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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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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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Gocal WA, Tong JY, Maxwell PJ, Sataloff RT. Systematic Review of Recurrence Rates of Benign Vocal Fold Lesions Following Surgery. J Voice 2022:S0892-1997(22)00321-6. [PMID: 36513559 DOI: 10.1016/j.jvoice.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Benign vocal fold lesions which include vocal fold nodules, polyps, cysts and other lesions often recur after surgery and require additional treatments. This systematic review of the current literature evaluated the effects of adjunctive therapies in addition to surgical resection on the recurrence rates of benign vocal fold lesions in adults. STUDY DESIGN Systematic review. METHODS A search using relevant keywords in electronic databases was conducted. Extracted data include author, year of publication, patient demographics, diagnostic approach, lesion type, surgical procedure, type of adjunctive therapy and the rates of recurrence. Descriptive statistics were performed on the collected data when appropriate. RESULTS Eleven articles were identified with a total of 1085 patients. The total 1101 lesions studied included 591 (53.7%) polyps, 125 (11.4%) nodules, 146 (13.3%) cysts, 184 (16.7%) pseudocysts, 19 (1.7%) midfold masses, 18 (1.6%) sulcus vocalis and 18 (1.6%) varices. Besides surgery, adjunctive therapies included voice therapy, steroid injection and reflux medication. There were 141 reported lesion recurrences, with an average recurrence rate of 13.0%. The recurrence rate in studies with adjunctive therapies was 7.14%, and in studies with no adjunctive therapies it was 24.44%. CONCLUSIONS Available evidence suggests that adjunctive therapies following surgery are associated with decreased lesion recurrence rates. However, due to differences in sample size, inconsistent reporting of lesion characteristics, heterogeneity of adjunctive therapies, variability in follow-up time across studies, and other factors, it is not possible to determine exactly which adjunctive therapies are of significant benefit and which lesion types may benefit the most.
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Affiliation(s)
- Wiktoria A Gocal
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine. Philadelphia, Pennsylvania
| | - Jane Y Tong
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland School of Medicine. Baltimore, Maryland
| | - Philip J Maxwell
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine. Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine. Philadelphia, Pennsylvania; Lankenau Institute for Medical Research. Philadelphia, Pennsylvania.
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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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