and muscle tension dysphonia. Nevertheless, telepractice for elderly patients with voice disorders has not yet been investigated. We conducted this study to examine the hypothesis that voice therapy via telepractice is not inferior to conventional voice therapy. Method Eighty patients with dysphonia aged more than 55 years participated in this study from September 2016 to June 2018. After screening the inclusion and the exclusion criteria, 69 patients were randomized into telepractice (33 patients) and conventional (36 patients) groups. The outcome measurements included Voice Handicap Index-10, videolaryngostroboscopy, maximum phonation time, auditory-perceptual evaluation, and acoustic analysis. Paired t test, Wilcoxon signed-ranks test, and repeated measures analysis of variance were used to examine treatment outcomes. Results The diagnoses of voice disorders included atrophy (n = 33), unilateral vocal paralysis (n = 13), muscle tension dysphonia (n = 7), nodules (n = 6), and polyps (n = 10). No significant differences were observed in age, sex, and baseline measurements between the two groups. Twenty-five patients in the telepractice group and 24 patients in the control group completed at least four weekly sessions. Significant improvements were observed for all the outcome measures (p < .05) in both groups. Improvements in Voice Handicap Index-10 in the telepractice group (24.84 ± 5.49 to 16.80 ± 8.94) were comparable to those in the conventional group (22.17 ± 7.29 to 13.46 ± 9.95, p = .764). Other parameters also showed comparable improvements between the two groups without statistically significant differences. Conclusions This is the first randomized controlled trial comparing telepractice and conventional voice therapy in elderly patients with voice disorders. The results showed that the effectiveness of voice therapy via telepractice was not inferior to that of conventional voice therapy, indicating that telepractice can be used as an alternative to provide voice care for elderly patients with vocal disorders.
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Affiliation(s)
- Feng-Chuan Lin
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
| | - Hsin-Yu Chien
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Sheng Hwa Chen
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Yi-Chia Kao
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
- Department of Electric Engineering, Yuan Ze University, Taoyuan, Taiwan
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17
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Assessing the utility of non-surgical treatments in the management of vocal process granulomas. The Journal of Laryngology & Otology 2020; 134:68-73. [PMID: 31918788 DOI: 10.1017/s0022215119002524] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine whether patients would have equivalent or improved outcomes when receiving non-surgical management versus surgical removal for vocal process granulomas. METHODS A chart review was performed for 53 adults with vocal process granulomas. All patients received baseline anti-reflux treatment consisting of twice-daily proton pump inhibitors and vocal hygiene education. Further treatment approaches were divided into non-surgical (i.e. inhaled corticosteroids, voice therapy, botulinum toxin injections) and surgical groups. Subjective parameters (Voice Handicap Index 10 and Reflux Symptom Index) and outcomes were tabulated and statistically compared. Cause of granuloma was also analysed to determine if this influenced outcomes. RESULTS Of 53 patients, 47 (89 per cent) experienced reduction in granuloma size, while 37 (70 per cent) experienced complete resolution. The rate of complete granuloma resolution after initial treatment strategy alone was significantly higher in non-surgical compared to surgical patients (67 and 30 per cent, respectively; p = 0.039). No difference in outcome was seen between iatrogenic and idiopathic granulomas. CONCLUSION Non-surgical patients were more likely to experience initial treatment success than those who underwent surgical removal. Continued emphasis should be placed on conservative treatment options prior to surgery for patients with this condition.
