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Dwyer CD, Fein M, Gordon L, Kridgen S, Roth D, Winston J, Carroll TL. Temporary Vocal Fold Augmentation Outcomes for Refractory Chronic Cough with Concurrent Nonparalytic Glottic Insufficiency due to Vocal Fold Atrophy. J Voice 2024:S0892-1997(24)00232-7. [PMID: 39107214 DOI: 10.1016/j.jvoice.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVE Determine the effect of temporary vocal fold augmentation on refractory chronic cough (RCC) in patients with glottic insufficiency (GI) due to vocal fold atrophy. METHODS Retrospective electronic chart review was conducted for patients with a diagnosis of bilateral vocal fold atrophy and RCC undergoing vocal fold augmentation with carboxymethylcellulose (CMC). Patients with vocal fold immobility were excluded, and cough must have been present for at minimum 8weeks. VHI-10, CSI, and RSI scores along with subjective overall patient report of chronic cough improvement were collected. RESULTS A total of 28 patients underwent 30 vocal fold augmentation procedures with CMC. All had undergone extensive cough work-up and treatment trials prior to their augmentation procedure. From chart review, 13 overall subjectively reported satisfactory improvement in their cough, 5 reported partial improvement, and 7 reported no improvement in their cough. An uncertain effect on cough was documented in 5 (either patient was uncertain or no mention of cough symptom in the interval chart history note). For those subjects with both pre- and post-augmentation data, mean preaugmentation CSI: 22.08± 6.8 (n = 13); VHI-10: 13.6± 8.9 (n = 18); RSI: 22.4± 7.5 (n = 17). Mean postaugmentation CSI was 20.7± 9.2 (n = 13); VHI-10: 15.2± 8.2 (n = 18); RSI: 21.1± 5.8 (n = 17). Mean pre-post change in CSI was -1.4± 5.1 (P = 0.175, n = 13, range -10 to +6). CONCLUSIONS Vocal fold augmentation seems to provide subjective cough improvement in some patients with concurrent GI due to vocal fold atrophy and RCC. It can be offered as a diagnostic trial, on which further augmentation may be offered, for patients with persistent cough despite prior work-up and treatment trials. Further controlled prospective studies are needed to identify factors that are predictive of successful cough improvement following vocal fold augmentation, as well as the effect of durable augmentation in those patients who had improvement with a diagnostic trial.
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Affiliation(s)
- Christopher D Dwyer
- Brigham & Women's Hospital, Department of Surgery, Division of Otolaryngology, Boston, Massachusetts
| | - Mira Fein
- Brigham & Women's Hospital, Department of Surgery, Division of Otolaryngology, Boston, Massachusetts
| | - Lindsey Gordon
- Brigham & Women's Hospital, Department of Surgery, Division of Otolaryngology, Boston, Massachusetts
| | - Samantha Kridgen
- Brigham & Women's Hospital, Department of Surgery, Division of Otolaryngology, Boston, Massachusetts
| | - Douglas Roth
- Brigham & Women's Hospital, Department of Surgery, Division of Otolaryngology, Boston, Massachusetts
| | - Jennifer Winston
- Brigham & Women's Hospital, Department of Surgery, Division of Otolaryngology, Boston, Massachusetts
| | - Thomas L Carroll
- Brigham & Women's Hospital, Department of Surgery, Division of Otolaryngology, Boston, Massachusetts.
