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Chadwick KA, Andreadis K, Sulica L. Prospective Outcomes of Microlaryngoscopy Versus Office Laser Photoangiolysis for Vocal Fold Polyps. Laryngoscope 2024; 134 Suppl 8:S1-S20. [PMID: 38742623 DOI: 10.1002/lary.31484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/02/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE(S) The objective of this study is to compare treatment outcomes for vocal fold polyps (VFPs) between operating room microlaryngoscopy and office-based photoangiolysis with the potassium titanyl phosphate (KTP) laser. METHODS Prospective nonrandomized cohort study of patients with VFPs undergoing microlaryngoscopy ("OR group") or KTP laser photoangiolysis ("KTP group"). Voice outcomes (patient-reported outcome measures [Voice Handicap Index-10 (VHI-10) and Singing VHI-10 (SVHI-10)], auditory-perceptual measures [Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)], videostroboscopic characteristics [Voice-Vibratory Assessment of Laryngeal Imaging (VALI)], and acoustic and aerodynamic measures) were performed at baseline and regular intervals after intervention. RESULTS Forty-four subjects (17 OR group, 27 KTP group) with VFPs were enrolled. Mean VHI-10 significantly improved from baseline to each follow-up interval in both groups, except for the 1-2-week interval in the OR group. Mean SVHI-10 improved for both groups at some intervals. Growth curve models and time-to-event analyses for patient-reported outcomes did not differ between groups. There were significant improvements in all categories of auditory-perceptual voice quality and some categories of videostroboscopic characteristics in both groups. No significant trends were identified in acoustic and aerodynamic measures. Improvements in most outcomes did not significantly differ between groups or based on polyp size. There were no major complications. CONCLUSIONS Significant improvements in patient-reported voice outcomes measures, auditory-perceptual voice evaluation, and videostroboscopic characteristics occur following surgical treatment of vocal fold polyps with either microlaryngoscopy or office-based KTP laser. Long-term voice outcomes do not significantly differ between treatment modalities. LEVEL OF EVIDENCE 3 Laryngoscope, 134:S1-S20, 2024.
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Affiliation(s)
- Keith A Chadwick
- Division of Otolaryngology-Head & Neck Surgery, Stony Brook University, Stony Brook, New York, USA
| | | | - Lucian Sulica
- Department of Otolaryngology-Head and Neck Surgery, The Sean Parker Institute for the Voice, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
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Longo L, Pipitone LL, Cilfone A, Gobbi L, Mariani L. Reinke's Edema: New Insights into Voice Analysis, a Retrospective Study. J Voice 2023:S0892-1997(23)00249-7. [PMID: 37716890 DOI: 10.1016/j.jvoice.2023.08.008] [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: 06/20/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Reinke's edema (RE) is a pathological condition involving increased volume of the vocal folds and resulting in significant impact on speech, fundamental frequency, and vocal range. Literature reports few studies which analyze vocal features according to the severity of RE. The aims of this study were to investigate the aerodynamics, acoustic characteristics, and sound spectrograms of a group of RE patients and to assess whether there was any correlation with their endoscopic grading. METHODS A total of 98 patients were included in the study, 49 patients with RE and 49 healthy volunteers (HV). Multidimensional Voice Program was used to perform objective voice assessment. Maximum phonation time (MPT) and Voice Handicap Index (VHI) questionnaire were collected. The spectrograms of the vowel /a/ and of the word /aiuole/, which contains the five Italian vowels, of each patient were analyzed according to the classification of Yanaghiara modified by Ricci Maccarini and De Colle. Laryngological assessment was used to record vocal folds morphology according to Yonekawa's classification. Univariate analysis was used to compare group outcomes. Bivariate analysis was used to compare endoscopic grading and voice analysis results. RESULTS Univariate analysis of the HV and RE groups revealed statistically significant differences (P < 0.05) for the following parameters: jitter%, shimmer%, harmonic-to-noise ratio (NHR), voice turbulence index (VTI), MPT, VHI except for soft phonation index. Spearman's rank correlation showed a positive correlation between vocal parameters such as jitter%, shimmer%, NHR, VTI, and RE gradings. A negative correlation was found between MPT and RE gradings. Bivariate analysis indicated a strong positive correlation between RE grading and the spectrogram classification performed both with the vowel / a / (Rho 0.86; P = 0.0001) and with the word / aiuole / (Rho 0.81; P = 0.0001). CONCLUSION The present study demonstrates that patients with RE have different voice characteristics compared to HV. In particular, the voice analysis highlighted acoustic parameters that correlated to differing degrees of RE. In addition, spectrogram analysis should be considered for acoustic assessments before and after medical and surgical therapy and also in forensic medicine.