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18
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Jo YS, Kim MY, So YK. Impact of Remnant Nodules on Immediate and Long-term Outcomes of Voice Therapy for Vocal Fold Nodules. J Voice 2019; 35:400-405. [PMID: 31679925 DOI: 10.1016/j.jvoice.2019.10.001] [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: 07/10/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In this study, we aimed to assess whether remnant vocal fold nodules (VFN) influence immediate and long-term voice outcomes after voice therapy. STUDY DESIGN This is a retrospective cohort study evaluating immediate and long-term voice outcomes. METHODS Twenty-five adult patients with VFN who completed voice therapy were included in this study. Patients were classified into remnant (n = 18) and nonremnant (n = 7) groups according to the presence of remnant nodules immediately after completion of voice therapy. Acoustic and perceptual parameters, as well as voice handicap index (VHI), were compared between groups immediately (immediate outcome) and more than 3 months (long-term outcome) after completion of voice therapy. RESULTS Immediately after voice therapy, there were no significant differences between groups in grade-roughness-breathiness-asthenia-strain (GRBAS) score, jitter, shimmer, noise-to-harmonics ratio, voice range profile, or s/z ratio. Postvoice therapy VHI scores did not significantly differ between the two groups (9.29 ± 8.94 in the nonremnant group vs. 12.78 ± 9.01 in the remnant group, P = 0.392). The overall GRBAS grade of all patients was maintained at 0 or 1 during long-term follow-up. There was no significant difference between the long-term VHI scores of the remnant group (10.00 ± 8.58) and the nonremnant group (5.67 ± 8.71) (P = 0.306). CONCLUSIONS Immediately after voice therapy, perceptual scores, acoustic parameters, and VHI scores all significantly improved regardless of presence of remnant nodules. Favorable outcomes of voice therapy were maintained during long-term follow-up regardless of presence of remnant nodules after voice therapy.
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Affiliation(s)
- Yong Seok Jo
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Min Yeong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Yoon Kyoung So
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea.
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19
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Hsu YC, Liao LJ, Huang TW, Wang CT. Assessment of Patient Outcomes After Adjuvant Vocal Fold Steroid Injection for Fibrosis After Microlaryngeal Surgery. JAMA Otolaryngol Head Neck Surg 2019; 145:811-816. [PMID: 31294770 DOI: 10.1001/jamaoto.2019.1682] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Microlaryngeal surgery (MLS) is one of the most common procedures in laryngology; however, in cases of postoperative fibrosis, few remedial options are available. Objective To investigate the outcomes of vocal fold steroid injection (VFSI) as an adjuvant treatment for fibrosis after MLS. Design, Setting, and Participants Case series of 228 consecutive patients who underwent MLS for benign vocal lesions between January 2014 and December 2016 at a tertiary medical center. Adjuvant VFSI was performed in 25 patients (11%) with postoperative fibrosis, defined as severely decreased or absent mucosal wave on videolaryngostroboscopy (VLS) lasting for longer than 1 month postoperatively. Data were analyzed from July 1, 2018 to April 30, 2019. Intervention All adjuvant VFSIs were performed in the office under local anesthesia and were repeated monthly if the status of the mucosal wave did not return to normal or mildly decreased on the follow-up VLS. Main Outcomes and Measures The outcome parameters, namely, the 10-item Voice Handicap Index (VHI-10), smoothed cepstral peak prominence (CPP) of recorded voice samples, and mucosal wave status on VLS, were measured before and after MLS and after adjuvant VFSI. Results In this case series of 228 patients (72 men and 156 women; mean [SD] age, 42.8 [12.3] years), 25 had a decreased or absent mucosal wave after MLS, indicating postoperative fibrosis. Of these patients, 22 presented with deep-seated lesions that were removed using a microflap approach. After 1 course of adjuvant VFSI in 17 patients and 2 serial monthly injections in 8 patients, VFSI was associated with improved VHI-10 scores (mean, 24.4 points preoperatively, 22.1 points postoperatively, and 12.9 points after VFSI) that were comparable to the scores of the other 203 patients without vocal fold fibrosis after MLS (mean, 24.8 points preoperatively, 11.7 points postoperatively). Adjuvant VFSI was also associated with improved CPP (mean, 4.04 preoperatively, 4.23 postoperatively, and 5.11 after VFSI) that was comparable to the CPP of the other patients without postoperative fibrosis (mean, 4.33 preoperatively and 5.15 postoperatively). Overall, 19 (76%) of 25 patients with vocal fold fibrosis after MLS had normal (n = 11) or mildly decreased (n = 8) mucosal wave after adjuvant VFSI. Conclusions and Relevance Adjuvant VFSI appeared to be associated with improvements in mucosal wave, voice quality, and subjective perception of dysphonia in patients with fibrosis after MLS, with outcomes comparable to those of the other patients without fibrosis. Adjuvant VFSI may be considered a rescue technique, reducing the rate of fibrosis after MLS from 11% to 3%.
