1
|
Lakshmipathy D, Allibone M, Rajasekaran K. Dysphagia in Head and Neck Cancer. Otolaryngol Clin North Am 2024; 57:635-647. [PMID: 38485539 DOI: 10.1016/j.otc.2024.02.013] [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] [Indexed: 07/01/2024]
Abstract
Dysphagia is a common symptom in patients with head and neck cancer that can significantly impact health outcomes and quality of life. The origin of dysphagia in these patients is often multifactorial, making diagnosis and management especially complex. The evaluating otolaryngologist should be well versed with the patient's neoplasm, comorbidities, and treatment history alongside dysphagia-specific imaging modalities. Management is often dynamic, requiring frequent monitoring, interprofessional collaboration, and a variety of supportive and invasive measures to achieve optimal outcomes.
Collapse
Affiliation(s)
- Deepak Lakshmipathy
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA
| | - Melissa Allibone
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA; Department of Speech-Language Pathology, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, USA.
| |
Collapse
|
2
|
Siu JM, Amin SN, Colyer J, Horner C, Bhat A, Bohuta L, Chan T, Dahl JP, Fridgen J, Johnson K, Yip C, Parikh SR. Injection Medialization in Infants with Vocal Fold Immobility Improves Dysphagia. Laryngoscope 2024. [PMID: 38676424 DOI: 10.1002/lary.31462] [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: 11/14/2023] [Revised: 03/25/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Unilateral vocal fold immobility (VFI) is a known cause of morbidity amongst children following congenital heart surgery. Injection medialization (IM) provides medial distraction and improves glottic closure. Limited objective data is available for the effect of IM in young children (<2 years-old) with VFI. METHODS Retrospective case series of infants <2 who underwent IM for VFI after congenital cardiac surgery. Primary outcome was objective reduced risk of aspiration based on Dysphagia and Outcome Severity Scores (DOSS) on Video swallow study (VFSS) performed prior to and within 4 weeks following IM. Secondary analysis included perioperative complications and number of children who were able to avoid NG or G tube placement. RESULTS 17 children <2 years of age had unilateral VFI after congenital cardiac surgery and underwent IM. The median age at time of initial cardiac surgery was 6 days (IQR 3-7). There was no intraoperative or postoperative stridor or associated complications. All 17 patients had preoperative aspiration noted on VFSS. Average swallowing outcomes on VFSS improved after IM with an increase in DOSS score (preop score 3 (IQR 2-4) to postop score 6.5 (IQR 5-7) [P = 0.001]). At 2 months following IM, of the patients who had improvement in swallowing function, 50% (n = 6) were able to feed completely orally, 25% (n = 3) were fed orally with an NG wean, and 3 (25%) had a G tube placed. CONCLUSION Initial results suggest that IM is safe and improves early objective swallowing outcomes in children <2 years old with VFI after congenital cardiac surgery. LEVEL OF EVIDENCE IV Laryngoscope, 2024.
Collapse
Affiliation(s)
- Jennifer M Siu
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaunak N Amin
- Division of Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jessica Colyer
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Cassie Horner
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Aarti Bhat
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Lyubomyr Bohuta
- Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Titus Chan
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - John P Dahl
- Division of Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jennifer Fridgen
- Division of Physical Therapy, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Kaalan Johnson
- Division of Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Caitlin Yip
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Sanjay R Parikh
- Division of Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| |
Collapse
|
3
|
Bullock L, Toles LE, Hillman RE, Mehta DD. Acoustic-Aerodynamic Voice Outcome Ratios Identify Changes in Vocal Function Following Vocal Fold Medialization for Unilateral Vocal Fold Paralysis. J Voice 2023:S0892-1997(23)00104-2. [PMID: 37068982 PMCID: PMC10576834 DOI: 10.1016/j.jvoice.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE This study aimed to determine whether ratio-based measures that combine acoustic (output) and aerodynamic (input) parameters detect postoperative change in vocal function following vocal fold medialization for unilateral vocal fold paralysis. METHOD Pre- and postoperative acoustic and aerodynamic measures were analyzed retrospectively from 149 patients who underwent vocal fold medialization for unilateral vocal fold paralysis. A 2 × 2 repeated-measures analysis of variance was conducted for each of four acoustic-aerodynamic ratios-traditional vocal efficiency (VE), sound pressure level to aerodynamic power (SPL/AP), SPL to average airflow (SPL/AFLOW), and SPL to subglottal pressure (SPL/Ps)-to investigate the main effects and interaction of treatment stage and loudness level (comfortable and loud). RESULTS The patient group showed significant postoperative improvements in self reports of vocal function (voice-related quality of life) and clinical auditory-perceptual judgments of dysphonia (consensus auditory-perceptual evaluation of voice). Main effects for both treatment stage and loudness level were statistically significant for all measures except SPL/Ps. There were interaction effects for VE and SPL/AP, suggesting that magnitude of the treatment effect differs based on loudness. SPL/AFLOW had medium-to-large effect sizes in both loudness conditions. There were postoperative changes in SPL/Ps that were dependent on the magnitude of the reduction in AFLOW; as expected, SPL/Ps increased postoperatively in a subgroup that had large postoperative reductions in AFLOW at the comfortable loudness level. CONCLUSIONS Acoustic-aerodynamic ratios can aid in tracking changes in vocal function following vocal fold medialization. SPL/AFLOW exhibited the largest effect size, which is expected since a reduction in abnormally high AFLOW typically accompanies the increased modulation of glottal air flow associated with successful vocal fold medialization. Future study is needed to model physiological changes in acoustic-aerodynamic voice outcome ratios across different types of voice disorders.
