Low-temperature radiofrequency coblation reduces treatment interval and post-operative pain of laryngotracheal recurrent respiratory papillomatosis

Systemic Bevacizumab for Recurrent Respiratory Papillomatosis: A Single Institution's Experience

OBJECTIVES

Medical therapies to limit disease recurrence are critically needed for recurrent respiratory papillomatosis (RRP). Systemic bevacizumab is emerging as an exciting adjuvant therapy toward this end, but uptake has been poor due to the lack of experience and awareness of best prescribing practices. The objective of this study was to describe a single tertiary care academic medical center's experience using systemic bevacizumab for the treatment of RRP.

METHODS

A retrospective review was performed to identify patients with RRP on systemic bevacizumab. Demographic and clinical characteristics, findings on imaging reports, and disease response at all anatomic subsites involved in papilloma were documented.

RESULTS

Of the 17 RRP patients on systemic bevacizumab, 9 (52.9%) were male, and 12 (70.6%) were diagnosed with juvenile-onset RRP. The total lifetime number of surgeries was high, with more than half (n = 9; 52.9%) undergoing more than 50 surgeries. Following induction of systemic bevacizumab, a significant reduction in patients with laryngeal (n = 15; 94.1% vs. n = 7; 41.2%, p < 0.001) and tracheal (n = 11; 64.7% vs. n = 5; 29.4%, p = 0.04) RRP was noted. Surgical frequency was significantly lower following systemic bevacizumab (2.5 vs. 0.5 surgeries per year; p < 0.001). The most common complications were new-onset hypertension (n = 4; 23.5%) and proteinuria (n = 5; 29.4%).

CONCLUSION

Systemic bevacizumab is effective in reducing the number of surgeries needed for RRP while exhibiting a relatively safe complication profile. Papillomas in the larynx and trachea are most responsive to systemic bevacizumab, while pulmonary RRP is most likely to exhibit a partial-to-stable response.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:3253-3259, 2024.

Plasma Radiofrequency Tuboplasty and Cartilage Underlay Myringoplasty for Repairing Chronic Large Perforation with Eustachian Tube Dysfunction

OBJECTIVE

The objective of this study was to compare the outcomes of endoscopic cartilage myringoplasty (ECM) with or without plasma radiofrequency (RF) tuboplasty (PRT) for repairing chronic large perforation with Eustachian tube dysfunction (ETD).

MATERIALS AND METHODS

Chronic large perforations with ETD were randomly divided into receiving ECM or ECM plus PRT. During the 24 months follow-up, the Eustachian tube score (ETS), Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), ET inflammation scale, hearing results, and graft success rate of the patients were analyzed.

RESULTS

A total of 61 subjects were included in the study. Difference of ETS was significant before and after surgery in the ECM + PRT group (P < .05) but the ECM group was not (P > .05). Also, significant between-group difference was found regardless of post-24 months ETS and improvement value. Postoperative ETDQ-7 scores were significantly reduced compared with preoperative ETDQ-7 scores in both groups (P < .05), also, significant between-group difference was found regardless of post-24 months ETDQ-7 scores and improvement value. The graft success rate was 86.7% in the ECM group and 96.8% in the ECM + PRT group at postoperative 24 months (P > .05). In addition, although the ECM + PRT group showed a better air-bone gap improvement than the ECM group, the difference was not significant (13.01 ± 2.97 vs 10.92 ± 0.69 dB; P > .05). No PRT procedure-related serious adverse events were reported during the follow-up process. No patients developed atelectasis or otitis media with effusion in either group.

CONCLUSION

ECM combined with low-temperature PRT did not affect the graft success rate but showed a better long-term improvement in ETS and ETDQ-7 than cartilage myringoplasty for the treatment of chronic perforation with ETD. In addition, although PRT showed a better hearing improvement, the difference was not significant between the 2 groups.