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Affiliation(s)
- Ying-Chieh Hsu
- Department of Otolaryngology Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Tsung-Wei Huang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan.,Department of Special Education, University of Taipei, Department of Otolaryngology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Otolaryngology Head and Neck Surgery, National Taiwan University Hospital, Taipei, Taiwan
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20
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Lechien JR, Saussez S, Nacci A, Barillari MR, Rodriguez A, Le Bon SD, Crevier-Buchman L, Harmegnies B, Finck C, Akst LM. Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review. Laryngoscope 2019; 129:E329-E341. [PMID: 30892725 DOI: 10.1002/lary.27932] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/14/2019] [Accepted: 02/25/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF). METHODS PubMed, Cochrane Library, and Scopus were searched by three independent investigators for articles published between January 1990 and November 2018 providing substantial information about the role of LPR in the development of nodules, polyps, cysts, Reinke's edema, and sulcus vocalis. Inclusion, exclusion, diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. RESULTS Of the 155 relevant publications, 42 studies were included. Thirty-five were clinical studies and seven were experimental research studying the impact of reflux on vocal fold tissue. Only seven clinical studies utilized objective LPR diagnoses (pH monitoring), suggesting an association between LPR and the development of nodules, polyps, and Reinke's edema. These studies were characterized by a substantial heterogeneity due to discrepancies in inclusion/exclusion criteria, diagnostic methods, and clinical outcome evaluation. The few basic science studies on this topic support that LPR creates an environment that may predispose to BLVF through changes in defense mechanisms of the vocal folds, cell-to-cell dehiscence, inflammatory reaction of the vocal folds, and reaction to phonotrauma. CONCLUSIONS Caustic mucosal injury from LPR could cause increased susceptibility of the vocal fold mucosa to injury and subsequent formation of nodules, polyps, or Reinke's edema. However, the heterogeneity and the low number of high-quality studies limit the ability to draw definitive conclusions. Future clinical and experimental studies are needed to better identify the role of reflux in development of BLVF. Laryngoscope, 129:E329-E341, 2019.
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Affiliation(s)
- Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology-Head and Neck Surgery, CHRU de Lille, Université de Lille, Lille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrea Nacci
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy
| | - Maria Rosaria Barillari
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Luigi Vanvitelli, Naples, Italy
| | - Alexandra Rodriguez
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge D Le Bon
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lise Crevier-Buchman
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, Paris, France
| | - Bernard Harmegnies
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium
| | - Camille Finck
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Lee M Akst
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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Vasconcelos DD, Gomes ADOC, Araújo CMTD. Vocal Fold Polyps: Literature Review. Int Arch Otorhinolaryngol 2019; 23:116-124. [PMID: 30647795 PMCID: PMC6331298 DOI: 10.1055/s-0038-1675391] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/02/2018] [Indexed: 10/27/2022] Open
Abstract
Introduction Vocal fold polyps are one of the most frequent benign laryngeal lesions, impacting the quality of life of those affected by them, primarily the vocal production. Despite being a well-established therapy in conjunction with surgery, speech therapy alone may also be effective in treating these lesions. As such, otolaryngologists and speech therapists need updated bibliographic knowledge on the issue. Objective To describe the literature findings on vocal fold polyps that discuss prevalence, etiology, histology, physiopathology, vocal characteristics or treatment. Data Synthesis The present study is a review article based on a bibliographic search using platforms, databases and search engines, with no restrictions on means of publication, methodological quality or language. All the articles on vocal fold polyps pertaining to the object of study published in the past 15 years were included. Among the characteristics investigated, the most discussed were prevalence of men, smoking as an etiological cofactor, the possibility of histological differentiation from vocal nodules, the relationship with cover minor structural alterations, and the indication and effectiveness of different treatment options. Conclusion Despite the discrepancies found in the present literature review on vocal fold polyps, there has been a notable scientific progress in the otolaryngologic techniques and in the effectiveness of speech therapy as initial treatment, with direct and indirect techniques, corroborating the need for scientific investigation of the issue.