Collapse
Affiliation(s)
- Latané Bullock
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts; Division of Medical Sciences, Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, Massachusetts
| | - Laura E Toles
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts; Division of Medical Sciences, Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts
| | - Daryush D Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts; Division of Medical Sciences, Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts.
| |
Collapse
|
4
|
Coulter M, Marvin K, Brigger M, Johnson CM. Dysphagia Outcomes Following Surgical Management of Unilateral Vocal Fold Immobility: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2023; 168:14-25. [PMID: 35021908 DOI: 10.1177/01945998211072832] [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: 09/02/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess dysphagia outcomes following surgical management of unilateral vocal fold immobility (UVFI) in adults. DATA SOURCES Ovid MEDLINE, Embase, Web of Science, and Cochrane Central. REVIEW METHODS A structured literature search was utilized, and a 2-researcher systematic review was performed following PRISMA guidelines. Extractable data were pooled, and a quantitative analysis was performed with a random effects model to analyze treatment outcome and complications by procedure. RESULTS A total of 416 publications were screened and 26 met inclusion criteria. Subjects encompassed 959 patients with UVFI who underwent 916 procedures (n = 547, injection laryngoplasty; n = 357, laryngeal framework surgery; n = 12, laryngeal reinnervation). An overall 615 were identified as having dysphagia as a result of UVFI and had individually extractable outcome data, which served as the basis for a quantitative meta-analysis. In general, dysphagia outcomes after all medialization procedures were strongly positive. Quantitative analysis demonstrated a success rate estimate of 90% (95% CI, 75%-100%) for injection laryngoplasty and 92% (95% CI, 87%-97%) for laryngeal framework surgery. The estimated complication rate was 7% (95% CI, 2%-13%) for injection laryngoplasty and 15% (95% CI, 10%-20%) for laryngeal framework surgery, with minor complications predominating. Although laryngeal reinnervation could not be assessed quantitatively due to low numbers, qualitative analysis demonstrated consistent benefit for a majority of patients for each procedure. CONCLUSION Dysphagia due to UVFI can be improved in a majority of patients with surgical procedures intended to improve glottal competence, with a low risk of complications. Injection laryngoplasty and laryngeal framework surgery appear to be efficacious and safe, and laryngeal reinnervation may be a promising new option for select patients.
Collapse
Affiliation(s)
- Michael Coulter
- Department of Otolaryngology-Head and Neck Surgery, Naval Hospital Camp Pendleton, California, USA
| | - Kastley Marvin
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Camp Lejeune, North Carolina, USA
| | - Matthew Brigger
- Division of Pediatric Otolaryngology, Rady Children's Hospital-San Diego, San Diego, California, USA.,Department of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, California, USA
| | - Christopher M Johnson
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, San Diego, California, USA
| |
Collapse
|
5
|
McRae J, Morgan S, Wallace E, Miles A. Oropharyngeal Dysphagia in Acute Cervical Spinal Cord Injury: A Literature Review. Dysphagia 2022:10.1007/s00455-022-10535-0. [DOI: 10.1007/s00455-022-10535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
AbstractDysphagia (swallowing impairment) is a frequent complication of cervical spinal cord injury (cSCI). Recently published national guidance in the UK on rehabilitation after traumatic injury confirmed that people with cSCI are at risk for dysphagia and require early evaluation while remaining nil by mouth [National Institute for Health and Care Excellence. Rehabilitation after traumatic injury (NG211), 2022, https://www.nice.org.uk/guidance/ng21]. While the pathogenesis and pathophysiology of dysphagia in cSCI remains unclear, numerous risk factors have been identified in the literature. This review aims to summarize the literature on the risk factors, presentation, assessment, and management of dysphagia in patients with cSCI. A bespoke approach to dysphagia management, that accounts for the multiple system impairment in cSCI, is presented; the overarching aim of which is to support effective management of dysphagia in patients with cSCI to prevent adverse clinical consequences.
Collapse
|
6
|
Pinzas LA, Chen DW, Liou NE, Donovan DT, Ongkasuwan J. Inpatient Type 1 Thyroplasty Versus Injection Laryngoplasty for Vocal Fold Movement Impairment After Extent type I and II Aortic Repair. Ann Otol Rhinol Laryngol 2022; 131:1340-1345. [PMID: 35016531 DOI: 10.1177/00034894211070132] [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: 11/17/2022]
Abstract
IMPORTANCE Vocal fold motion impairment (VFMI) due to neuronal injury is a known complication following thoracic aortic repair that can impair pulmonary toilet function and post-operative recovery. OBJECTIVE To demonstrate clinical outcomes of patients undergoing inpatient vocal fold medialization for VFMI after aortic surgery. DESIGN A 15-year retrospective chart review (2005-2019) of 259 patients with postoperative VFMI after thoracic aortic surgery registry was conducted. Data included demographics, surgery characteristics, laryngology exam, and postoperative clinical outcomes. Medialization procedures consisted of type 1 thyroplasty and injection laryngoplasty. SETTING Tertiary care hospital. PARTICIPANTS Two hundred and fifty-nine patients (median age 61, 71% male) with VFMI post-thoracic aortic repair met inclusion criteria; inpatient vocal fold medialization was performed for 203 (78%) patients. One hundred and twenty-six. (49%) received type 1 thyroplasty and 77 (30%) received injection laryngoplasty procedures at a median 7 days (IQR 5-8 days) from extubation. MAIN OUTCOMES Primary study outcome measurements consisted of median LOS, median ICU LOS, complications intra- and postoperatively, and pulmonary complications (post-medialization bronchoscopies, pneumonia, tracheostomy, etc.). RESULTS Post-medialization bronchoscopy rates were significantly lower in the medialization (n = 11) versus the non-medialization group (n = 8) (5% vs 14%, P = .02) and significantly higher in the injection laryngoplasty group (n = 77) versus thyroplasty group (n = 126) (10% vs 2%, P = .02). Further analysis revealed no significant difference in overall LOS and pulmonary complications between the techniques. CONCLUSION Inpatient thyroplasty and injection laryngoplasty are both effective vocal fold medialization techniques after extent I and II aortic repair. Thyroplasty may have a small pulmonary toilet advantage, as measured by need for post-medialization bronchoscopy, compared to injection laryngoplasty.
