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Filauro M, Ioppi A, Vallin A, Sampieri C, De Vecchi M, Gabella G, Benzi P, Mora F, Peretti G. Office-Based Treatment of Vocal Fold Polyps and Reinke's Edema: A Rational Comparison With Suspension Laryngoscopy. Laryngoscope 2023; 133:2665-2672. [PMID: 36647733 DOI: 10.1002/lary.30576] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/17/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Benign laryngeal lesions have traditionally been treated through suspension laryngoscopy under general anesthesia (GA). Recently, the development of operative videoendoscopes coupled with photoangiolytic lasers has allowed clinicians to treat these conditions in the outpatient clinic. We report our experience in the office-based (OB) setting for the treatment of patients affected by vocal fold polyps (VFPs) and Reinke's edema (RE), comparing it to patients treated under GA. METHODS A retrospective analysis was conducted on patients affected by VFP or RE. A 445 nm diode blue laser was used through the operative channel of a flexible video-endoscope for OB procedures, while GA surgeries were carried out with cold steel instrumentation. The Voice Handicap Index-10 (VHI-10) represented the primary outcome. Endoscopic outcomes, duration, and morbidity of the procedures were investigated as secondary outcomes. RESULTS A total of 153 patients were retrospectively enrolled. 52 were treated in an OB setting, while 91 underwent GA. Regarding patients with RE, both the OB and GA cohorts showed a significant improvement in VHI-10 (from 12.7 to 2.6 and 19.5 to 5.1, respectively; p < 0.001), as did those with VFPs (from 11.8 to 2.3 and 15.9 to 2.9 respectively; p < 0.001). No differences were found when comparing VHI-10 in the OB and GA cohorts. The mean procedural time of OB treatment (4.9 min) was significantly shorter than GA (37.1 min). No adverse events were reported. CONCLUSION Our data demonstrate the efficacy and safety of the OB setting. For selected patients, OB treatments offer comparable vocal outcomes, favorable morbidity, and reduced operation times, making them an appealing alternative to the traditional approach. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2665-2672, 2023.
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Affiliation(s)
- Marta Filauro
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Department of Medical Science (DIMES), University of Genoa, Genoa, Italy
| | - Alessandro Ioppi
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alberto Vallin
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Claudio Sampieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Marta De Vecchi
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Giulia Gabella
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Pietro Benzi
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Francesco Mora
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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Hamdan AL, Abou Raji Feghali P, Hosri J, Ghanem A, Alam E. Office-Based Laser Therapy for Vocal Fold Cyst: A Promising Alternative Therapy Using the 445 nm Blue Laser. J Voice 2023:S0892-1997(23)00172-8. [PMID: 37604747 DOI: 10.1016/j.jvoice.2023.05.019] [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: 03/23/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 08/23/2023]
Abstract
Vocal fold cysts are benign lesions commonly encountered in laryngology practice. They are traditionally classified as mucus retention cysts and epidermoid cysts. The mainstay treatment is surgical excision with diligent dissection of the cyst wall. The authors of this manuscript report a series of two cases of vocal fold mucous retention cysts and one case of vocal fold pseudocyst treated with the blue laser (Wolf TruBlue 445 nm; A.R.C. Laser Company) in an office setting. All three cases had complete regression of the lesion with improved glottic closure and mucosal waves during phonation. The disease regression was associated with a decrease in the VHI-10 score, perceptual voice evaluation scores, and acoustic perturbation parameters. There was also an increase in maximum phonation time in all three cases. The authors advocate office-based blue laser therapy for vocal fold cysts as a promising treatment modality, particularly in patients at high risk for general anesthesia. Nevertheless, the possible increased risk of vocal fold scarring given the lack of binocular microscopic examination should not be underestimated. A larger study is needed to cast more information on the surgical outcome and long-term effects of blue laser therapy in the management of vocal fold cysts.
