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Woo P. Platelet-rich plasma in treatment of scar, atrophy, and sulcus: Short- and long-term results. Laryngoscope Investig Otolaryngol 2023; 8:1304-1311. [PMID: 37899871 PMCID: PMC10601577 DOI: 10.1002/lio2.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/30/2023] [Accepted: 08/13/2023] [Indexed: 10/31/2023] Open
Abstract
Objective Platelet-rich plasma (PRP) is rich in growth factors and is easily obtained from blood samples. Long-term data after PRP injection into the larynx should be improved. This study reports the short-term (3 months) and long-term (12 months) voice results after PRP injection. Materials and Methods Sixty-three patients with scars (n = 34), sulcus vocalis (n = 17), recalcitrant nodules (n = 5), atrophy (n = 4), or a combination of these (n = 3) were included (158 injections; median follow-up = 12.3 months). Stroboscopy, voice handicap index (VHI-10), and cepstral spectral index of dysphonia (CSID) before and after treatment (3 months) and at 12 months were tabulated. Results VHI-10 changed from 19.5 to 14 at 3 months and 21 to 15 in the long term. The CSID scores improved from 31 to 21 in the short term and 31 to 26 in the long term (p < 0.001, paired t-test). Patients reported improved vocal effort and stamina with slight VHI or CSID score changes. Stroboscopy revealed improved closure and mucosal waves. Patients with severe dysphonia were less likely to improve compared to those with mild to moderate dysphonia. Some patients showed short-term improvements and then deteriorated back to baseline CSID over time (p < .05, paired t-test). Conclusion Both short- and long-term improvements in voice following PRP injection have been reported. Patients with mild-to-moderate dysphonia had better outcomes. PRP injection is an alternative treatment for patients with mild-to-moderate dysphonia due to vocal fold scarring, sulcus, and atrophy. Level of evidence II Prospective case series treatment.
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Affiliation(s)
- Peak Woo
- Department of Otolaryngology, Head and Neck SurgeryIcahn School of Medicine at Mount SinaiNew YorkNYUSA
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Başer E, Denizoğlu İİ. Mucosal Bridge Reconstruction: A Novel Approach for the Vocal Fold Mucosal Bridge. Ann Otol Rhinol Laryngol 2022; 131:1281-1286. [PMID: 34984939 DOI: 10.1177/00034894211053272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Mucosal Bridges (MBs) are defined as benign connective tissue abnormalities of unclear etiology that extend over the free surface of the vocal fold, are attached to the front and back of the vocal fold but are not attached to its free surface, and are histologically covered by stratified squamous epithelium. In order to overcome these drawbacks, we aimed to retrospectively evaluate and present the preoperative and postoperative results of patients with MB, who were applied the method we call "Mucosal Bridge Reconstruction" (MBR), which we apply as suturing rather than resection of the MB. METHODS Between January 2016 and February 2020, 5 patients who applied to the voice clinic due to dysphonia and were diagnosed with MB via laryngostroboscopic examination and direct laryngoscopy under general anesthesia were included in the study. Dr Speech software was used for acoustic analysis; mean fundamental frequency (fo), jitter %, shimmer %, and noise to harmonic ratio (NHR) were objectively measured and recorded. Voice Handicap Index-10 (VHI-10) was used for positive self-reporting of the severity of vocal symptoms. GRBAS scale (G: Grade, R: Roughness, B: Breathiness, A: Asthenia, and S: Strain) was also used (by the same clinician) for clinic subjective evaluation. RESULTS Patient age ranged from 33 to 55 years and mean patient age was 42 years. Mean duration of symptoms was 22 months (range 16-30). Mean postoperative follow-up time was 14 months (range 6-24). Unilateral MB was observed in all patients (2 left, 3 right). There was a significant improvement in objective and subjective assessment methods in all our patients after surgery. CONCLUSIONS According to the results of our few patients, MBR offers a physiological and anatomical approach to the treatment of patients with MB. The outcomes of delicate microlaryngeal surgery are promising.