Collapse
Affiliation(s)
| | - Diane W Chen
- Department of Otolaryngology - Head & Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Nelson Eddie Liou
- Department of Otolaryngology - Head & Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Donald T Donovan
- Department of Otolaryngology - Head & Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Julina Ongkasuwan
- Department of Otolaryngology - Head & Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
7
|
Miles A, Barua S, McLellan N, Brkic L. Dysphagia and medicine regimes in patients following lung transplant surgery: A retrospective review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:339-348. [PMID: 32933315 DOI: 10.1080/17549507.2020.1807051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Dysphagia is reported following lung transplantation. Characteristics and trajectory for dysphagia are poorly understood. This retrospective study explored dysphagia and medicine regimes in patients following lung transplant. METHOD Medical records and endoscopic recordings of 101 patients (M:50yrs, range 20-67yrs, SD 13yrs) were reviewed. Standardised endoscopic swallowing measures were reported. Discharge reports were analysed for medicines known to cause dysphagia. RESULT All patients received bilateral sequential single-lung transplant. Prevalence of referral to speech pathology was 65% with 37 requiring more than one instrumental assessment. Twenty-nine patients were referred to otorhinolaryngology with suspected laryngeal abnormalities. Seventy-five percent of patients (n = 49/65) who received an instrumental assessment aspirated; of whom 63% aspirated silently (31/49). Diet on first day transferred from Intensive Care Unit (ICU) was significantly associated with intubation duration, ICU and hospital length of stay, tracheostomy and vocal fold paralysis (p < 0.001). In contrast, pre-operative reflux was significantly associated with diet on discharge (p < 0.05). Only three patients remained enterally fed on discharge. Polypharmacy (concurrent use of 5+ medicines) was prevalent. CONCLUSION Endoscopic, radiographic and/or manometric assessment of dysphagia in patients prior to, and following, lung transplant may allow for early management and prevention of secondary complications. Teams must consider pre-surgical reflux, length of stay in ICU and current medicine regimes when managing patients.
Collapse
Affiliation(s)
- Anna Miles
- School of Psychology, The University of Auckland, Auckland, New Zealand and
| | - Sujay Barua
- School of Psychology, The University of Auckland, Auckland, New Zealand and
| | | | - Lejla Brkic
- Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
8
|
Hsu CM, Tsai YT, Chang GH, Yang YH, Fang TJ, Lee YC, Liu CY, Lin MH, Wang YT, Tsai MS. Reduction in Short- and Long-term Pneumonia Rate With Laryngoplasty for Unilateral Vocal Fold Paralysis. Otolaryngol Head Neck Surg 2021; 166:343-349. [PMID: 34058910 DOI: 10.1177/01945998211015174] [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: 11/17/2022]
Abstract
OBJECTIVE To examine the association of laryngoplasty, voice therapy, and pneumonia rate in patients with unilateral vocal fold paralysis (UVFP). STUDY DESIGN Population-based retrospective cohort study. SETTING Data were collected from the LHID2000 (Longitudinal Health Insurance Database 2000), containing the information of 1 million randomly selected patients in Taiwan. METHODS In the LHID2000, we identified 439 patients having new diagnoses of UVFP from 1997 to 2013. We grouped the aforementioned patients according to UVFP treatment and probed the occurrence of pneumonia: 305 patients underwent laryngoplasty or voice therapy, and 134 patients did not undergo treatment. Follow-up procedures were executed for the enrollees until death or December 31, 2013, representing the end of the study period. We assessed the association of UVFP treatment and pneumonia by executing Cox proportional hazards regression. RESULTS The pneumonia cumulative incidence was significantly higher among enrolled patients without treatment than in those receiving treatment (P < .001). The pneumonia incidence was significantly lower in patients receiving UVFP treatment (hazard ratio, 0.49; 95% CI, 0.27-0.88; P = .018), as validated by the Cox proportional hazards model after adjustment. Patients undergoing laryngoplasty with or without voice therapy had a significantly lower incidence of pneumonia at 6 months and 1, 3, and 5 years, whereas those undergoing voice therapy alone did not. CONCLUSION Laryngoplasty was associated with a lower incidence of short- and long-term pneumonia in patients with UVFP. Physicians should encourage patients with UVFP at risk of aspiration to receive prompt evaluation as well as treatment.