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Kim JF, Watson W, Becerra BJ, Crawley BK, Saab R, Krishna P, Murry T. The Diagnosis and Time of Onset of Voice Disorders in Patients with Chronic Cough. J Voice 2022:S0892-1997(22)00298-3. [PMID: 36357238 DOI: 10.1016/j.jvoice.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Chronic cough is a complaint of up to 46% of patients referred to specialist clinics. Patients with cough often report hoarseness at the time of the cough diagnosis. When the cough fails to resolve with standard medications, referrals to other specialists including otolaryngologists are made. This is the first study to report the specific diagnosis and length of time it took to obtain a specific voice disorder diagnosis in patients with chronic cough. STUDY DESIGN Case Series METHODS: The charts of 105 patients referred to the Loma Linda Voice and Swallowing Center were reviewed. The first complaint of cough and/or hoarseness and the specific voice disorder diagnosis following otolaryngologic evaluation were identified. Voice disorders were divided into neurogenic or other/functional disorders and common comorbidities were identified. Statistical analysis between diagnostic groups, gender, and age were obtained. RESULTS The specific voice disorders in the cohort were identified. There was a high prevalence of neurogenic voice disorders (n = 85, 81%). There were significant relationships between chronic cough and the two most common neurogenic voice disorders, vocal fold paresis and vocal fold atrophy. The average length of time between complaint of hoarseness and the specific voice disorder diagnosis was 32.3 months. Most patients (86%) complained of voice problems after diagnosis of chronic cough. A significant association was found in prevalence of asthma (OR = 4.52, P = 0.02) and dyspnea (OR = 4.24, P = 0.02) in the cohort who presented first with voice complaints and later developed chronic cough. CONCLUSIONS There is a high incidence of neurogenic voice disorders accompanying patients with chronic cough. Understanding the relationship between chronic cough and hoarseness provides the clinician with specific diagnostic information in the treatment of both disorders.
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Affiliation(s)
- Jessica F Kim
- Loma Linda University School of Medicine, Loma Linda, CA.
| | - WayAnne Watson
- Loma Linda University Medical Center Department of Otolaryngology-Head and Neck Surgery, Loma Linda, CA
| | - Benjamin J Becerra
- California State University, Center for Health Equity Department of Information & Decision Sciences, San Bernardino, CA
| | - Brianna K Crawley
- Loma Linda University Medical Center Department of Otolaryngology-Head and Neck Surgery, Loma Linda, CA
| | - Rim Saab
- Drexel University School of Medicine, Philadelphia, PA
| | - Priya Krishna
- Loma Linda University Medical Center Department of Otolaryngology-Head and Neck Surgery, Loma Linda, CA
| | - Thomas Murry
- Loma Linda University Medical Center Department of Otolaryngology-Head and Neck Surgery, Loma Linda, CA; Drexel University College of Medicine Department of Otolaryngology-Head and Neck Surgery, Philadelphia, PA
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3
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Novakovic D, Sheth M, Stewart T, Sandham K, Madill C, Chacon A, Nguyen DD. Supraglottic Botulinum Toxin Improves Symptoms in Patients with Laryngeal Sensory Dysfunction Manifesting as Abnormal Throat Sensation and/or Chronic Refractory Cough. J Clin Med 2021; 10:jcm10235486. [PMID: 34884187 PMCID: PMC8658444 DOI: 10.3390/jcm10235486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022] Open
Abstract
Laryngeal sensory dysfunction (LSD) encompasses disorders of the vagal sensory pathways. Common manifestations include chronic refractory cough (CRC) and abnormal throat sensation (ATS). This study examined clinical characteristics and treatment outcomes of LSD using a novel approach of laryngeal supraglottic Onabotulinum toxin Type A injection (BTX). This was a retrospective review of clinical data and treatment outcomes of supraglottic BTX in patients with LSD. Between November 2019 and May 2021, 14 patients underwent 25 injection cycles of supraglottic BTX for treatment of symptoms related to LSD, including ATS and CRC. Primary outcome measures included the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ), Cough Severity Index (CSI), Reflux Symptom Index (RSI), and Voice Handicap Index-10 (VHI-10) at baseline and within three months of treatment. Pre- and post-treatment data were compared using a linear mixed model. After supraglottic BTX, LHQ scores improved by 2.6. RSI and CSI improved by 8.0 and 5.0, respectively. VHI-10 did not change as a result of treatment. Short-term response to SLN block was significantly associated with longer term response to BTX treatment. These findings suggest that LSD presents clinically as ATS and CRC along with other upper airway symptoms. Supraglottic BTX injection is a safe and effective technique in the treatment of symptoms of LSD.