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Affiliation(s)
- Lucia Longo
- Department of Sense Organs, Sapienza University, Rome, Italy
| | | | - Armando Cilfone
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Luca Gobbi
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Laura Mariani
- Department of Sense Organs, Sapienza University, Rome, Italy
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Lou X, Lou Z. Reinke's Edema: Cold Steel Versus Radiofrequency Coblation. EAR, NOSE & THROAT JOURNAL 2023:1455613231194131. [PMID: 37596878 DOI: 10.1177/01455613231194131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023] Open
Abstract
OBJECTIVE This study compared the effects of radiofrequency (RF) coblation and cold steel (CS) surgery for the treatment of Reinke's edema (RE). METHODS A retrospective analysis was conducted on 61 patients with RE, with 33 (54.1%) in the CS surgery group and 28 (45.9%) in the RF coblation group. The primary endpoints were the bilateral operation time and dyspnea severity, assessed preoperatively and at 1 and 3 months postoperatively. Secondary endpoints included subjective and objective vocal assessments, laryngovideostroboscopy (LVS) images, and Voice Handicap Index-10 (VHI-10) scores obtained before and at 1 and 3 months postoperatively. RESULTS The average bilateral operation time was significantly shorter in the RF coblation group (24.2 ± 3.9 min) compared to the CS group (38.4 ± 5.2 min) (P = .041). All patients experienced a decrease in their Dyspnea Severity Index (DSI) scores postoperatively, with no significant differences observed between the two groups at any time point. However, improvements in the grade of hoarseness, roughness, and asthenia were significantly greater in the RF coblation group than in the CS group (P < .001). There were no statistically significant differences in breathiness and strain between the two groups. The average VHI-10 score significantly decreased from preoperative values in both groups (P < .001), with no significant differences observed between the two groups at any time point. CONCLUSIONS The RF coblation procedure is a reliable and safe method for RE surgery, offering an effective treatment choice for RE.
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Affiliation(s)
- Xudan Lou
- Department of Operating Theater, Yiwu Central Hospital, Yiwu City, Zhejiang Province, China
| | - Zhengcai Lou
- Department of Otolaryngology-Head and Neck Surgery, Yiwu Central Hospital, Yiwu City, Zhejiang Province, China
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Kruse CM, Hoffman MR, Hennessy BN, Schoeff SS, Dailey SH. Voice Outcomes Following Serial Office-Based Steroid Injections and Voice Therapy for Vocal Fold Scar. J Voice 2023:S0892-1997(23)00093-0. [PMID: 37076383 DOI: 10.1016/j.jvoice.2023.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Previous studies indicate that certain voice outcomes can improve following a single office-based steroid injection with voice therapy for vocal fold scar. We evaluated voice outcomes after a series of three timed office-based steroid injections with voice therapy. STUDY DESIGN Retrospective case series with chart review. SETTING Academic medical center. METHODS We evaluated pre-and postprocedural patient-reported, perceptual, acoustic, aerodynamic, and videostroboscopic parameters. We evaluated 23 patients who underwent three office-based dexamethasone injections into the superficial lamina propria one month apart. All patients pursued voice therapy. RESULTS Voice Handicap Index (n = 19; P= .030) decreased after injection series. Total GRBAS score (grade, roughness, breathiness, asthenia, strain) decreased (n = 23; P = 0.001). Dysphonia severity index score improved (n = 20; P = 0.041). Phonation threshold pressure did not decrease significantly (n = 22; P = 0.536). Videostroboscopic parameters of vocal fold edge (P = 0.023), right mucosal wave (P = 0.023) improved or normalized after injection series. Glottic closure (P = 0.134) did not improve. CONCLUSIONS Series of three office-based steroid injections combined with voice therapy for vocal fold scar does not appear to provide further benefit than one injection. Despite lack of improvements of PTP and other parameters, injection series is likewise unlikely to worsen dysphonia. A partially negative study provides value in investigation of less invasive treatment alternatives for a disorder that is challenging to treat. Future studies exploring effects of voice therapy alone without other intervention and consideration of sham injection versus steroid injection are warranted.