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Affiliation(s)
- Abdul-Latif Hamdan
- 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
| | - Jad Hosri
- 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
| | - Elie Alam
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
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Hamdan AL, Abou Raji Feghali P, Hosri J, Abi Zeid Daou C, Ghanem A. Office-based blue laser therapy for dyspnea in patients with type 3 Reinke's edema. Eur Arch Otorhinolaryngol 2023; 280:3323-3328. [PMID: 37039895 DOI: 10.1007/s00405-023-07964-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/03/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To investigate the effectiveness of in-office blue laser therapy on dyspnea in patients with type 3 Reinke's edema. METHODS The medical records and video-recordings of patients with Reinke's edema type 3 who had undergone office-based blue laser therapy between March 2022 and January 2023 were reviewed. The primary outcome measures assessed before and after surgery were dyspnea severity, risk of obstructive sleep apnea (OSA), and disease regression. The severity of dyspnea was measured using the Dyspnea Severity Index (DSI), the risk of OSA was assessed using the STOP-BANG questionnaire, and disease regression was assessed by reviewing the laryngeal examination before and after surgery. The Voice Handicap Index-10 (VHI-10) was used as a secondary outcome measure. RESULT A total of 10 patients were included. The mean age of the study population was 58.9 ± 4.2 years. The male-to-female ratio was 2:3. In total, 20 vocal fold lesions were treated among which 18 were reviewed. Eight lesions regressed completely and 10 partially. There was a statistically significant drop in the mean score of DSI after surgery (16.1 ± 10.2 pre-operatively vs 2.3 ± 2.3 post-operatively, p-value < 0.001). The mean STOP-BANG score decreased from 4.8 ± 1.47 to 3.1 ± 1.28 (p-value = 0.001). There was also a significant improvement in VHI-10 score (22.7 ± 7.0 vs 4.4 ± 5.6, p-value < 0.001). CONCLUSION Office-based blue laser therapy offers a safe and effective treatment for shortness of breath in patients with type 3 Reinke's edema.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Patrick Abou Raji Feghali
- 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
| | - Anthony Ghanem
- Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Hamdan AL, Abi Zeid Daou C, Ghanem A, Ar Feghali P, Hosri J, Sataloff RT. Office-based Laser Therapy in Reinke's Edema: A Systematic Review and Meta-analysis. J Voice 2023:S0892-1997(22)00392-7. [PMID: 36681567 DOI: 10.1016/j.jvoice.2022.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To analyze voice outcomes and lesion regression in patients with Reinke's edema treated in the office with lasers. STUDY DESIGN Systematic review and meta-analysis METHODS: The search was performed in the Medline, Embase, Medline, Cochrane, and Google Scholar databases using the PRISMA framework. There were no limitations to the year of publication and the search included studies looking at voice outcomes and lesion evolution of in-office laser treatment for Reinke's edema measured through voice-handicap index, acoustic analysis or aerodynamics measures. Risk of bias was assessed using Cochrane's ROBINS-I tool for observational studies. Data analysis was performed SPSS software with a significance level of 5%. RESULTS The initial search identified 650 articles, 6 of which met the inclusion criteria and were analyzed. The total number of participants was 58. Meta-analysis showed significant improvement in VHI-10 scores after in-office laser therapy (95% CI, [-1.46; -0.75]). It also showed significant improvement in jitter, significant increase in fundamental frequency (95% CI, [0.52; 1.71]) and significant decrease in lesion size (95% CI, [-2.03; -0.35]). CONCLUSION Office-based laser therapy is a reliable alternative to the traditional phono-microsurgery performed in the operating room. Patients show significant improvement in voice outcomes and laryngeal examination.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut, Beirut, Lebanon; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine; Lankenau Institute for Medical Research..
| | - Christophe Abi Zeid Daou
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut, Beirut, Lebanon; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine; Lankenau Institute for Medical Research
| | - Anthony Ghanem
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut, Beirut, Lebanon; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine; Lankenau Institute for Medical Research
| | - Patrick Ar Feghali
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut, Beirut, Lebanon; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine; Lankenau Institute for Medical Research
| | - Jad Hosri
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut, Beirut, Lebanon; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine; Lankenau Institute for Medical Research
| | - Robert T Sataloff
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut, Beirut, Lebanon; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine; Lankenau Institute for Medical Research
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Ghanem A, Hamdan AL. Unsedated Office-Based Blue Laser Therapy in Female Patients With Reinke's Edema: A Retrospective Review of 8 Cases. J Voice 2022:S0892-1997(22)00266-1. [PMID: 36220740 DOI: 10.1016/j.jvoice.2022.08.025] [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: 07/22/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To report on the outcomes of unsedated blue laser therapy in female patients with Reinke's edema. STUDY DESIGN Retrospective chart review. METHODS A retrospective chart review of female patients undergoing unsedated office-based blue laser treatment of Reinke's edema between February 2020 and March 2022 at the Hamdan Voice and Swallowing Unit at the American University of Beirut Medical Center in Beirut, was conducted. Patients were assessed before and after the procedure with a follow-up interval of 3-6 weeks. Demographic data included age, history of smoking and grade of Reinke's edema. Voice outcome measures included the Voice Handicap Index-10 questionnaire, perceptual evaluation (GRBAS scale), acoustic analysis and maximum phonation time. Vocal fold lesions were evaluated using indirect laryngeal endoscopy. RESULTS A total of eight patients were reviewed. The mean age was 59.63 ± 7.98 years. One patient was lost to follow-up. We report on a total of 10 Reinke's edema lesions treated with the blue laser. There was a significant decrease in the mean VHI-10 score (14.86 ± 5.84-6.71 ± 7.32; P < 0.01) as well as in the means of three perceptual evaluation parameters (G, R, B; P < 0.05). There was also a nonstatistically significant increase in the mean fundamental frequency and habitual pitch. Laryngeal examination showed complete regression in 50% of the lesions, and partial regression in the remaining 50%. CONCLUSIONS Office-based blue laser treatment of Reinke's edema under local anesthesia can be considered an effective treatment modality as evidenced by improvement in post-procedure voice outcome measures.
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Affiliation(s)
- Anthony Ghanem
- Department of Otorhinolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Latif Hamdan
- Department of Otorhinolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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