Evaluation of Size, Laterality, and Location of Unilateral Vocal Fold Lesions on Voice Quality

INTRODUCTION

The presence of a vocal fold mass implies high mechanical stress at the vocal fold base during vibration and an impaired glottic closure. However, evidence about its potential effects on diagnostic tools used in voice evaluation is lacking. We aimed to evaluate the impact of the location, laterality, and size of a unilateral unique vocal fold lesion on patient self-assessment questionnaires, acoustic-aerodynamic voice measures, and perceptual voice evaluation (GRBAS scale).

METHODS

A retrospective chart review involving patients with a diagnosis of a unique unilateral vocal fold lesion and a complete voice evaluation was performed. A total of 58 patients were enrolled and demographics, characteristics of the vocal fold lesion (size, laterality, and location), self-assessment questionnaires, acoustic-aerodynamic measures, and perceptual evaluation (GRBAS scale) were analyzed. Pearson correlation and ANOVA analysis were completed to evaluate the correlation between the clinical characteristics of the vocal fold mass and self-assessment questionnaires, and to compare the level of significance for the differences between the continuous variables between groups of patients once stratified according to the location or laterality of the vocal fold mass.

RESULTS

Glottal Function Index was found to correlate with the location of the vocal fold mass (P < 0.05), however, no correlation was found when evaluating the Reflux Symptom Index or the Voice Handicap Index (P > 0.05). Patients with a lesion located in the anterior-middle 2/3 of the vocal fold were found to have a higher mean Glottal Function Index and (G) component of the GRBAS scale (P < 0.05). No differences were observed when analyzing the remaining self-assessment questionnaires or the acoustic-aerodynamic voice measures according to size, location, or laterality of the vocal fold lesion (P > 0.05).

CONCLUSION

The size and location of unilateral vocal fold lesions were found to have no effect on the majority of measures analyzed in this study. This is the first study we know of to assess the effect that laterality of the vocal fold lesion may have on the self-assessment questionnaires, audio-perceptual, and acoustic-aerodynamic measures included in this study. Our study found no significant differences in regard to laterality. This may indicate that other factors (eg, stiffness of lesion, amount of extraneous muscle tension, etc) could have more of an impact on audio-perceptual, self-assessment questionnaires, and acoustic-aerodynamic measures. Further research with larger cohort sizes and possibly prospective analysis is needed.

Sinonasal Outcomes Using Oral Corticosteroids in Patients with Chronic Rhinosinusitis with Nasal Polyps and Positive Sinonasal Cultures

Introduction Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and positive sinonasal bacterial cultures may be recalcitrant to topical therapy alone due to the additional local inflammatory burden associated with bacterial infection/colonization.

Objective To evaluate sinonasal outcomes in CRSwNP patients with a positive perioperative bacterial culture, who were treated with postoperative intranasal corticosteroids (INCS) alone versus INCS in combination with a short-term course of oral corticosteroids (OCS).

Methods This is a retrospective chart review of CRSwNP patients. A total of 59 patients met inclusion criteria, including positive perioperative bacterial culture and treatment with INCS with or without concomitant use of OCS. Two cohorts were formed based on the chosen postoperative medical treatment; 32 patients underwent postoperative INCS alone, while 27 underwent INCS plus a ≤ 2-week course of OCS. The 22-item sinonasal outcome test (SNOT-22) scores and Lund-Kennedy scores (LKS) were assessed preoperatively, and at 2-week, 4-week, and 4 to 6 months after endoscopic sinus surgery (ESS).

Results There were no statistically significant differences in postoperative sinonasal symptoms or endoscopic scores between the cohorts treated with INCS plus OCS versus those prescribed INCS alone (p > 0.05). Our regression model failed to demonstrate a relationship between the use of OCS and better sinonasal outcomes at 2-week, 4-week, and 4 to 6 months after ESS (p > 0.05).

Conclusion Our study suggests that in a cohort of CRSwNP patients with recent bacterial infections, the postoperative use of combined OCS and INCS did not result in a statistical improvement of endoscopic and symptomatic outcomes over INCS irrigation alone. However, both treatment groups had a clinically significant improvement based on the Minimal Clinically Important Difference.

Giant Gastroduodenal Duplication Cyst with Juxta-Pancreatic Communication

Enteric duplication cysts are rare congenital malformations with a low incidence and there are only a few reports in the literature. Their clinical presentation varies according to the location and the type of duplication. Their overall prognosis is good if early surgical intervention is provided. We report a 2-month-old boy who presented with a case of a giant gastroduodenal duplication cyst with a juxta-pancreatic communication and was successfully treated surgically. It is imperative to be aware of this rare congenital malformation that can present clinically with a wide range of non-specific symptoms that can cause significant morbidity and mortality if the treatment is delayed.

Endoscopic outcomes in patients with AERD treated with topical antibiotics and intranasal corticosteroids

Background

Identifying effective therapy for recalcitrant chronic rhinosinusitis with nasal polyposis (CRSwNP) is a major challenge; and subtypes such as aspirin-exacerbated respiratory disease (AERD) are even more difficult to treat. Evidence on topical antibiotics use in (CRSwNP) is lacking. Current consensus guidelines recommend against its routine use, but recent reviews show some benefit when managing recalcitrant disease after endoscopic sinus surgery (ESS).

Objective

Evaluate the effect of culture-directed topical antibiotics on sinonasal outcomes in AERD patients with a positive perioperative sinonasal bacterial culture who have undergone ESS.