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Affiliation(s)
- Engin Başer
- Department of Otorhinolaryngology-Head and Neck Surgery, Ministry of Health, Bandırma, Balıkesir Private Practice, Turkey
| | - İsmail İlter Denizoğlu
- Department of Otorhinolaryngology-Head and Neck Surgery, Ministry of Health, İzmir Private Practice, Turkey
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Cai M, Sun Z, Sun G, Zhang Q, He S. [Autologous fat granule filling combined with microsuture technique for sulcus vocalis]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021; 35:405-409. [PMID: 34304463 PMCID: PMC10128472 DOI: 10.13201/j.issn.2096-7993.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Indexed: 11/12/2022]
Abstract
Objective:To explore and observe voice effect of the resection of the vocal fold sulcus, suture of the vocal fold mucosa, and fat granule packing under the support laryngoscope. Methods:A total of 25 patients with vocal fold sulcus underwent vocal fold sulcus resection under a support laryngoscope. After the vocal fold sulcus was removed, the mucosa on both sides of the vocal fold sulcus was sutured into a pouch. Next the fat granules removed from the abdomen were stuffed into the pouch until the vocal folds were full, and the mucosa was repaired, and then the pouched mucosa was sutured. After the operation, the patients were silent for 2 weeks and followed up at 3, 6, and 12 months postoperatively to observe the state of the vocal fold mucosa and the voice effect of the vocal fold under the stroboscopic laryngoscopy. The main outcome measures were the mucosal movement, fundamental frequency (F0), fundamental frequency perturbation (Jitter), amplitude perturbation (Shimmer), normalized noise energy (NNE), harmony/noise (H/N) and maximum phonation time (MPT). Results: Among the 25 patients, 23 patients had good vocal fold closure and smooth mucosa. Under the stroboscopic laryngoscope, the mucosal movement was good and smooth, and the F0, Jitter, Shimmer, NNE, H/N, MPT were significantly improved, and the voice quality was significantly improved. The other 2 patients had fat particles spillover in the vocal fold. The voice function recovered well after the second treatment. Conclusion:Resection of vocal fold sulcus, suture of vocal fold mucosa, and fat granule packing under support laryngoscope are very effective for the treatment of vocal fold sulcus. Indispensably, the operation is done properly, and the patient silence the voice according to the doctor's advice, thus the voice quality will be satisfactory after the operation. .
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Affiliation(s)
- Mingjing Cai
- Department of Otolaryngology Head and Neck Surgery,Nanjing Tongren Hospital,School of Medicine,Southeast University,Nanjing Tongren ENT Hospital,Nanjing,210002,China
| | - Zihui Sun
- Department of Otolaryngology Head and Neck Surgery,Nanjing Tongren Hospital,School of Medicine,Southeast University,Nanjing Tongren ENT Hospital,Nanjing,210002,China
| | - Guoyan Sun
- Department of Otolaryngology Head and Neck Surgery,Nanjing Tongren Hospital,School of Medicine,Southeast University,Nanjing Tongren ENT Hospital,Nanjing,210002,China
| | - Qingxiang Zhang
- Department of Otolaryngology Head and Neck Surgery,Nanjing Tongren Hospital,School of Medicine,Southeast University,Nanjing Tongren ENT Hospital,Nanjing,210002,China
| | - Shuangba He
- Department of Otolaryngology Head and Neck Surgery,Nanjing Tongren Hospital,School of Medicine,Southeast University,Nanjing Tongren ENT Hospital,Nanjing,210002,China
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Enver N, Azizli E, Akbulut S, Çadallı Tatar E, Yelken MK, Öztürk K, Coşkun H, Birkent AH, Büyükatalay ZÇ, Özgürsoy OB, Oğuz H. Inflammatory complications of vocal fold injection with hyaluronic acid: a multiinstitutional study. Turk J Med Sci 2021; 51:819-825. [PMID: 33350297 PMCID: PMC8203174 DOI: 10.3906/sag-2008-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/21/2020] [Indexed: 11/09/2022] Open
Abstract