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Affiliation(s)
- Daniel Novakovic
- Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (M.S.); (T.S.); (C.M.); (A.C.); (D.D.N.)
- The Canterbury Hospital, Campsie, NSW 2194, Australia
- Sydney Voice and Swallowing, St. Leonards, NSW 2065, Australia;
- Correspondence:
| | - Meet Sheth
- Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (M.S.); (T.S.); (C.M.); (A.C.); (D.D.N.)
- Department of Otolaryngology, Christian Medical College, Vellore 632004, India
| | - Thomas Stewart
- Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (M.S.); (T.S.); (C.M.); (A.C.); (D.D.N.)
- Sydney Voice and Swallowing, St. Leonards, NSW 2065, Australia;
| | - Katrina Sandham
- Sydney Voice and Swallowing, St. Leonards, NSW 2065, Australia;
| | - Catherine Madill
- Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (M.S.); (T.S.); (C.M.); (A.C.); (D.D.N.)
| | - Antonia Chacon
- Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (M.S.); (T.S.); (C.M.); (A.C.); (D.D.N.)
| | - Duy Duong Nguyen
- Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (M.S.); (T.S.); (C.M.); (A.C.); (D.D.N.)
- National Hospital of Otorhinolaryngology, Hanoi 11519, Vietnam
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4
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Sikavi DR, Cai JX, Carroll TL, Chan WW. Prevalence and clinical significance of esophageal motility disorders in patients with laryngopharyngeal reflux symptoms. J Gastroenterol Hepatol 2021; 36:2076-2082. [PMID: 33373479 DOI: 10.1111/jgh.15391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/12/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Esophageal motor dysfunction may underlie impaired bolus/refluxate clearance in laryngopharyngeal reflux (LPR). However, the prevalence of esophageal dysmotility and its correlation with reflux parameters and symptoms in LPR is not well established. The aim of this study was to evaluate the prevalence of coexisting esophageal dysmotility among patients with suspected LPR. METHODS This was a retrospective cohort study of 194 consecutive patients with LPR symptoms referred for high-resolution manometry (HRM) and combined hypopharyngeal-esophageal multichannel intraluminal impedance and pH testing at a tertiary center in March 2018 to August 2019. Validated symptom surveys were prospectively collected at time of testing, including Reflux Symptom Index, Gastroesophageal Reflux Disease Questionnaire, dominant symptom intensity, and 12-Item Short-Form Health Survey. HRM findings were categorized using Chicago Classification v3.0. RESULTS Abnormal findings on HRM were identified in 84 (43.3%) patients, with ineffective esophageal motility (n = 60, 30.9%) as the most common diagnosis. A disorder of esophagogastric junction outflow or a major disorder of peristalsis was identified in 26 (13.4%) patients, including 2 (1%) with achalasia and 7 (3.6%) with jackhammer esophagus. Reflux burden (distal, proximal, or pharyngeal) on combined hypopharyngeal-esophageal multichannel intraluminal impedance and pH testing did not differ across HRM findings. Patients reporting esophageal symptoms were more likely to have a primary motility disorder (odds ratio 2.34, P = 0.04). However, no significant differences in Reflux Symptom Index, Gastroesophageal Reflux Disease Questionnaire, or 12-Item Short-Form Health Survey were noted across HRM diagnoses. CONCLUSION Esophageal motility disorders are prevalent among patients with LPR symptoms, including up to one in seven with esophagogastric junction outflow or major peristaltic disorder. Patients with abnormal motility more likely report esophageal symptoms. Clinicians should be aware of these coexisting conditions, particularly in those with refractory symptoms.