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Affiliation(s)
- Chelsea M Kruse
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Matthew R Hoffman
- Department of Otolaryngology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Brienne N Hennessy
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | | | - Seth H Dailey
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
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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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7
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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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Dewan K, Chhetri DK, Hoffman H. Reinke's edema management and voice outcomes. Laryngoscope Investig Otolaryngol 2022; 7:1042-1050. [PMID: 36000026 PMCID: PMC9392404 DOI: 10.1002/lio2.840] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Reinke's edema is a chronic disease of the respiratory tract that occurs in adults with a history of chronic smoke exposure. Also known as polypoid corditis, polypoid laryngitis, and polypoid degeneration of the vocal fold, it is strongly associated with smoking, frequently with vocal misuse/abuse, and occasionally with laryngopharyngeal reflux. Reinke's edema remains a cause of chronic dysphonia that is difficult to manage. This review provides perspectives on current and future management of Reinke's edema. Results Reinke's edema impacts <1% of the population. The excessive mass is seen in polypoid degeneration results in a loss of pitch control and a rough voice. Women are more likely to present for treatment as the characteristic lowering of vocal pitch is more noticeable in women than men. Multiple grading systems have been proposed within the literature. The current standard of care is surgical excision, after smoking cessation. The microflap technique remains the approach of choice for bulky lesions. Surgical management of Reinke's edema has evolved with the introduction of various lasers into otolaryngologic practice; some which can now be used in the office setting. While many management approaches have been described within the literature, there is a little direct comparison and no obvious superior method of Reinke's edema management. Conclusion To date, the biology of Reinke's edema is not well understood. Additional research is needed further elucidate the role of uncontrolled reflux in the development and recurrence of Reinke's edema.
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Affiliation(s)
- Karuna Dewan
- Department of Otolaryngology—Head and Neck Surgery Louisiana State University Shreveport Louisiana USA
| | - Dinesh K. Chhetri
- Department of Head and Neck Surgery David Geffen School of Medicine at University of California Los Angeles Los Angeles California USA
| | - Henry Hoffman
- Department of Otolaryngology—Head and Neck Surgery University of Iowa Hospitals and Clinics Iowa City Iowa USA
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Ulmschneider C, Baker J, Vize I, Jiang J. Phonosurgery: A review of current methodologies. World J Otorhinolaryngol Head Neck Surg 2021; 7:344-353. [PMID: 34632350 PMCID: PMC8486699 DOI: 10.1016/j.wjorl.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/31/2020] [Accepted: 09/13/2020] [Indexed: 01/11/2023] Open
Abstract
Cold-steel has served as the gold standard modality of phonosurgery for most of its history. Surgical laser technology has revolutionized this field with its wide use of applications. Additional modalities have also been introduced such as coagulative lasers, photodynamic therapy, and cryotherapy. This review will compare the surgical modalities of cold steel, surgical lasers, phototherapy and cryotherapy. The mechanism of action, tissue effects and typical uses will be addressed for each modality.
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Affiliation(s)
| | - Jeffrey Baker
- University of Wisconsin Madison School of Medicine and Public Health, United States
| | - Ian Vize
- University of Wisconsin Madison School of Medicine and Public Health, United States
| | - Jack Jiang
- University of Wisconsin Madison School of Medicine and Public Health, United States
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Alves M, Silva G, Bispo BC, Dajer ME, Rodrigues PM. Voice Disorders Detection Through Multiband Cepstral Features of Sustained Vowel. J Voice 2021; 37:322-331. [PMID: 33663909 DOI: 10.1016/j.jvoice.2021.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 11/28/2022]
Abstract
This study aims to detect voice disorders related to vocal fold nodule, Reinke's edema and neurological pathologies through multiband cepstral features of the sustained vowel /a/. Detection is performed between pairs of study groups and multiband analysis is accomplished using the wavelet transform. For each pair of groups, a parameters selection is carried out. Time series of the selected parameters are used as input for four classifiers with leave-one-out cross validation. Classification accuracies of 100% are achieved for all pairs including the control group, surpassing the state-of-art methods based on cepstral features, while accuracies higher than 88.50% are obtained for the pathological pairs. The results indicated that the method may be adequate to assist in the diagnosis of the voice disorders addressed. The results must be updated in the future with a larger population to ensure generalization.
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Affiliation(s)
- Marco Alves
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal.
| | - Gabriel Silva
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal.
| | - Bruno C Bispo
- Department of Electrical and Electronic Engineering, Federal University of Santa Catarina, Florianópolis-SC, Brazil.
| | - María E Dajer
- Department of Electrical Engineering, Federal University of Technology - Paraná, Cornélio Procópio-PR, Brazil.
| | - Pedro M Rodrigues
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal.