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Affiliation(s)
- Daniela de Vasconcelos
- Speech Therapy Service, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, PE, Brazil
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22
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Cha W, Ro JH, Yang SC, Choi CJ, Yang I, Kang H, Cho IY, Jo MG, Seo H. Real-Time Light-Guided Vocal Fold Injection: Ex Vivo Feasibility Study in a Canine Model. Laryngoscope 2018; 129:935-942. [PMID: 30548614 DOI: 10.1002/lary.27507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The transcricothyroid (CT) membrane approach is a good option for office-based vocal fold injection (VFI). However, because the needle tip is invisible during injection using the CT approach, precise localization requires a high level of experience, and mastering this approach involves a steep learning curve. To overcome current limitations, we conceptualized a novel technique: real-time light-guided VFI (RL-VFI), which enables simultaneous VFI under direct visualization of the lighted needle tip. Herein, we aimed to verify the feasibility of RL-VFI in cadaveric canine model, simulating the setting of office-based VFI, as well as to explore its clinical usefulness. STUDY DESIGN Animal study. METHODS A customized prototype device was developed. It consisted of three parts: light source, controller, and injector. Light source comprised laser diodes of two wavelengths (635 nanometers [nm], red; 532 nm, green). Four types of injector were developed using 40-mm needles of 23- and 25-gauge and optic fibers of 50 and 100 μm. ex vivo canine larynx was prepared for the experiment. Flexible laryngoscopy system was used to examine canine vocal folds. RESULTS Various routes from three insertion points (3 mm, 10 mm, and 17 mm from the midline) were validated using the device. Regardless of the injection routes, the location of the needle tip was accurately indicated by light. RL-VFI was feasible under light guidance without difficulties. Moreover, precise and simultaneous re-injection could be performed at the intended point using the device. CONCLUSION We introduced RL-VFI using our customized prototype device in an ex vivo canine larynx, simulating the setting of office-based VFI. Clinical application of RL-VFI will improve safety and precision of CT approach, as well as expand its applications in laryngology. LEVEL OF EVIDENCE NA. Laryngoscope, 129:935-942, 2019.
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Affiliation(s)
- Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Republic of Korea
| | - Jung Hoon Ro
- Department of Biomedical Engineering, Pusan National University School of Medicine, Busan , Republic of Korea
| | - Sun Choel Yang
- Medical Device Development Center, OSONG Medical Innovation Foundation, Cheongju, Chungbuk , Republic of Korea
| | - Chang Jun Choi
- Medical Device Development Center, OSONG Medical Innovation Foundation, Cheongju, Chungbuk , Republic of Korea
| | - Inchul Yang
- Research Institute, Solmedix Co., Ltd, Seoul, Republic of Korea
| | - Hochul Kang
- Research Institute, Solmedix Co., Ltd, Seoul, Republic of Korea
| | - Il-Young Cho
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Republic of Korea
| | - Min-Gyu Jo
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Republic of Korea
| | - Hyoseok Seo
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Republic of Korea
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Khoramshahi H, Khatoonabadi AR, Khoddami SM, Dabirmoghaddam P, Ansari NN. Responsiveness of Persian Version of Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), Persian Version of Voice Handicap Index (VHI), and Praat in Vocal Mass Lesions with Muscle Tension Dysphonia. J Voice 2018; 32:770.e21-770.e30. [PMID: 29029830 DOI: 10.1016/j.jvoice.2017.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study was aimed at determining the internal and external responsiveness of the Persian version of the Consensus Auditory-Perceptual Evaluation of Voice (called ATSHA), Persian version of the Voice Handicap Index (VHI), and Praat scales among patients with vocal mass lesions and secondary muscle tension dysphonia. STUDY DESIGN Prospective, within-participant repeated measures. METHOD Thirty patients with vocal fold nodules, polyps, and cysts related to secondary muscle tension dysphonia participated in the study. The measures of interest and videostroboscopy examination were used before and after treatment. The Global Perceived Effect questionnaire was used to separate those improved (moderately or greatly improved) and stable (slightly improved) patients. RESULTS The mean standardized response, standardized effect size, and Guyatt analyses indicated high internal responsiveness for the all target parameters of the ATSHA, total score of the VHI, and two parameters of the Praat (0.8<). There was poor correlation between the videostroboscopy and the other target scales (r Pearson = -0.1-0.1). The receiver operating characteristic analysis indicated that all the target scales did not significantly separate those improved and stable subjects (area under the curve = 0), except for the overall severity and roughness parameters of the ATSHA scale (area under the curve = 1). CONCLUSION This study recommends both the Consensus Auditory-Perceptual Evaluation of Voice and the VHI scales to show voice therapy changes. The target voice scale changes were not able to predict the videostroboscopy changes as external standard. Furthermore, we recommend that the overall severity and roughness may properly classify those improved and stable patients.