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Affiliation(s)
- Daniel R Sikavi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer X Cai
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas L Carroll
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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5
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LaTour D, Crawley B, Krishna P, Hahn R, Murry T. Effects of Cough Suppression Therapy on Voice Disorder Severity. Laryngoscope 2021; 131:2747-2751. [PMID: 34165792 DOI: 10.1002/lary.29705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES//HYPOTHESIS To determine changes in voice severity when treating chronic cough refractory to medical treatment with cough suppression therapy (CST) in patients with chronic cough and voice complaints. Chronic cough has been reported to be refractory to medical treatment and frequently co-occurs with voice disorders. The possible effects of CST on self-assessed changes in chronic cough and voice disorders have not been demonstrated. STUDY DESIGN Retrospective analysis of the effects of cough suppression therapy (CST) on self-assessed changes in chronic cough and voice disorder severity in patients with both chronic cough and voice disorders. METHODS Forty-three adult patients with the primary complaint of chronic refractory cough underwent pre- and post-treatment diagnostic examinations, completed pre- and post-treatment Voice Handicap Index-10 (VHI-10) and Cough Severity Index assessments, and were treated by a licensed speech-language pathologist using CST. Twenty-seven subjects were assigned to the cough (C) group and 16 to the cough-voice (CV) group based on the severity of their VHI-10 scores. RESULTS Post-test analysis showed significant improvement in cough severity for both groups and significant improvement in voice severity for the CV group. The VHI-10 scores for the C group did not change significantly. The median number of treatment sessions was 3, with a range of 1-13 sessions. Correlation between changes in severity and number of treatment sessions was not found to be significant at the tested level. CONCLUSIONS CST represents a unifying approach for treatment of patients with CRC and comorbid voice disorders. CST offered cross-over effects to the voice when subjects were treated for their primary complaint of chronic cough. This treatment of the primary complaint improves function in systems that share a common pathway. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Donn LaTour
- School of Medicine, Loma Linda University, Loma Linda, California, U.S.A
| | - Brianna Crawley
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, U.S.A
| | - Priya Krishna
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, U.S.A
| | - Rachel Hahn
- School of Medicine, Loma Linda University, Loma Linda, California, U.S.A
| | - Thomas Murry
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
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6
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Duffy JR, Litts JK, Fink DS. Superior Laryngeal Nerve Block for Treatment of Neurogenic Cough. Laryngoscope 2021; 131:E2676-E2680. [PMID: 33894012 DOI: 10.1002/lary.29585] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/19/2021] [Accepted: 04/12/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVES This study aimed to add to the body of evidence for efficacy of Superior Laryngeal Nerve (SLN) blocks for treatment of neurogenic cough. Efficacy at short- and long-term intervals are presented as well as relationships with laryngoscopic findings. METHODS A retrospective chart review of patients treated with SLN block between 2018 and 2020 was conducted. Patient demographics, videostroboscopic findings, and patient-subjective perception of outcomes were recorded and analyzed. Cough Severity Index (CSI) scores from pre-injection, short-term follow-up, and long-term follow-up were compared. RESULTS Twenty patients underwent SLN block in the clinic setting. Four patients were excluded for incomplete records. The indication was neurogenic cough refractory to medical management and/or cough suppression therapy. Patients