Collapse
Affiliation(s)
- Cheng-Ming Hsu
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan
| | - Geng-He Chang
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan.,Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan.,Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi
| | - Tuan-Jen Fang
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan.,Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan
| | - Yi-Chan Lee
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan.,Department of Otolaryngology-Head and Neck Surgery, Keelung Chang Gung Memorial Hospital, Keelung
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi
| | - Yun-Ting Wang
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan
| | - Ming-Shao Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan.,Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi
| |
Collapse
|
9
|
Baijens LWJ, Walshe M, Aaltonen LM, Arens C, Cordier R, Cras P, Crevier-Buchman L, Curtis C, Golusinski W, Govender R, Eriksen JG, Hansen K, Heathcote K, Hess MM, Hosal S, Klussmann JP, Leemans CR, MacCarthy D, Manduchi B, Marie JP, Nouraei R, Parkes C, Pflug C, Pilz W, Regan J, Rommel N, Schindler A, Schols AMWJ, Speyer R, Succo G, Wessel I, Willemsen ACH, Yilmaz T, Clavé P. European white paper: oropharyngeal dysphagia in head and neck cancer. Eur Arch Otorhinolaryngol 2021; 278:577-616. [PMID: 33341909 PMCID: PMC7826315 DOI: 10.1007/s00405-020-06507-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. METHODS Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. RESULTS Twenty-four sections on HNC-specific OD topics. CONCLUSION This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.
Collapse
Affiliation(s)
- Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Reinie Cordier
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Patrick Cras
- Department of Neurology, Born Bunge Institute, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Lise Crevier-Buchman
- Voice, Speech, Swallowing Lab, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UVSQ and Research lab CNRS-UMR7018, Hôpital Foch, Suresnes, France
| | - Chris Curtis
- Swallows Head and Neck Cancer Charity, Blackpool, UK
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland
| | - Roganie Govender
- Head and Neck Cancer Centre, University College London Hospital, London, UK
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kate Heathcote
- Robert White Centre for Airway, Voice and Swallow, Poole Hospital NHS Foundation Trust, Dorset, UK
| | - Markus M Hess
- Deutsche Stimmklinik, Hamburg, Germany
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Hosal
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Atılım University, Medicana International Ankara, Ankara, Turkey
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - C René Leemans
- Department of Otolaryngology, Head and Neck Surgery, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
| | - Denise MacCarthy
- Division of Restorative Dentistry and Periodontology, Faculty of Health Sciences, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Beatrice Manduchi
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Jean-Paul Marie
- Department of Otorhinolaryngology, Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Reza Nouraei
- Department of Ear Nose and Throat Surgery, The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Claire Parkes
- Department of Speech and Language Therapy, St. James's Hospital, Dublin, Ireland
| | - Christina Pflug
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Nathalie Rommel
- Department Neurosciences, Experimental Otorhinolaryngology, Deglutology, University of Leuven, Leuven, Belgium
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Renee Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Faculty of Health, School of Health and Social Development, Victoria, Australia
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
- Department of Oncology, University of Turin, Orbassano, TO, Italy
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna C H Willemsen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Taner Yilmaz
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| |
Collapse
|
10
|
Pan S, Sadoughi B. Effectiveness of Injection Laryngoplasty for Aspiration in Acute Iatrogenic Vocal Fold Paralysis: A Systematic Review. Laryngoscope 2020; 132:813-821. [PMID: 33305851 DOI: 10.1002/lary.29326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/29/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE/HYPOTHESIS To review current evidence on effectiveness of injection laryngoplasty on aspiration outcomes in acute unilateral vocal fold paralysis. STUDY DESIGN Systematic review. METHODS A literature search was performed on MEDLINE, Embase, Scopus, and the Cochrane Library from inception of each database to May 2019. Inclusion criteria included case series, case-control studies, prospective cohort studies, and randomized controlled trials assessing the outcomes of early injection laryngoplasty on aspiration in unilateral vocal fold paralysis, in the acute setting. Only English articles with adult study populations were included. Two independent investigators screened all abstracts and manuscripts. Data on study design, patient demographics, interventions, and outcome measures were systematically extracted by both authors for included studies. RESULTS Fourteen case series studies comprising 582 patients were included. Results were not quantitatively synthesized due to the heterogeneity of outcome measures. Eleven studies reported that a majority (ranging 50%-100%) of patients in each respective study showed improvement in diet intake (progression from nil per os to oral) or Penetration-Aspiration Scale (PAS) scores after injection laryngoplasty. However, none of the investigations used a control group, and therefore, did not account for the possibility of improvement of function related to placebo or Hawthorne effects rather than attributed to intervention. CONCLUSIONS No robust evidence was found to support injection laryngoplasty as an effective measure to improve aspiration outcomes in acute iatrogenic vocal fold paralysis. Current practices rely on empirical observations and scarce expert opinions. Further prospective investigations with controlled objective measures are necessary to definitively demonstrate the effectiveness of IL for aspiration management. Laryngoscope, 2020.