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Affiliation(s)
- Hassan Khoramshahi
- Tehran University of Medical Sciences, School of Rehabilitation, Speech Therapy Department, Tehran, Iran
| | - Ahmad Reza Khatoonabadi
- Tehran University of Medical Sciences, School of Rehabilitation, Speech Therapy Department, Tehran, Iran.
| | - Seyyedeh Maryam Khoddami
- Tehran University of Medical Sciences, School of Rehabilitation, Speech Therapy Department, Tehran, Iran
| | - Peyman Dabirmoghaddam
- Tehran University of Medical Sciences, School of Rehabilitation, Speech Therapy Department, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran; Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
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Mansuri B, Tohidast SA, Soltaninejad N, Kamali M, Ghelichi L, Azimi H. Nonmedical Treatments of Vocal Fold Nodules: A Systematic Review. J Voice 2018; 32:609-620. [DOI: 10.1016/j.jvoice.2017.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/11/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
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Kim JS, Kwon SH, Lee SE, Lee EJ, Lee MH. Effect of single-dose intravenous dexamethasone on subjective voice quality after thyroidectomy: A meta-analysis. Medicine (Baltimore) 2018; 97:e11832. [PMID: 30200067 PMCID: PMC6133636 DOI: 10.1097/md.0000000000011832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/20/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Corticosteroids are widely used to treat voice change after thyroidectomy. In this study, we evaluated the effect of a single dose of intravenous dexamethasone after thyroidectomy using a metaanalysis. METHODS Relevant studies were identified by searching the following databases: Medline, Embase, and Cochrane through February 2017. We followed PRISMA guidelines. The following search terms were used: "thyroidectomy," "voice," "steroid." Random-effects models were used to estimate standardized mean differences (SMDs) and 95% confidence intervals. RESULTS Our search yielded one retrospective cohort study involving 122 thyroidectomy patients and 3 randomized controlled studies involving 242 thyroidectomy patients. The pooled SMD for voice quality after thyroidectomy was -0.80 (P < .05). Subgroup analysis showed significant voice quality change 1 day after administration of dexamethasone. CONCLUSIONS Single-dose intravenous dexamethasone after thyroidectomy significantly improves subjective voice quality on day 1. The effect was not different significantly after day 1. LEVEL OF EVIDENCE Level 2a.
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Affiliation(s)
- Jong Seung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University
- Research Institute of Clinical Medicine of Chonbuk National University—Biomedical Research Institute of Chonbuk National University Hospital, Jeonju
| | - Sam Hyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University
- Research Institute of Clinical Medicine of Chonbuk National University—Biomedical Research Institute of Chonbuk National University Hospital, Jeonju
| | - So Eun Lee
- Department of Practical Music, SoHae University, Gunsan
| | - Eun Jung Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University
- Research Institute of Clinical Medicine of Chonbuk National University—Biomedical Research Institute of Chonbuk National University Hospital, Jeonju
| | - Min Hee Lee
- Presbyterian Medical Center, Department of Internal Medicine, Division of Allergy and Pulmonology, Jeonju, Republic of Korea
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Ramavat AS, Tiwana H, Banumathy N, Bakshi J, Panda N, Goel A. Efficacy of Intralesional Steroid Injection in Small Benign Vocal Fold Lesions. J Voice 2018; 33:767-772. [PMID: 30077419 DOI: 10.1016/j.jvoice.2018.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 04/12/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The present study was conducted to study the efficacy of intralesional steroid (ILS) injection in small benign vocal fold lesions and compare the outcomes with microlaryngeal surgery in terms of improvement in symptoms and reduction in lesion size. METHODS The current randomized control trial was conducted in the Department of Otolaryngology at the Postgraduate Institute of Medical Education and Research in Chandigarh between 2014 and 2015. The clinical diagnosis was based on appearance of the lesion during endoscopy and the mucosal vibration pattern. Subjects with lesions of size less than or equal to 5 mm were included. RESULTS A total of 29 subjects were included in the study and 15 (nine men and six women) of them were randomized to receive ILS injection. Fourteen (13 men and one woman) were randomized to the second group to receive initial microlaryngeal surgery. We noted significant reduction in the size of the lesion among subjects undergoing ILS injection at 12 weeks (1.11 + 1.45 mm) as compared to baseline (2.63 + 1.28 mm) with no recurrence. CONCLUSIONS ILSs are effective in reducing size of lesion and also improve acoustic parameters, perceptual analysis, and grade of dysphonia in patients presenting with small benign vocal cord lesions.