with short-term follow-up (n = 13) had statistically significant decrease in CSI scores, with a mean baseline CSI of 24.3 decreasing to 16.15 (P = .006). Patients with evidence of Vocal Fold Motion/Vibratory Abnormalities (VFA) (n = 8) showed improvement in short-term CSI scores, with a mean baseline CSI of 24.13 decreasing to 14.5 (P = .004). Those without evidence of VFA did not have statistically significant improvement in short-term CSI scores. At long-term follow-up, patients with VFA had improvements that approached statistical significance with a mean baseline CSI of 22.56 decreasing to 14.56 (P = .057), while patients without VFA showed no improvement. CONCLUSIONS Our results are consistent with previous literature indicating efficacy of SLN block. The presence of VFA may be an indicator of patients who experience increased therapeutic effect. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- James R Duffy
- Department of Otolaryngology, University of Colorado, Denver, Colorado, U.S.A
| | - Juliana K Litts
- Department of Otolaryngology, University of Colorado, Denver, Colorado, U.S.A
| | - Daniel S Fink
- Department of Otolaryngology, University of Colorado, Denver, Colorado, U.S.A
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7
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Vocal Fold Paresis 2020. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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Dwyer CD, Leclerc AA, Schneider SL, Young VN, Rosen CA. Creation and Implementation of the UCSF Laryngeal Symptom Diary for Trial Vocal Fold Injection. J Voice 2020; 36:707-718. [PMID: 32873434 DOI: 10.1016/j.jvoice.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Patient recollection of their trial vocal fold injection outcomes is crucial in determining future treatment. This study aims to assess a new clinical tool, the UCSF Laryngeal Symptom Diary, for its ease of use, clinical value in patient symptom tracking, and utility for long-term decision-making following trial vocal fold injection. MATERIALS AND METHODS In this prospective cohort study, consecutive patients undergoing trial vocal fold injection between June 2019 and January 2020 completed the UCSF Laryngeal Symptom Diary. Patients rated standardized and customized laryngeal symptoms weekly. Upon follow-up, a survey pertaining to the diary was completed by both the patient and treating laryngologist. RESULTS A total of 29 patients opted to participate and were provided with the UCSF Laryngeal Symptom Diary. The diary was returned by 82.3% (n = 24/29) of patients. Mean time to follow up was 5.98 weeks. Survey participation rate was 93.1% (n = 27/29). From the patients' perspective, 66.7% (n = 18/27) found the diary useful in following their symptom evolution. Treating laryngeal surgeon noted excellent concordance between diary entries and patient's overall injection benefit (91.7%, n = 22/24). The diary was useful in clinician-recommendation of subsequent treatment options in 70.8% (n = 17/24) of patients. CONCLUSION The UCSF Laryngeal Symptom Diary is a patient friendly clinical tool for trial vocal fold injection that facilitates patient tracking of symptom evolution and helps guide treating clinicians in subsequent treatment planning.
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Affiliation(s)
- Christopher D Dwyer
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, UCSF Voice and Swallowing Center, University of California, San Francisco, San Francisco, California
| | - Andrée-Anne Leclerc
- Division of Otolaryngology-Head and Neck Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Sarah L Schneider
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, UCSF Voice and Swallowing Center, University of California, San Francisco, San Francisco, California
| | - VyVy N Young
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, UCSF Voice and Swallowing Center, University of California, San Francisco, San Francisco, California
| | - Clark A Rosen
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, UCSF Voice and Swallowing Center, University of California, San Francisco, San Francisco, California.