Methods

A retrospective cohort study of AERD patients with positive sinonasal culture, who underwent ESS from 2016 to 2021 was performed. Forty-four patients were identified and stratified based on their postoperative medical treatment. Twenty-six underwent postoperative intranasal corticosteroids (INCS) alone, while eighteen underwent INCS plus a 4-weeks treatment with topical antibiotics. SNOT-22 and Lund-Kennedy score (LKS) were assessed preoperatively and at 4-weeks and 4-6 months after ESS.

Results

A statistically significant improvement in the 4-weeks and 4-6 months postoperative SNOT-22 and LKS were noted within both groups (p&lt;0.05). However, only a statistically significant difference was found in the 4-weeks postoperative LKS when comparing between treatment groups (p=0.01). Our linear regression model demonstrated a relationship between the use of combined therapy with INCS and topical antibiotics and the LKS 4-weeks post ESS (p=0.015).

Conclusion

In AERD patients with a confirmed sinus infection, the combination of culture-directed topical antibiotics and intranasal corticosteroid irrigations in the postoperative period can provide a short-term improvement in endoscopic scores.

Zenker Diverticulum: Does Size Correlate With Preoperative Symptoms?

Introduction Zenker diverticulum (ZD) usually affects adults after the 7th decade of life. Treatment for ZD is indicated for all symptomatic patients, but some patients prefer to defer surgical treatment until symptoms get worse and decrease their quality of life.

Objective To evaluate the association of the preoperative symptoms in ZD patients with the size of the ZD.

Methods A retrospective study design. Electronic medical records were used to identify patients diagnosed with ZD and treated over 11 years. Data collection included the chief complaints and symptoms, medical history, and findings on radiologic swallow evaluations of the patients. The diverticulum size was stratified into 3 groups: small (< 1 cm), moderate (1–3 cm), and large (> 3 cm).

Results A total of 165 patients were enrolled and stratified by diverticulum size (48 small, 67 medium, and 50 large). Dysphagia, cough, and regurgitation were the most prevalent symptoms. Dysphonia was more frequent among patients with a small pouch. Logistic regression analysis showed that dysphagia and choking were associated with large and medium diverticulum size (p < 0.05). Additionally, dysphonia was significantly associated with the presence of a small-sized ZD (p < 0.04).

Conclusion Upper gastrointestinal symptoms such as dysphagia and choking may be associated with a ZD > 1 cm and should always be evaluated. Additionally, the presence of dysphonia was found to be correlated with a ZD < 1 cm, suggesting that a prompt and appropriate fluoroscopic evaluation must be considered in those patients in whom no other clear cause of dysphonia is evident.

Effect of Partial Uncinectomy After Balloon Sinuplasty on Maxillary Sinus Irrigant Penetration: A Cadaveric Study

Objective

The uncinate process may play a role in the amount of irrigation penetrance. In this cadaver study, we aimed to investigate if the addition of partial uncinectomy provides better maxillary sinus irrigation penetrance than balloon sinuplasty (BSP) alone.

Study Design

Cadaveric study.

Setting

Simulation laboratory at the Mayo Clinic in Florida.

Methods

Five fresh-frozen human cadaveric heads (10 sides) were used to assess maxillary sinus irrigation penetration after 3 interventions performed sequentially: irrigation penetrance with no intervention, irrigation after BSP, and irrigation after BSP and partial removal of the uncinate. Penetrance was recorded with intrasinus endoscopy and scored by 4 blinded observers using a scale from 0 (no irrigation) to 5 (fully irrigated). The diameter of the maxillary ostium was measured before and after BSP. Internal consistency was evaluated with Cronbach’s alpha.

Results

Mean ostium size increased from 4.1 to 6.8 mm after BSP (P = .013). Cronbach’s alpha was 0.93. The median scores of irrigation penetration after no intervention, BSP, and BSP and partial uncinectomy were 2.5, 3, and 4, respectively. We found a significantly higher penetrance following partial uncinectomy plus BSP versus BSP alone (P = .008). Both interventions had a statistically significant difference in irrigation penetrance as compared with no intervention (P = .0001).

Conclusion

Maxillary sinus irrigation penetration increased from baseline after BSP. The addition of a partial uncinectomy to the balloon dilation of the maxillary sinus was associated with a statistically significant increase in irrigation penetrance scores as compared with BSP alone.

Patient Experience Contributing to Outcomes of Laryngeal Botulinum Toxin Injection

OBJECTIVES

Laryngeal Botulinum Toxin injection (LBTX) in the adductor musculature is the current therapy for Adductor Spasmodic Dysphonia. This study explores nonbiological factors that can affect the patient experience during this procedure and their association with better or worse self-reported effectiveness.

METHODS

A 14 item survey was used to evaluate the patient experience in patients who had undergone LBTX in Mayo Clinic Jacksonville, Florida, during 2019. Information from the survey, previous medical history, and demographic data were collected, and a descriptive analysis was performed.

RESULTS

Of the 36 patients who participated, the mean age was 65 years and a female predominance was found (66%). The average age at onset of symptoms was 57 years, and voice tremor was associated with 36.1% of patients. Preprocedure education was recognized as a factor affecting outcomes in 87% of patients; 11 patients reported that body position used during the injection could affect the results. Pain or stress experienced at the time of procedure was referred in one-third of patients as an influencing factor too.

CONCLUSION

This study has shown that nonpharmacological factors such as education before the procedure, body position, pain, and stress sensation before LBTX may have a role in the botulinum toxin effect on Adductor Spasmodic Dysphonia patients. This study is the first to describe these variables qualitatively, and further studies may help to improve the patient experience and outcome of LBTX around the world.