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Affiliation(s)
- Anurag Snehi Ramavat
- Department of Otorhinolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Harsimran Tiwana
- Department of Otorhinolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nagamani Banumathy
- Department of Otorhinolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaimanti Bakshi
- Department of Otorhinolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Panda
- Department of Otorhinolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Goel
- Department of Medicine, University College of Medical Sciences, Delhi, India
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Wu PH, Cheng PW, Lin FC, Wang CT. Intralesional steroid injection as an alternative treatment for 57 patients of vocal fold mucus retention cysts. Clin Otolaryngol 2018; 43:1375-1378. [PMID: 29770572 DOI: 10.1111/coa.13137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
- P-H Wu
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - P-W Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - F-C Lin
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.,Master's Program of Speech and Language Pathology, Department of Special Education, University of Taipei, Taipei, Taiwan
| | - C-T Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.,Master's Program of Speech and Language Pathology, Department of Special Education, University of Taipei, Taipei, Taiwan.,Department of Otolaryngology Head and Neck Surgery, National Taiwan University College of Medicine, Taipei, Taiwan
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29
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Pirmez R, Abraham LS, Duque-Estrada B, Damasco P, Farias DC, Kelly Y, Doche I. Trichoscopy of Steroid-Induced Atrophy. Skin Appendage Disord 2017; 3:171-174. [PMID: 29177140 DOI: 10.1159/000471771] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/15/2017] [Indexed: 11/19/2022] Open
Abstract
Intralesional corticosteroid (IL-CS) injections have been used to treat a variety of dermatological and nondermatological diseases. Although an important therapeutic tool in dermatology, a number of local side effects, including skin atrophy, have been reported following IL-CS injections. We recently noticed that a subset of patients with steroid-induced atrophy presented with ivory-colored areas under trichoscopy. We performed a retrospective analysis of trichoscopic images and medical records from patients presenting ivory-colored areas associated with atrophic scalp lesions. In this paper, we associate this feature with the presence of steroid deposits in the dermis and report additional trichoscopic features of steroid-induced atrophy on the scalp, such as prominent blood vessels and visualization of hair bulbs.
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Affiliation(s)
- Rodrigo Pirmez
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo S Abraham
- Department of Dermatology, Hospital Regional da Asa Norte, Brasília, Brazil
| | - Bruna Duque-Estrada
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patrícia Damasco
- Department of Dermatology, Hospital Regional da Asa Norte, Brasília, Brazil
| | - Débora Cadore Farias
- Department of Dermatology, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Yanna Kelly
- Department of Dermatology, Universidade de São Paulo, São Paulo, Brazil
| | - Isabella Doche
- Department of Dermatology, Universidade de São Paulo, São Paulo, Brazil
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30
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Cho JH, Kim SY, Joo YH, Park YH, Hwang WS, Sun DI. Efficacy and Safety of Adjunctive Steroid Injection After Microsurgical Removal of Benign Vocal Fold Lesions. J Voice 2017; 31:615-620. [DOI: 10.1016/j.jvoice.2017.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/03/2017] [Accepted: 01/06/2017] [Indexed: 11/17/2022]
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31
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Wang CT, Lai MS, Cheng PW. Long-term Surveillance Following Intralesional Steroid Injection for Benign Vocal Fold Lesions. JAMA Otolaryngol Head Neck Surg 2017; 143:589-594. [PMID: 28334309 DOI: 10.1001/jamaoto.2016.4418] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The short-term outcomes of vocal fold steroid injection (VFSI) are well documented. However, few studies have reported the long-term outcomes following VFSI. Objective To investigate the incidence rates of symptom recurrence and secondary interventions following VFSI for benign vocal fold lesions. Design, Setting, and Participants This prospective cohort study was conducted at a tertiary referral medical center in Taipei, Taiwan. The cohort included 189 patients with vocal fold lesions who had received VFSI as the primary treatment between August 2011 and September 2013. Exposures All participants underwent VFSI. Main Outcomes and Measures Long-term surveillance was conducted through structured telephonic interviews and by reviewing medical charts every 6 months over a 2-year period. We assessed the 10-item voice handicap index, dysphonic symptoms, and whether the patients had received any additional interventions after the initial VFSI. Results The 189 participants (32 men and 157 women; mean [SD] age, 39 [10] years [range, 20-74 years] included patients