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9
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Borges LF, Chan WW, Carroll TL. Dual pH Probes Without Proximal Esophageal and Pharyngeal Impedance May Be Deficient in Diagnosing LPR. J Voice 2019; 33:697-703. [DOI: 10.1016/j.jvoice.2018.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022]
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10
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Dhillon VK. Superior laryngeal nerve block for neurogenic cough: A case series. Laryngoscope Investig Otolaryngol 2019; 4:410-413. [PMID: 31453350 PMCID: PMC6703134 DOI: 10.1002/lio2.292] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/28/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives To demonstrate that an in‐office superior laryngeal nerve (SLN) block with lidocaine and steroids is an effective alternative to neuromodulators for patients with neurogenic cough. Study Design Retrospective study. Methods A retrospective review of 10 patients who underwent in office nerve block to the laryngeal nerve (SLN) for neurogenic cough. Demographic data and pre‐ and postcough survey index are the measure outcomes. Follow‐up was 3–6 months. Results We find that all patients in this study that underwent an SLN block showed significant improvement in cough severity index (CSI). The average number of blocks was 2.3. The mean follow‐up time from the first SLN block is 3.4 months. The mean CSI improvement 16.30. 95% confidence interval, 11.44–21.16; P < .0001. All patients in this study completed at least one session of cough suppression therapy with speech language pathology (SLP). No patients were on neuromodulators at the time of the SLN block. Conclusions There is a role for in‐office SLN block with lidocaine and steroids for patients with neurogenic cough, and can be an effective alternative to neuromodulators. Level of Evidence NA
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Affiliation(s)
- Vaninder K Dhillon
- Division of Laryngology, Department of Head and Neck Surgery Johns Hopkins University Bethesda Maryland U.S.A
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11
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Simpson CB, Tibbetts KM, Loochtan MJ, Dominguez LM. Treatment of chronic neurogenic cough with in‐office superior laryngeal nerve block. Laryngoscope 2018; 128:1898-1903. [DOI: 10.1002/lary.27201] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/29/2018] [Accepted: 03/05/2018] [Indexed: 11/07/2022]
Affiliation(s)
- C. Blake Simpson
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Voice CenterUniversity of Texas Health Science Center‐San Antonio San Antonio
| | - Kathleen M. Tibbetts
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallas Texas
| | | | - Laura M. Dominguez
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Voice CenterUniversity of Texas Health Science Center‐San Antonio San Antonio
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12
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Carroll TL, Faudoa E, Van Doren M. Evaluation of a Shorter Follow-up Time to Capture Benefit of a Trial Vocal Fold Augmentation. J Voice 2018; 33:169-175. [PMID: 29373176 DOI: 10.1016/j.jvoice.2017.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Trial vocal fold injection (TVFI) is employed diagnostically for patients with subtle glottic insufficiency to explore potential for improvement. Clinical experience demonstrates the time to and length of peak benefit of the TVFI is variable. Previous studies collected data 4 weeks or more after TVFI. The aim of this study was to compare subjectively successful and unsuccessful TVFI patient groups. It is hypothesized that patients with subjectively reported success will also have significant improvements in Voice Handicap Index-10 (VHI-10), phase closure percentage, and aerodynamic measures 2 weeks after trial augmentation. METHODS/DESIGN Subjects with glottic insufficiency were included in this retrospective review if they underwent office-based, per-oral vocal fold injection augmentation specifically for trial purposes. Patients were divided into "successful" and "unsuccessful" groups based on their subjective experience during the 2-week post-TVFI period. VHI-10, subjective report, phase closure evaluation using frame-by-frame analysis, and aerodynamic data were collected pre- and 2 weeks post-TVFI. RESULTS Of the subjects, 15 of 23 (65%) reported a successful subjective improvement of their symptom, whereas 8 (35%) were unsuccessful (only partial improvement or no improvement). The number of subjects with an improvement in VHI-10 by 5 or more points was not significantly different between groups. The number of subjects that demonstrated complete, long phase closure was significantly higher in the successful group (P = 0.021). CONCLUSIONS The understanding of how to more precisely determine the success of TVFI remains incomplete. Subjective improvement of successful TVFI was captured with basic clinical questioning, yet the VHI-10 was unable to confidently demonstrate this reported success 2 weeks after TVFI.
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Affiliation(s)
- Thomas L Carroll
- Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Elizabeth Faudoa
- Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Maxine Van Doren
- Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
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13
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Litts JK, Fink DS, Clary MS. The effect of vocal fold augmentation on cough symptoms in the presence of glottic insufficiency. Laryngoscope 2017; 128:1316-1319. [DOI: 10.1002/lary.26914] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/24/2017] [Accepted: 08/19/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Juliana K. Litts
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Colorado School of MedicineAurora Colorado U.S.A
| | - Daniel S. Fink
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Colorado School of MedicineAurora Colorado U.S.A
| | - Matthew S. Clary
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Colorado School of MedicineAurora Colorado U.S.A
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