A Patient with Juvenile Recurrent Respiratory Papillomatosis Complicated by Laryngeal Stenosis after Laryngeal Microsurgery: A Clinical Case

BACKGROUND: The relevance of the problem of juvenile respiratory papillomatosis lies in the recurrent course of the disease in young children. This can lead to the development of respiratory stenosis, requiring repeated, in some cases, monthly surgical treatments for endolaryngeal removal of papillomas, which sometimes leads to persistent scar stenosis of the larynx. We present clinical case of achieving remission of recurrent juvenile papillomatosis of the larynx. CLINICAL CASE: Patient, 5 years old, who applied in February 2016, was hospitalized in the ENT department with severe dyspnea, laryngoscopy revealed laryngeal papillomatosis with 3–4 grade stenosis. Over the past 10 months, the patient has undergone laryngeal surgery 6 times using cold instruments and a CO2 laser due to papillomatosis. Taking into account the recurrent nature of the course of the disease, the patient is administered to consult an allergist-immunologist. Based on the anamnesis and the results of the tests, the immunologist-allergist diagnosed: Primary immunodeficiency, unspecified (insufficiency in the production of specific antibodies), persistent allergic rhinitis, in the stage of incomplete remission and prescribed treatment. The patient was operated twice from 2017 to 2018 for a developed post-operative complication – cicatricial stenosis of the larynx. With these surgical repairs, no recurrence of laryngeal papillomatosis was detected. Furthermore, in 2021, according to endovideolaryngoscopy, remission was confirmed. R In this clinical case, we managed to achieve remission of laryngeal papillomatosis in a patient after surgery and treatment by an immunologist. Allergen elimination and immunocorrection helped us achieve deep remission. Surgical treatment eliminated laryngeal stenosis, recovering breathing and voice quality. Furthermore, this clinical case demonstrates the importance of studying the immune status in patients with laryngeal papillomatosis. CONCLUSION: The results obtained by us show the need for the use of immunomodulators in these patients. All children with prolonged hoarseness should undergo laryngoscopy, which will allow diagnosing laryngeal papillomatosis at earlier uncomplicated stages of the disease. Treatment of laryngeal papillomatosis should be comprehensive and in addition to surgical treatment should include differential immune correction. RESULTS AND DISCUSSION: In the above clinical case, we managed to achieve remission of laryngeal papillomatosis in a patient after surgery and treatment by an immunologist. Allergen elimination and immunocorrection helped us achieve deep remission. Surgical treatment eliminated laryngeal stenosis, recovering breathing and voice quality. Furthermore, this clinical case demonstrates the importance of studying the immune status in patients with laryngeal papillomatosis. The results obtained by us show the need for the use of immunomodulators in these patients. All children with prolonged hoarseness should undergo laryngoscopy, which will allow diagnosing laryngeal papillomatosis at earlier uncomplicated stages of the disease. Treatment of laryngeal papillomatosis should be comprehensive and in addition to surgical treatment should include differential immune correction.

Possibilities of coblation in otorhinolaryngology: analytical review

OBJECTIVE

Review literature data on the coblation method in otorhinolaryngology.

MATERIALS AND METHODS

All materials from our study are published in peer-reviewed journals. The review is PubMed generated. In our clinic, 20 patients with bilateral paralytic laryngeal stenosis underwent cold-plasma posterior arytenoidcordotomy with Coblator II.

RESULTS

The analysis of the high-energy techniques currently applied in otorhinolaryngology shows the benefits of coblation due to the effect of lower temperatures on tissues. Patients subjectively reported improved breathing on day 10 with a closed coblation tracheostoma; after 3-6 months everyone underwent successful decannulation with plastic surgery of the cutaneous-tracheal fistula. Lately, the operated vocal fold was in the abduction position and the lumen of the glottis in the posterior third was 7-8 mm. Compensation of vocal function in the long-term postoperative period was achieved by patients due to long-term orthophonic training and the development of a vestibuloscapular phonation mechanism.

CONCLUSION

The advantages of coblation are mainly minimal trauma to the surrounding tissues, convenient resection, the ability to perform complete hemostasis at one time, and easier postoperative period for the patient.