who had undergone VFSI for vocal fold nodules (n = 72), polyps (n = 72), or mucus-retention cysts (n = 45). Following VFSI, 141 patients (74.6%; 23 men and 118 women; mean age, 39 years [range, 20-70 years]) showed positive response (ie, clinically significant symptom resolution without the need for additional procedures) and received long-term surveillance. The median follow-up period was 19.4 months, and 2 patients were lost to follow-up postoperatively within 1 year. The cumulative failure rates (subjective symptom recurrence plus secondary treatments) at 6, 12, 18, and 24 months after VFSI were 12%, 17%, 24%, and 32%, respectively. When the initial response rate to VFSI (141 of 189, 74.6%) was considered altogether, VFSI remained effective after 2 years in 50% of the initially recruited 189 patients. The highest rate of long-term effectiveness of VFSI occurred in vocal polyps (54%), followed by nodules (49%) and cysts (43%). Conclusions and Relevance This study demonstrates that VFSI can be beneficial in managing benign vocal lesions, especially when first-line treatments are unsuitable. However, the long-term results of this study clarify that a substantial number of patients experience symptom recurrence or receive subsequent interventions within 2 years after VFSI; this should be considered in medical decision making.
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Affiliation(s)
- Chi-Te Wang
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan2Department of Otolaryngology-Head and Neck Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan3Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Mei-Shu Lai
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
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Wang C, Liao L, Lo W, Huang T, Cheng P. Effects of comorbidity and medication use on the haemodynamic status during office-based laryngeal procedures: A prospective cohort study. Clin Otolaryngol 2017; 43:124-130. [DOI: 10.1111/coa.12909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2017] [Indexed: 01/18/2023]
Affiliation(s)
- C.T. Wang
- Department of Otolaryngology Head and Neck Surgery; Far Eastern Memorial Hospital; Taipei Taiwan
- Section of Language Therapy; Department of Special Education; University of Taipei; Taipei Taiwan
- Department of Otolaryngology Head and Neck Surgery; National Taiwan University College of Medicine; Taipei Taiwan
| | - L.J. Liao
- Department of Otolaryngology Head and Neck Surgery; Far Eastern Memorial Hospital; Taipei Taiwan
- Department of Otolaryngology Head and Neck Surgery; National Taiwan University College of Medicine; Taipei Taiwan
- Department of Electrical Engineering; Yuan Ze University; Taoyuan Taiwan
| | - W.C. Lo
- Department of Otolaryngology Head and Neck Surgery; Far Eastern Memorial Hospital; Taipei Taiwan
- Department of Otolaryngology Head and Neck Surgery; National Taiwan University College of Medicine; Taipei Taiwan
| | - T.W. Huang
- Department of Otolaryngology Head and Neck Surgery; Far Eastern Memorial Hospital; Taipei Taiwan
- Department of Electrical Engineering; Yuan Ze University; Taoyuan Taiwan
| | - P.W. Cheng
- Department of Otolaryngology Head and Neck Surgery; Far Eastern Memorial Hospital; Taipei Taiwan
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Treatment for Vocal Polyps: Lips and Tongue Trill. J Voice 2017; 31:252.e27-252.e36. [DOI: 10.1016/j.jvoice.2016.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 11/22/2022]
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Chang DS, Lee HY, Choi MS, Song K, Kim AY, Cho CS. Intralesional triamcinolone injections for the treatment of preauricular sinus infections. Am J Otolaryngol 2016; 37:523-527. [PMID: 27567384 DOI: 10.1016/j.amjoto.2016.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/15/2016] [Accepted: 08/01/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study is to confirm the effect of adjuvant intralesional triamcinolone acetonide injections (TRIAM) for the treatment of an infected preauricular sinus (PAS). METHODS The medical charts of 103 patients diagnosed with PAS from March 2013 to December 2015 were reviewed and documented. The mean duration of treatment and postoperative follow-up period were compared between patients who received TRIAM and patients who received conventional treatment. RESULTS Fifteen patients received TRIAM. The mean duration of treatment was 12.5±11.0days in patients treated with TRIAM, which was significantly shorter than patients without TRIAM (25.5±25.7days, p=0.010). In addition, the percentage of patients experiencing early recovery (within 10days) was 4.15 times higher with TRIAM (95% confidence interval: 1.07-16.13, p=0.040). The mean postoperative follow-up period revealed a similar tendency; patients treated with TRIAM required a shorter follow-up period (8±2.6days) than patients not treated with TRIAM (13.5±7.4days). However, this difference was not significant (p=0.242). CONCLUSION Although the sample was small, patients with PAS infections who were treated with TRIAM as an adjuvant therapy required a significantly shorter treatment duration than patients receiving conventional treatment alone. This finding suggests a beneficial effect of TRIAM for the short-term control of PAS infections. Clinicians should consider TRIAM as an adjuvant treatment option.