Collapse
Affiliation(s)
- Sabrina Pan
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, U.S.A
| | - Babak Sadoughi
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, U.S.A
| |
Collapse
|
11
|
Straub JM, Calamari KA, Shin TJ, Janse SA, Forrest LA, deSilva BW, Matrka LA. The safety of in-office laryngologic procedures during active antithrombotic therapy. Laryngoscope Investig Otolaryngol 2020; 5:890-894. [PMID: 33134536 PMCID: PMC7585240 DOI: 10.1002/lio2.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/08/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine whether patients undergoing in-office laryngologic procedures on antithrombotic therapy are at increased risk for treatment-related complications. METHODS Patients were those who underwent at least one in-office laryngologic procedure with any of three fellowship-trained laryngologists. Procedures were identified by current procedural terminology (CPT) code and included biopsies, excisions, laser ablations, and injections (therapeutic and augmentative). Patients were divided into two groups based on the use of antithrombotic therapy at the time of their procedure. Retrospective chart review was performed to identify any complications, with an average follow-up of 186 days. RESULTS Five hundred-sixty-four unique individuals were identified with ages ranging from 18 to 93 years old and with a relatively even distribution between females (45%) and males (55%). They underwent 647 procedures in total, 310 of which were performed while on some form of antithrombotic therapy. Sixteen procedures were associated with complications either during or after the procedure. In comparing overall complication rates, there was no significant difference between non-antithrombotic (2.4%) and antithrombotic (3.3%) cohorts (OR 1.09, 95% CI [0.46-2.60], P = .8454). CONCLUSIONS In spite of known risks in other settings, antithrombotic agents do not appear to confer increased risk of treatment-related complications during in-office laryngologic procedures, obviating the need for cessation of therapy prior to these interventions. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Jeffrey M. Straub
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Kevin A. Calamari
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Timothy J. Shin
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Sarah A. Janse
- Department of Biomedical InformaticsThe Ohio State UniversityColumbusOhioUSA
| | - Lowell A. Forrest
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Brad W. deSilva
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Laura A. Matrka
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| |
Collapse
|
12
|
de la Rosa A, Aguilar J, Barbu AM, Chang D, Kobashigawa J. Uniqueness of laryngeal nerve injury following heart transplantation. Clin Transplant 2020; 34:e14075. [PMID: 32916014 DOI: 10.1111/ctr.14075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/18/2020] [Accepted: 08/26/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The incidence of recurrent laryngeal nerve injury (RLNI) after heart transplantation has not been well studied. This can manifest as vocal cord dysfunction causing dysphonia. Previous research is limited to aortic, coronary bypass, and valvular surgery. Identifying RLNI after heart transplantation is important in order to more accurately detail complications associated with this major surgery. METHODS This is a retrospective study assessing 972 adult patients who underwent orthotopic heart transplantation between 2010-2019. Primary outcome was incidence of RLNI. Secondary outcomes were 1-year mortality and length of stay. Cardiology and otolaryngology notes were examined. Key word searches were used to identify possible RLNI in patients' health care record. RESULTS 2.9% (29/972) of patients developed new RLNI confirmed by laryngoscopy during hospitalization. Patients with RLNI had a significantly increased risk of 1-year mortality (P = .015) and length of stay (P = .006) compared to those without RLNI. 68.9% (20/29) of RLNI was left-sided (68.9%). CONCLUSIONS Recurrent laryngeal nerve injury is a recognizable adverse outcome following heart transplantation. This study supports that RLNI is associated with increased 1-year mortality and length of stay. Early otolaryngology evaluation may be warranted to evaluate vocal cord mobility and address potential management.
Collapse
Affiliation(s)
- Angelo de la Rosa
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jack Aguilar
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Anca M Barbu
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Chang
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Smidt Heart Institute, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jon Kobashigawa
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Smidt Heart Institute, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
13
|
Ha JF. Unilateral vocal fold palsy & dysphagia: A review. Auris Nasus Larynx 2020; 47:315-334. [DOI: 10.1016/j.anl.2020.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022]
|
14
|
Reder L, Bertelsen C, Angajala V, O'Dell K, Fisher L. Hospitalized Patients With New-Onset Vocal Fold Immobility Warrant Inpatient Injection Laryngoplasty. Laryngoscope 2020; 131:115-120. [PMID: 32176334 DOI: 10.1002/lary.28606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/04/2020] [Accepted: 02/13/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To evaluate the impact of early inpatient bedside injection laryngoplasty (IL) in hospitalized patients with iatrogenic unilateral vocal fold immobility (UVFI). STUDY DESIGN Retrospective cohort study. METHODS A retrospective review of hospitalized patients with iatrogenic UVFI undergoing IL between September 2013 and June 2017 was performed. Patients had a swallow evaluation by a speech-language pathologist and bedside IL. Evaluated outcomes included swallow scores, return to diet, secondary events/procedures, and hospital length of stay. Outcomes related to etiology of UVFI were also examined. RESULTS The cohort consisted of 90 patients (61% male, 52% after cardiac/cardiothoracic surgery). Seventy-seven percent of all patients who could improve had increased swallow scores after IL. The lowest number (40%) from the subgroup of patients with high vagal injuries as the cause of UVFI obtained improvement in swallow scores, whereas 87% of those in the cardiac surgery group improved. There were more bronchoscopies and reintubations in patients before IL than after IL. CONCLUSION Hospitalized patients with UVFI are at increased risk of morbidity and mortality due to dysphagia. We advocate for early swallow evaluation and intervention with IL if there is dysphagia and risk of aspiration. Coordination of care between interdisciplinary teams is paramount to a successful inpatient IL program. LEVEL OF EVIDENCE 2b Laryngoscope, 131:115-120, 2021.
Collapse
Affiliation(s)
- Lindsay Reder
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Caitlin Bertelsen
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Varun Angajala
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Laurel Fisher
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| |
Collapse
|
15
|
Han YJ, Jang YJ, Park GY, Joo YH, Im S. Role of injection laryngoplasty in preventing post-stroke aspiration pneumonia, case series report. Medicine (Baltimore) 2020; 99:e19220. [PMID: 32049860 PMCID: PMC7035062 DOI: 10.1097/md.0000000000019220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Injection laryngoplasty is a common procedure for patients with vocal fold dysfunction, but the literature on its benefits has been mainly focused on those related to structural lesions or laryngeal nerve involvement. Stroke patients may be at increased risk of aspiration due to insufficient vocal fold motion. However, how injection laryngoplasty can be of benefit in stroke patients has not been reported yet. PATIENT CONCERNS Six chronic stroke patients with long-standing swallowing difficulties and who showed severe aspiration despite long-term swallowing rehabilitation. DIAGNOSIS Laryngoscope evaluation revealed insufficient glottic closure as the cause of aspiration. INTERVENTIONS Injection laryngoplasty was done per-orally under local anaesthesia with calcium hydroxylapatite (Radiesse Voice, 1-1.5 mL) in an office setting. Respiratory pressures and peak cough flows were assessed at baseline and at 2 weeks follow-up. OUTCOMES At 2 weeks, the mean peak cough flow (Δ = +95.09 L/min) increased significantly after the procedure. The maximal expiratory (Δ = +18.40 cm H2O) and inspiratory (Δ = +20.20 cm H2O) pressures also improved, indicating that injection laryngoplasty was effective in augmenting respiratory and cough parameters. All cases showed improvement in the Functional Oral Intake Scale (Δ = +4). Feeding tubes were successfully removed. CONCLUSION Injection laryngoplasty proved to be both successful and safe in improving glottic closure with immediate results in those who had failed to show a positive response after long-term swallowing rehabilitation. The positive and dramatic clinical outcomes were observed through changes in the coughing force. Our case series support the use of injection larygnoplasty as a powerful adjunctive treatment method to prevent aspiration pneumonia in post-stroke patients with vocal fold insufficiency. Pre- and post-injection peak cough flow changes may reflect improvement in glottic closure and indicate the safety of swallowing with reduced risk of aspiration.