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11
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Hamdan AL, Ghanem A, Abi Akl PR, El Hage A. Unsedated Office-Based Thulium Laser Therapy in Patients With Reinke's Edema. J Voice 2020; 36:134-139. [PMID: 32434678 DOI: 10.1016/j.jvoice.2020.03.017] [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: 12/26/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the outcome of unsedated office based Thulium laser therapy for Reinke's edema. MATERIALS AND METHODS A retrospective chart review of patients operated between March 2017 and November 2018 was conducted. Twelve patients were included, two of whom had two procedures performed. Demographic data included age, gender, smoking status, and grade of Reinke's edema. Outcome measures included Voice Handicap Index-10 (VHI), perceptual evaluation, extent of disease regression, acoustic analysis, and maximal phonation time. RESULTS Twelve patients were enrolled in this study, one of whom was lost for follow-up. There were eight females and three males. The mean age was 51.27 ± 9.12 years. Endoscopic evaluation 6-12 weeks after surgery revealed complete and partial regression of disease in three and eight patients, respectively. There was a significant improvement in the mean score of VHI-10 (15.00 ± 9.45 vs 3.07 ± 3.81) and the mean score of GRABS parameters following surgery (P < 0.05). The mean habitual pitch increased from 125.11 ± 28.48 Hz to 155.86 ± 55.14 Hz (P = 0.070). There was improvement in the mean jitter and shimmer but none reached a statistical significance. There was no significant change in the mean Maximum phonation time (MPT) scores before and after surgery. CONCLUSION Unsedated office-based Thulium laser therapy can be considered as an alternative therapy to patients with Reinke's edema who are not willing to undergo conventional microlaryngeal surgery.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology - Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Anthony Ghanem
- Department of Otolaryngology - Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pierre Richard Abi Akl
- Department of Otolaryngology - Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aya El Hage
- Department of Otolaryngology - Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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12
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Marinone Lares SG, Allen JE. Safety of in-office laryngology procedures. Curr Opin Otolaryngol Head Neck Surg 2020; 27:433-438. [PMID: 31567495 DOI: 10.1097/moo.0000000000000585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW A wide range of diagnostic and therapeutic laryngology procedures are currently performed in an office setting. In-office laryngology procedures (IOLP) are increasingly seen as standard-of-care, and while generally considered safe, high-quality evidence supporting the latter statement is lacking. This review aims to summarize recent literature regarding the safety of IOLP. RECENT FINDINGS There is a paucity of guidelines and standardized protocols for IOLP. To date, there is one available safety protocol specific to in-office laser procedures. Haemodynamic changes during IOLP have been documented and the significance of these changes continues to be unclear. Therefore, monitoring of vital signs is recommended. Continuing antithrombotic therapy during IOLP also appears safe, and this decision may be left to surgeon discretion. A protocol for management of antithrombotic therapy prior to in-office laser procedures is available. Actual serum lidocaine levels following topical application of mixed lidocaine preparations falls well below reported toxic levels but persists for longer than previously reported. SUMMARY IOLP are safer that suspension laryngoscopy under general anaesthetic. Although complication rates of IOLP are low, patient characteristics and potential complications of both the procedure and of topical anaesthetic use must be considered. One must be prepared and equipped to deal with these potential complications.
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Affiliation(s)
| | - Jacqueline E Allen
- Department of Surgery, University of Auckland.,Department of Otolaryngology, North Shore Hospital, Auckland, New Zealand
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13
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Lechien JR, Burns JA, Akst LM. The Use of 532-Nanometer-Pulsed Potassium-Titanyl-Phosphate (KTP) Laser in Laryngology: A Systematic Review of Current Indications, Safety, and Voice Outcomes. EAR, NOSE & THROAT JOURNAL 2020; 100:4S-13S. [PMID: 31928082 DOI: 10.1177/0145561319899183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To investigate the indications, efficacy, safety, and outcomes of potassium-titanyl-phosphate (KTP) laser procedures for treatment of laryngeal disease. METHODS PubMed, Cochrane Library, and Scopus were searched for studies providing information about the indications, efficacy, and safety of both in-office and operative suspension microlaryngoscopy KTP laser procedure in treatment of laryngeal disease. 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 initial screened 140 papers, 17 met our inclusion criteria. Six papers involved KTP laser procedures for benign and malignant vocal fold lesions in suspension microlaryngoscopy only, 10 papers focused on only in-office KTP laser procedures for benign vocal fold lesions, and 1 paper included both in-office and suspension microlaryngoscopy procedures. The following lesions may be considered as indications for KTP laser procedures: Reinke's edema, sulcus vocalis, vocal fold hemorrhage, polyp, granuloma, cyst, scar, papillomatosis, dysplasia, leukoplakia, and early vocal fold malignancies. Irrespective of the types of procedure (in-office vs suspension microlaryngoscopy), the KTP laser is associated with a low complication rate and overall good vocal fold vibration recovery. There is an important heterogeneity among studies concerning laser settings, indications, and outcomes used for the assessment of treatment effectiveness. There are no controlled studies directly comparing KTP laser with other lasers (ie, carbon dioxide laser). CONCLUSION The use of KTP laser procedures for treatment of laryngeal disease has increased over the past decade, especially for office-based management of vocal fold lesions. Future controlled studies are needed to compare the safety and outcomes of the KTP laser to other techniques.