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Affiliation(s)
- Dong Sik Chang
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Ho Yun Lee
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea.
| | - Myoung Su Choi
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Kudamo Song
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Ah-Young Kim
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Chin Saeng Cho
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
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Surgical Management of Phonotraumatic Lesions: Current Techniques. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Koss SL, Kidwai SM, Pitman MJ. Contralateral Vocal Fold Reactive Lesions. Otolaryngol Head Neck Surg 2016; 154:1079-83. [DOI: 10.1177/0194599816637061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/12/2016] [Indexed: 12/29/2022]
Abstract
Objective Contralateral reactive lesions (RLs) represent a distinct entity among benign bilateral vocal fold (VF) lesions. Lack of uniform nomenclature and a myriad of surgical options have hampered attempts to develop treatment guidelines. The objective of this study is to better define RLs and their prognosis, through the development of a standard nomenclature, with an aim to guide treatment and delineate the role of phonosurgery. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Analysis was performed on patients with Current Procedural Terminology code 31545. Operative reports with a primary lesion and contralateral RL were included. Outcomes included the Voice Handicap Index–10 (VHI-10) and GRBAS (grade, roughness, breathiness, asthenia, and strain) scale, lesion persistence/recurrence, mucosal wave, and edge character based on blinded videostroboscopy review. Results A nomenclature was developed based on intraoperative RLs (n = 30), defined by lesion consistency (fibrous or polypoid) and relationship to normal VF edge (gradual or steep). Reactive lesion treatment included no intervention, excision, potassium titanyl phosphate laser, steroid injection, or a combination thereof. Observations included the following: inconsistent treatment modalities were employed, excision of RLs did not yield better outcomes, fibrous RLs were more likely to persist and polypoid lesions more likely to recur, gradual lesions were more likely to remain disease free, and most treatments showed improved mucosal wave, VHI-10, and GRBAS. Conclusions Reactive lesions have not been well classified, and treatments are based on subjective intraoperative decision making with unpredictable outcomes. The nomenclature proposed will allow for a better definition of the RL and provide a framework for future research to identify optimal treatment.
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Affiliation(s)
- Shira L. Koss
- Department of Otolaryngology–Head and Neck Surgery, Voice and Swallowing Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Sarah M. Kidwai
- Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA
| | - Michael J. Pitman
- Department of Otolaryngology–Head and Neck Surgery, Voice and Swallowing Institute, Columbia University Medical Center, New York, New York, USA
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Cha W, Ro JH, Wang SG, Jang JY, Cho JK, Kim GH, Lee YW. Development of a device for real-time light-guided vocal fold injection: A preliminary report. Laryngoscope 2015; 126:936-40. [DOI: 10.1002/lary.25661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/17/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery; Pusan National University Hospital; Busan Korea
- Biomedical Research Institute; Pusan National University Hospital; Busan Korea
| | - Jung Hoon Ro
- Department of Biomedical Engineering; School of Medicine, Pusan National University; Busan Korea
| | - Soo-Geun Wang
- Department of Otorhinolaryngology-Head and Neck Surgery; Pusan National University Hospital; Busan Korea
| | - Jeon Yeob Jang
- Department of Otorhinolaryngology-Head and Neck Surgery; Pusan National University Hospital; Busan Korea
| | - Jae Keun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery; Pusan National University Hospital; Busan Korea
| | - Geun-Hyo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery; Pusan National University Hospital; Busan Korea
| | - Yeon Woo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery; Pusan National University Hospital; Busan Korea
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