Collapse
Affiliation(s)
- Yeon Jae Han
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine
| | - Yong Jun Jang
- Department of Rehabilitation Medicine, Graduate School
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine
| | - Young Hoon Joo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine
| |
Collapse
|
16
|
Abu-Ghanem S, Rudy S, Deane S, Tsai SW, Shih LC, Damrose EJ, Sung CK. Early Injection Laryngoplasty After Surgery: 30 Cases and Proposed Aspiration Assessment Protocol. J Voice 2020; 34:121-126. [DOI: 10.1016/j.jvoice.2018.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
|
17
|
Ricci Maccarini A, Stacchini M, Mozzanica F, Schindler A, Basile E, DE Rossi G, Woo P, Remacle M, Magnani M. Efficacy of trans-nasal fiberendoscopic injection laryngoplasty with centrifuged autologous fat in the treatment of glottic insufficiency due to unilateral vocal fold paralysis. ACTA ACUST UNITED AC 2019; 38:204-213. [PMID: 29984796 DOI: 10.14639/0392-100x-2012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/11/2018] [Indexed: 11/23/2022]
Abstract
SUMMARY The objective of this work is to evaluate the safety, feasibility and efficacy of trans-nasal fiberendoscopic injection laryngoplasty (IL) with centrifuged autologous fat, performed under local anaesthesia, in the treatment of glottic insufficiency due to unilateral vocal fold paralysis (UVFP). It is a within-subject study with follow-up 1 week after phonosurgery and after 6 months. A total of 22 patients with chronic dysphonia caused by glottic insufficiency due to UVFP were enrolled. Each patient underwent trans-nasal IL with centrifuged autologous fat through flexible operative endoscope under local anaesthesia and was evaluated before and twice (1 week and 6 months) after phonosurgery, using a multidimensional set of investigations. The assessment protocol included videolaryngostroboscopy, perceptual evaluation of dysphonia, maximum phonation time and patient's self-assessment on voice-related quality of life (QOL) with the Voice Handicap Index-10 and the comparative self-assessment on vocal fatigue and voice quality pre-post treatment. Trans-nasal IL with centrifuged autologous fat was performed in all 22 patients and there were no complications in any case. Significant improvements in videolaryngostroboscopic findings, perceptual evaluation of dysphonia, maximum phonation time and QoL self-assessment were reported after 1 week and were maintained at 6 months. In one patient, the result after 6 months was not satisfactory and this patient then underwent a medialization laryngoplasty (thyroplasty type I) with satisfactory long-term results. In conclusion, trans-nasal fiberendoscopic IL with centrifuged autologous fat seems to be a safe, feasible and efficacious phonosurgical procedure for treatment of glottic insufficiency due to unilateral vocal fold paralysis.
Collapse
Affiliation(s)
| | - M Stacchini
- ENT Department, M. Bufalini Hospital, Cesena, Italy
| | - F Mozzanica
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | - A Schindler
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | - E Basile
- ENT Clinic, University of Messina, Messina, Italy
| | - G DE Rossi
- Medical Center of Phoniatrics and Phonosurgery, Padua, Italy
| | - P Woo
- Clinical Professor, Department Of Otolaryngology Head and Neck Surgery, Icahn School of Medicine, New York, USA
| | - M Remacle
- Department of Otorhinolaryngology Head and Neck Surgery, Centre Hospitalier Luxemburg, Luxemburg
| | - M Magnani
- ENT Department, M. Bufalini Hospital, Cesena, Italy
| |
Collapse
|
18
|
Crowson MG, Tong BC, Lee HJ, Song Y, Misono S, Jones HN, Cohen S. Vocal Fold Paralysis/Paresis as a Marker for Poor Swallowing Outcomes After Thoracic Surgery Procedures. Dysphagia 2019; 34:904-915. [PMID: 30798360 DOI: 10.1007/s00455-019-09987-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/06/2019] [Indexed: 12/31/2022]
Abstract
(1) To examine the association between vocal fold paresis/paralysis (VFP) and poor swallowing outcomes in a thoracic surgery cohort at the population level, and (2) to assess utilization of ENT/speech-language pathology intervention in these cases. The National Inpatient Sample (NIS) represents a 20% stratified sample of discharges from US hospitals. Using ICD-9 codes, discharges undergoing general thoracic surgical procedures between 2008 and 2013 were identified in the NIS. Sub-cohorts of discharges with VFP and those who utilized ENT/SLP services were also identified. Weighted logistic regression models were used to compare binary outcomes such as dysphagia, aspiration pneumonia, and other complications; generalized linear models with generalized estimating equations (GEE) were used to compare total hospital costs and length of stay (LOS). We identified a weighted estimate of 673,940 discharges following general thoracic surgery procedures. The weighted frequency of VFP was 3738 (0.55%). Compared to those without VFP, patients who discharged with VFP had increased odds of dysphagia (6.56, 95% CI 5.07-8.47), aspiration pneumonia (2.54, 95% CI 1.74-3.70), post-operative tracheotomy (3.10, 95% CI 2.16-4.45), and gastrostomy tube requirement (2.46, 95% CI 1.66-3.64). Discharges with VFP also had a longer length of stay and total hospital costs. Of the discharges with VFP, 15.7% received ENT/SLP intervention. VFP after general thoracic procedures is associated with negative swallowing-related health outcomes and higher costs. Despite these negative impacts, most patients with VFP do not receive ENT/SLP intervention, identifying a potential opportunity for improving adverse swallowing-related outcomes.