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Affiliation(s)
- Jerome R Lechien
- Laryngology Study Group of Young-Otolaryngologists, International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Human Anatomy and Experimental Oncology, School of Medicine, UMONS Research Institute for Health Sciences and Technology, 54521University of Mons (UMons), Mons, Belgium.,Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin en Yvelines (University Paris Saclay), Paris, France
| | - James A Burns
- Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, 1811Harvard Medical School, Boston, MA, USA
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, 1501Johns Hopkins School of Medicine, Baltimore, MD, USA
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Khodeir MS, Hassan SM, El Shoubary AM, Saad MNA. Surgical and Nonsurgical Lines of Treatment of Reinke's Edema: A Systematic Literature Review. J Voice 2019; 35:502.e1-502.e11. [PMID: 31761692 DOI: 10.1016/j.jvoice.2019.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The aim of this study was to carry out a systematic review of different surgical and nonsurgical lines of treatment of Reinke's edema to identify the effectiveness and the guidelines described to use each of them. METHODS We searched PubMed and Coherence for randomized controlled trials and case reports studies did on adult humans aged from 18 to 80 years, from January 1997 to December 2018. We included studies that treated patients with Reinke's edema by one and/or combinations of the following interventions: cold steel microlaryngeal phonosurgery, microdebrider, CO2 laser, photoangiolytic laser, voice therapy, Steroid and Hyaluronidase injection. We selected studies that assessed patients pre- and post-treatment by at least one of the following measures: subjective assessment of the patient's voice by the voice handicap index, perceptual analysis of the voice by GRBAS scale, video laryngeoscopic examination of the VFs and the lesion, aerodynamic measures, and acoustic analysis of the voice by the computerized speech lab. We assessed quality of the included studies with the Cochrane risk of bias assessment Tool. RESULTS After removal of duplicates, research yielded 262 studies. Of 217 abstracts and titles, 36 full-text articles were read, and one study was added through hand search, resulting in 10 included studies. CONCLUSIONS Most of literature analyzed were deficient to address the effectiveness of any of the six lines included in this study. This is mainly due to the small number of the included articles and the small sample size in most of these studies. We found only 10 articles that reported the effectiveness based on comparing the results of before and after treatment. In addition, the variability of outcome measures used and the lack of the comprehensive assessment of the patient's voice, vocal image in most of the included studies made it hard to us to compare the results of any of the included studies. More researches with larger sample size and accurate randomization are needed for further accurate assessment of the effectiveness of the surgical and nonsurgical lines of treatment of Reinke's edema. The future researches should take in their consideration the use of an agreed comprehensive assessment protocol for assessing and comparing the outcome measures before and after treatment.
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Affiliation(s)
- Mona Sameeh Khodeir
- Unit of Phoniatrics, Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt.
| | - Sabah Mohamed Hassan
- Unit of Phoniatrics, Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt.
| | - Aleyia Mahmoud El Shoubary
- Unit of Phoniatrics, Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt.
| | - Mira Nabil Abdo Saad
- Unit of Phoniatrics, Otorhinolaryngology Department, Manshyeit El-Bakry Hospital, Cairo, Egypt.