Collapse
Affiliation(s)
- Matthew G Crowson
- Otolaryngology-Head & Neck Surgery, Sunnybrook Health Science Center, Toronto, ON, Canada
| | - Betty C Tong
- Surgery, Duke University Medical Center, DUMC Box 3805, Durham, NC, USA
| | - Hui-Jie Lee
- Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - Yao Song
- Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - Stephanie Misono
- Department of Otolaryngology Head & Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Seth Cohen
- Surgery, Duke University Medical Center, DUMC Box 3805, Durham, NC, USA.
| |
Collapse
|
19
|
Bertelsen C, Jacobson L, Osterbauer B, Hochstim C. Safety and efficacy of Early injection laryngoplasty in pediatric patients. Laryngoscope 2018; 129:1699-1705. [DOI: 10.1002/lary.27436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/08/2018] [Accepted: 06/18/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Caitlin Bertelsen
- Caruso Department of Otolaryngology-Head and Neck Surgery; Los Angeles California U.S.A
| | - Lia Jacobson
- Caruso Department of Otolaryngology-Head and Neck Surgery; Los Angeles California U.S.A
| | - Beth Osterbauer
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Los Angeles; Keck School of Medicine of the University of Southern California; Los Angeles California U.S.A
| | - Christian Hochstim
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Los Angeles; Keck School of Medicine of the University of Southern California; Los Angeles California U.S.A
| |
Collapse
|
20
|
Crowson MG, Tong BC, Lee HJ, Song Y, Harpole DH, Jones HN, Cohen S. Prevalence and resource utilization for vocal fold paralysis/paresis after esophagectomy. Laryngoscope 2018; 128:2815-2822. [PMID: 30229921 DOI: 10.1002/lary.27252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/12/2018] [Accepted: 04/06/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold paralysis/paresis (VFP) is an uncommon but serious complication following esophagectomy. The objectives of this study were to: 1) identify the prevalence of VFP and associated complications after esophagectomy in the United States, and 2) determine the utilization and otolaryngology-head and neck surgery/speech-language pathology (OHNS/SLP) and predictors of such utilization in the management of these patients. STUDY DESIGN Retrospective database analysis. METHODS The National Inpatient Sample (NIS) represents a 20% stratified sample of discharges from US hospitals. Using International Classification of Diseases, Ninth Revision, Clinical Modification codes, patients undergoing esophagectomy between 2008 and 2013 were identified in the NIS. Subcohorts of patients with VFP and OHNS/SLP utilization were also identified. Weighted logistic regression models were used to compare binary outcomes such as complications; generalized linear models were used to compare total hospital charges and length of stay (LOS). RESULTS We studied 10,896 discharges, representing a weighted estimate of 52,610 patients undergoing esophagectomy. The incidence of VFP after esophagectomy was 1.96%. Compared to those without VFP, patients with VFP had a higher incidence of postoperative pneumonia, more medical complications, and were more likely to undergo tracheostomy; hospital charges and LOS were also higher. Of the patients with VFP, 35.0% received OHNS/SLP intervention. CONCLUSIONS VFP after esophagectomy is associated with postoperative complications, prolonged LOS, and higher hospital costs. OHNS/SLP intervention occurred in roughly one-third of postesophagectomy VFP patients, suggesting there may be opportunities for enhanced evaluation and management of these patients. LEVEL OF EVIDENCE 4 Laryngoscope, 128:2815-2822, 2018.
Collapse
Affiliation(s)
- Matthew G Crowson
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Betty C Tong
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, U.S.A
| | - Yao Song
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, U.S.A
| | - David H Harpole
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Harrison N Jones
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Seth Cohen
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| |
Collapse
|
21
|
Voice outcome measures after flexible endoscopic injection laryngoplasty. World J Otorhinolaryngol Head Neck Surg 2018; 4:130-134. [PMID: 30101223 PMCID: PMC6074013 DOI: 10.1016/j.wjorl.2018.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 11/22/2022] Open
Abstract
Objective To report voice outcome measures after injection laryngoplasty using the transnasal or transoral flexible endoscopic technique. Methods A retrospective review of all patients who underwent flexible endoscopic injection laryngoplasty between June 2010 and August 2016 was carried out. Only those patients who had pre- and post-injection voice outcome measures recorded were included. Voice outcome measures recorded included perceptual voice evaluation using GRBAS, Voice Handicap Index-10 (VHI-10), maximum phonation time (MPT) and closed quotient (CQ) before and after treatment. Results Forty-six patients were identified, of which 32 had pre- and post-injection voice outcome measures recorded. There were 19 males and 13 females. The mean age was 56.97 years (range 20-86 years) and the most common indication was unilateral vocal fold paralysis. Thirteen patients had a transnasal flexible endoscopic injection), while 19 patients were injected transorally. Following injection laryngoplasty, there was significant improvement in the mean grade of dysphonia (2.81 vs. 1.22, P < 0.01, roughness (2.44 vs. 1.34, P < 0.01), breathiness (2.72 vs. 1.13, P < 0.01), asthenia (2.78 vs. 1.06, P < 0.01), and strain (2.44 vs. 1.19, P < 0.01), MPT (3.85 s vs. 9.85 s, P < 0.01) and mean CQ (0.19 vs. 0.46, P < 0.01). There was also a decrease in the mean VHI-10 score (33.31 vs. 7.94, P < 0.01). Conclusion s: Patients achieved significant improvement in both subjective and objective voice measures after flexible endoscopic injection laryngoplasty via the nasal or transoral route. Voice outcomes were comparable to those reported for other approaches. This technique provides an alternative approach for the management of patients with vocal fold paralysis or glottal insufficiency.