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Lin YH, Wang CT, Lin FC, Liao LJ, Lo WC, Cheng PW. Treatment Outcomes and Adverse Events Following In-Office Angiolytic Laser With or Without Concurrent Polypectomy for Vocal Fold Polyps. JAMA Otolaryngol Head Neck Surg 2019; 144:222-230. [PMID: 29346486 DOI: 10.1001/jamaoto.2017.2899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance In-office angiolytic laser procedures have been used successfully as an alternative treatment for vocal fold polyps; little is known in detail about the treatment outcomes and adverse events. Objective To examine the outcomes and incidence rates of adverse events associated with in-office angiolytic laser procedures with or without concurrent polypectomy as an alternative treatment for vocal fold polyps. Design, Setting, and Participants Retrospective cohort study at a tertiary medical center. We identified 114 consecutive patients with vocal polyps who underwent in-office angiolytic laser treatments between January 1, 2014, and August 31, 2016. After the exclusion of 17 with missing or incomplete data, 97 were enrolled. Interventions In-office 532-nm laser procedures with or without concurrent polypectomy. Main Outcomes and Measures Between 1 and 2 months after the surgical procedures, we collected the following outcome data: videolaryngostroboscopy, perceptual rating of voice quality, acoustic analysis, maximal phonation time, and subjective rating of voice quality using a visual analogue scale and 10-item voice handicap index. Results This study enrolled 97 patients (mean [SD] age, 45.6 [11.3] years; 48 [49%] male). The mean duration of symptoms was 10.1 months (range, 1-60 months). Twenty-nine patients (30%) had angiolytic laser procedures only, while 68 (70%) received laser with concurrent polypectomy. Both treatment modalities offered significant improvements. Only 1 patient (1%) receiving angiolytic laser with concurrent polypectomy underwent another treatment session, so this group had significantly less need for multiple treatments than those receiving laser treatment alone (6 [21%]; effect size, -1.57; 95% CI, -2.77 to -0.36). We identified 8 adverse events (8% of the cases): vocal fold edema (n = 5), vocal hematoma (n = 2), and vocal ulceration (n = 1). Patients treated with laser plus concurrent polypectomy had significantly fewer adverse events than those treated with angiolytic laser alone (2 [3%] vs 6 [21%]; effect size, 1.20; 95% CI, 0.26 to 2.13). Conclusions and Relevance In-office angiolytic laser procedures can be an effective alternative treatment for vocal polyps, although with possible need for multiple treatment sessions and occasional occurrence of minor postoperative adverse events. Concurrent polypectomy following laser coagulation allows less laser energy delivery and reduces the risk of postoperative adverse events and the need for additional treatment sessions.
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Affiliation(s)
- Yu-Hsuan Lin
- Department of Otolaryngology-Head and Neck Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Te Wang
- 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.,Master's Program of Speech and Language Pathology, Department of Special Education, University of Taipei, Taipei, Taiwan
| | - Feng-Chuan Lin
- 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 Otolaryngology-Head and Neck Surgery, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Wu-Chia 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
| | - Po-Wen Cheng
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
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Two-handed tying technique in vocal fold mucosa microsuture for the treatment of Reinke's edema. Eur Arch Otorhinolaryngol 2019; 276:2015-2022. [PMID: 31123818 DOI: 10.1007/s00405-019-05480-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Removal of Reinke's edema may result in moderate to large-sized mucosal defect on the vocal fold, which heals by secondary intention. Microsuturing this defect may lead to primary wound healing with fastened recovery and less scar, but costs extra time and effort. Exploring methods that can shorten microsuture time is helpful for the wider application of this technology. STUDY DESIGN Retrospective. METHODS 57 patients with Reinke's edema, who were admitted from November 2010 to June 2018, were enrolled as research subjects for the retrospective analysis. 27 patients were the knot pusher group (from November 2010 to March 2015), and 30 patients were the two-handed tying group (from April 2015 to June 2018). Evaluation indicators include the number of knots, the average time for suturing and tying the knot for each patient, and the occurrence of complications, subjective and objective voice assessments. RESULTS All patients underwent successful operation. The average time for making knots in the knot pusher group and two-handed tying group was 668.40 ± 173.73 s and 328.73 ± 121.0 s, respectively, and there was a statistically significant difference between the two groups (p < 0.001). No significant difference was noted in the mucosal avulsion, overall incidence of complications between the groups, and no significant difference was found between the two groups in terms of the preoperative and 3-month postoperative subjective and objective indicators. CONCLUSION Microsuturing of Reinke's edema microflaps using the two-handed tying technique can achieve the similar effect with the knot pusher method, and save operation time while the surgeon is well trained. LEVEL OF EVIDENCE 4.
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Abstract
Reinke's edema (RE) is the polypoid degeneration of one or both vocal folds within Reinke's space. The viscoelastic properties of the mucosal folds are characteristically altered by the expansion of the subepithelial space. Most frequently, patients present with dysphonia, with women being more affected than men. The primary risk factor is tobacco use. Voice overuse and laryngopharyngeal reflux are also considered to be contributory. Although RE shares the same primary risk factor as malignancy, the risk of malignancy is low, and dysplasia is found only in 0% to 3% of cases. Treatment is focused on decrease of risk factors, such as implementation of smoking cessation, voice therapy, and reflux control. Surgical techniques aim to decrease redundant polypoid mucosa in order to improve voice and restore the glottic airway. Recurrence of RE is high.