Collapse
|
22
|
Anis MM, Memon Z. Injection medialization laryngoplasty improves dysphagia in patients with unilateral vocal fold immobility. World J Otorhinolaryngol Head Neck Surg 2018; 4:126-129. [PMID: 30101222 PMCID: PMC6074009 DOI: 10.1016/j.wjorl.2018.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/11/2018] [Indexed: 11/26/2022] Open
Abstract
Objective To assess patient reported swallowing outcomes before and after injection medialization laryngoplasty in patients with unilateral vocal fold immobility (UVFI). Methods Case series with chart review of patients with UVFI who underwent injection medialization laryngoplasty at a community laryngology practice by a single clinician between October 2015 and December 2017. Patient-reported validated surveys of swallowing impairment, Eating Assessment Tool (EAT-10), demographics, etiology and duration of symptoms were recorded before and after injection. A paired t test was done on EAT-10 surveys before and after IML to assess for statistical significance. Results Twenty-one patients with UVFI and glottic insufficiency underwent IML between October 2015 and December 2017. Nineteen of 21 patients (90%) presented with dysphagia (EAT-10 ≥ 3). 76% of patients with dysphagia reported improvement in swallowing function after IML. The EAT-10 scores of UVFI patients with dysphagia before and after IML were 17.0 ± 14.0 and 4.2 ± 9.6, respectively (p = 0.004). Conclusions Nearly all patients with UVFI and glottic insufficiency report associated dysphagia. Three fourths of these patients perceive improvement in their swallowing function after injection medialization laryngoplasty. Patients with idiopathic UVFI may have a more sustained improvement and those with severe preop dysphagia may not benefit. Further research is necessary to refine patient selection and to assess duration of improved swallowing function.
Collapse
Affiliation(s)
- Mursalin M Anis
- Coastal Ear, Nose and Throat, Neptune, NJ, USA.,Department of Otolaryngology, University of Miami, Miami, FL, USA
| | | |
Collapse
|
23
|
Miles A, McLellan N, Machan R, Vokes D, Hunting A, McFarlane M, Holmes J, Lynn K. Dysphagia and laryngeal pathology in post-surgical cardiothoracic patients. J Crit Care 2018; 45:121-127. [DOI: 10.1016/j.jcrc.2018.01.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 01/05/2023]
|
24
|
Kaye R, Sinclair C, Blitzer A. The saline challenge-A test of injection laryngoplasty outcome. Laryngoscope 2017; 128:1182-1185. [PMID: 28990675 DOI: 10.1002/lary.26933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/11/2017] [Accepted: 08/29/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Rachel Kaye
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Catherine Sinclair
- Department of Otolaryngology, Mount Sinai Icahn School of Medicine, New York, New York, U.S.A.,Head and Neck Surgical Group, New York, New York, U.S.A
| | - Andrew Blitzer
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Head and Neck Surgical Group, New York, New York, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A
| |
Collapse
|
25
|
Chen DW, Price MD, LeMaire SA, Coselli JS, Liou NE, Ongkasuwan J. Early versus late inpatient awake transcervical injection laryngoplasty after thoracic aortic repair. Laryngoscope 2017; 128:144-147. [DOI: 10.1002/lary.26747] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/12/2017] [Accepted: 05/23/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Diane W. Chen
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine; Houston Texas U.S.A
| | - Matt D. Price
- Department of Cardiothoracic Surgery; Baylor College of Medicine; Houston Texas U.S.A
| | - Scott A. LeMaire
- Department of Cardiothoracic Surgery; Baylor College of Medicine; Houston Texas U.S.A
| | - Joseph S. Coselli
- Department of Cardiothoracic Surgery; Baylor College of Medicine; Houston Texas U.S.A
| | - N. Eddie Liou
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine; Houston Texas U.S.A
| | - Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine; Houston Texas U.S.A
| |
Collapse
|
26
|
Anticoagulation and antiplatelet therapy in awake transcervical injection laryngoplasty. Laryngoscope 2017; 127:1850-1854. [DOI: 10.1002/lary.26508] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 11/12/2016] [Accepted: 12/16/2016] [Indexed: 11/07/2022]
|
27
|
Sulica L, Mor N. In-Office Laryngeal Injection. CURRENT OTORHINOLARYNGOLOGY REPORTS 2015. [DOI: 10.1007/s40136-015-0100-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
28
|
Krouse JH. Highlights from the Current Issue: December 2015. Otolaryngol Head Neck Surg 2015; 153:899-900. [PMID: 29135390 DOI: 10.1177/0194599815611622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John H Krouse
- 1 Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|