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Affiliation(s)
- Raluca Tavaluc
- Department of Head and Neck Surgery, University of California Los Angeles, 200 Medical Plaza, Suite 550, Los Angeles, CA 90025, USA
| | - Melin Tan-Geller
- ENT&Allergy Associates, 222 Bloomingdale Road, Suite 205, White Plains, NY 10506, USA; Department of Otolaryngology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
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18
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Shoffel‐Havakuk H, Sadoughi B, Sulica L, Johns MM. In‐office procedures for the treatment of benign vocal fold lesions in the awake patient: A contemporary review. Laryngoscope 2018; 129:2131-2138. [DOI: 10.1002/lary.27731] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Hagit Shoffel‐Havakuk
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Sackler Faculty of MedicineTel‐Aviv University Israel
| | - Babak Sadoughi
- Sean Parker Institute for the Voice, Department of Otolaryngology–Head and Neck SurgeryWeill Cornell Medical College/New York Presbyterian Hospital New York New York
| | - Lucian Sulica
- Sean Parker Institute for the Voice, Department of Otolaryngology–Head and Neck SurgeryWeill Cornell Medical College/New York Presbyterian Hospital New York New York
| | - Michael M. Johns
- USC Voice Center, Department of Otolaryngology Head and Neck SurgeryUniversity of Southern California Los Angeles California U.S.A
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Wellenstein DJ, Schutte HW, Takes RP, Honings J, Marres HA, Burns JA, van den Broek GB. Office-Based Procedures for the Diagnosis and Treatment of Laryngeal Pathology. J Voice 2018; 32:502-513. [DOI: 10.1016/j.jvoice.2017.07.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/07/2017] [Accepted: 07/25/2017] [Indexed: 12/17/2022]
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Hu HC, Lin SY, Hung YT, Chang SY. Feasibility and Associated Limitations of Office-Based Laryngeal Surgery Using Carbon Dioxide Lasers. JAMA Otolaryngol Head Neck Surg 2017; 143:485-491. [PMID: 28208177 DOI: 10.1001/jamaoto.2016.4129] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance There are few reports evaluating awake, office-based carbon dioxide (CO2) laser surgery for laryngeal lesions. To date, this study was the largest reported case series of office-based laryngeal surgery by fiber delivery CO2 laser. Office-based laryngeal surgical procedures have become increasingly popular. Technical problems and treatment outcomes associated with the use of a CO2 laser for office-based laryngeal surgery have yet to be fully addressed. Objectives To discuss a single institution's clinical experience with office-based CO2 laser laryngeal surgery and the feasibility and limitations associated with this procedure. Design, Setting, and Participants This retrospective study evaluated 49 laryngeal surgical procedures performed using a CO2 laser in 40 consecutive adult patients at a single institution in Taiwan from July 1, 2014, through September 30, 2015. Laryngeal lesions treated included vocal fold leukoplakia (n = 13), benign vocal fold lesions (n = 10), Reinke edema (n = 4), recurrent respiratory papillomatosis (n = 6), and lesions outside the vocal folds (n = 7). Interventions Office-based laryngeal surgery performed using a CO2 laser under topical anesthesia. Main Outcomes and Measures Videolaryngoscopy was performed on all patients at each follow-up point. Among patients with benign vocal lesions and Reinke edema, videolaryngostroboscopy, voice laboratory measurements, perceptual measurements of vocal quality, and subjective evaluations were conducted before and after surgery. Results Among the 40 patients included in this study (28 men [70%] and 12 women [30%]; median [range] age, 56 [29-83] years), median follow-up time was 6.5 months (range, 1-21 months). Among the 49 procedures, 2 (4%) could not be tolerated by patients owing to severe gag reflex and laryngeal hypersensitivity, 6 (12%) could not completely evaporate lesions owing to an inadequate surgical field or laryngeal instability, and 1 (2%) led to a complication (ie, mild vocal fold wound stiffness). In addition, 2 patients with premalignant vocal fold leukoplakia showed lesion recurrence in the subglottic area. Among patients with benign vocal lesions and Reinke edema, postoperative phonatory function showed large improvements in jitter (effect size, 0.61; median difference, -0.98%; 95% CI, -1.57% to -0.11%), noise to harmonic ratio (effect size, 0.63; median difference, -0.02; 95% CI, -0.07 to -0.01), maximal phonation time (effect size, 0.61; median difference, 3.6 seconds; 95% CI, 1.9 to 8.8 seconds), and Voice Handicap Index-10 score (effect size, 0.60; median difference, -7; 95% CI, -12 to -2). Conclusions and Relevance Office-based laryngeal surgery performed using a CO2 laser was shown to be a feasible treatment option for various types of vocal lesions. However, patients should not undergo this procedure if they have multiple bulky lesions or lesions involving the subglottic area, the laryngeal ventricle, or (in cases of inadequate laryngeal stability) the free edge of a vocal fold.
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Affiliation(s)
- Hao-Chun Hu
- Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan2Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shu-Yi Lin
- Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yi-Ting Hung
- Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shyue-Yih Chang
- Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan3Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan
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Hoffman MR, Coughlin AR, Dailey SH. Serial office-based steroid injections for treatment of idiopathic subglottic stenosis. Laryngoscope 2017; 127:2475-2481. [PMID: 28581185 DOI: 10.1002/lary.26682] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/10/2017] [Accepted: 04/22/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Current treatment options for idiopathic subglottic stenosis include endoscopic interventions, resection, and tracheotomy. Recently, serial office-based steroid injections were proposed as an alternative that may stabilize or induce regression of airway stenosis without the need for repeated operations. Procedure completion rate, pain, complications, effect on stenosis, time since the last operation, and limitations have not been described. STUDY DESIGN Retrospective case series. METHODS Retrospective series of 19 patients undergoing serial office-based steroid injection for idiopathic subglottic stenosis. Outcome measures included completion rate, procedure-related pain scores, complications, percentage of airway stenosis, and time since the last operative intervention. RESULTS Procedure completion rate was 98.8%. Average pain score during the procedure was 2.3 ± 1.7 on a 10-point scale. There were no immediate complications. One patient underwent awake tracheotomy 8 days after her second injection and was later decannulated. Average stenosis decreased from 35% ± 15% to 25% ± 15% (n = 16; P = .086) over the first of three injections and 40% ± 15% to 25% ± 10% to 20% ± 10% (n = 8; P = .002) for those patients completing two sets of three injections. Fourteen of 17 patients undergoing at least three injections have not returned to the operating room since the first injection. CONCLUSIONS Office-based steroid injection represents a promising new treatment pathway for a disease that requires long-term management, offering a purely pharmacologic approach to a disorder that has traditionally been approached from a mechanical perspective. It is safe, well tolerated, and effective. Furthermore, it may help patients and physicians avoid repeated trips to the operating room and the associated risks. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2475-2481, 2017.
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Affiliation(s)
- Matthew R Hoffman
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Adam R Coughlin
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Seth H Dailey
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
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Young WG, Hoffman MR, Koszewski IJ, Whited CW, Ruel BN, Dailey SH. Voice Outcomes following a Single Office-Based Steroid Injection for Vocal Fold Scar. Otolaryngol Head Neck Surg 2016; 155:820-828. [PMID: 27507145 DOI: 10.1177/0194599816654899] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 05/25/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Persistent dysphonia from vocal fold scar remains a clinical challenge, with current therapies providing inconsistent outcomes. We evaluated voice outcomes after a single office-based steroid injection. STUDY DESIGN Case series with chart review. SETTING Academic medical center. SUBJECTS AND METHODS This study was based on pre- and postoperative analysis of patient-reported, perceptual, acoustic, aerodynamic, and videostroboscopic parameters. The sample comprised 25 patients undergoing office-based dexamethasone injection into the superficial lamina propria for mild/moderate vocal fold scar. Average follow-up was 13.7 ± 4.4 weeks; patients completed 3.5 ± 2.3 sessions of voice therapy between assessments. Complete data sets were not available for each parameter; sample size is noted with results. RESULTS Voice handicap index (n = 24; P < .001) and glottal function index (n = 22; P < .001) decreased after injection. Total GRBAS score (grade, roughness, breathiness, asthenia, strain) decreased (n = 25; P < .001). Fundamental frequency range increased (n = 24; P = .024). Phonation threshold pressure decreased (n = 14; P = .017). Videostroboscopic parameters of vocal fold edge (P = .004), glottic closure (P = .003), and right mucosal wave (P = .016) improved after injection. CONCLUSIONS Office-based steroid injection combined with voice therapy for mild/moderate vocal fold scar is associated with improved patient-reported and functional voice measures. These findings provide preliminary support for this approach. Importantly, the procedure is low risk and can be performed in the office, thus offering a simple treatment alternative to patients with a disorder that has traditionally been difficult to manage. Prospective studies evaluating the effects of multiple injections are warranted.
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Affiliation(s)
- William G Young
- Proliance Eastside Ear Nose and Throat, Kirkland, Washington, USA.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Matthew R Hoffman
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Ian J Koszewski
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Chad W Whited
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.,Austin Ear, Nose & Throat Clinic, Austin, Texas, USA
| | - Brienne N Ruel
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Seth H Dailey
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
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