Background/aim This study aimed to assess the inflammatory adverse reactions of vocal fold injection laryngoplasty with hyaluronic acid. Materials and methods This study was a retrospective chart review of patients who underwent vocal fold injection augmentation with HA injection from January 2005 to September 2016 in nine different institutions. Demographic data, indication for injection, injection techniques, types of injection material, settings of procedure, and complications were reviewed. The types of complication, onset time, and management of complications were also noted. Results In all, 467 patients were identified. The majority of patients had been injected under general anesthesia (n = 382, 84.7%). For injection material, two different types of hyaluronic acid were used: hyaluronic acid alone or hyaluronic acid with dextranomer. Complications occurred in nine patients (1.9%). The majority of complications were inflammatory reactions (n = 7, 1.47%). Main symptoms were dysphonia and/or dyspnea with an onset of 0 h to 3 weeks after the hyaluronic acid injection. Three patients were hospitalized, one of which was also intubated and observed in the intensive care unit for 24 h. Systemic steroids and antibiotics were the main medical treatment in the majority of cases. There was no statistical difference in complication rates between patients who received hyaluronic acid and those who received hyaluronic acid with dextranomer (P = 0.220). Conclusion Hyaluronic acid can be considered as a safe substance for the injection of vocal folds with a low risk of inflammatory reaction.
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Affiliation(s)
- Necati Enver
- Department of Otolaryngology, Pendik Training and Research Hospital, Marmara University, İstanbul, Turkey
| | - Elad Azizli
- Department of Otolaryngology, Private Practise, İstanbul, Turkey
| | - Sevtap Akbulut
- Department of Otolaryngology, Faculty of Medicine, Yeditepe University, İstanbul, Turkey
| | - Emel Çadallı Tatar
- Department of Otolaryngology, Dışkapı Yıldırım Beyazıt Research and Training Hospital, University of Health Sciences, Ankara,Turkey
| | | | - Kayhan Öztürk
- Department of Otorhinolaryngology, Medicana Konya Hospital, Faculty of Medicine, KTO Karatay University, Konya, Turkey
| | - Hakan Coşkun
- Department of Otolaryngology, Faculty of Medicine, Bursa Uludağ University, Turkey
| | | | - Zahide Çiler Büyükatalay
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Ankara University Ankara, Turkey
| | - Ozan Bağış Özgürsoy
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Ankara University Ankara, Turkey
| | - Haldun Oğuz
- Department of Otolaryngology, Fonomer, Ankara, Turkey
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Abstract
OBJECTIVE Type III sulcus is a pathologic structural deformity of the vocal folds that is challenging to accurately diagnose without endoscopic examination under anesthesia. This study aims to further define the clinical presentation and examination features shared among a patient cohort intraoperatively diagnosed with type III sulcus. STUDY DESIGN Case series with chart review. SETTING Tertiary laryngology practice. SUBJECTS AND METHODS All patients diagnosed intraoperatively with type III sulcus from 2002 to 2014 at a tertiary laryngology practice were included. Clinical history of presenting symptoms, videostroboscopy, and intraoperative and histologic findings were reviewed. RESULTS Twenty-two patients were included in the study. A majority were female (77%) and had a mean age of 32.4 years. All patients endorsed hoarseness, and 86% were defined as professional voice users. Endoscopic examination revealed bilateral type III sulcus in 23% of patients. The most common preoperative stroboscopic findings included decreased mucosal wave (100%), dilated vessel (95%), phase asymmetry (91%), additional benign lesion (91%), and cyst (82%). Histology revealed epithelial changes of atypia and keratosis. CONCLUSION Both the severity of dysphonia and the difficulty observing structural malformations of the vocal folds make type III sulcus challenging to preoperatively diagnose. This study reports the clinical and endoscopic features seen within a cohort of patients with type III sulcus.
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Affiliation(s)
| | - Paul M Paddle
- Department of Otolaryngology-Head and Neck Surgery, Monash Health, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - Ramon A Franco
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Inna A Husain
- Rush University Medical Center, Chicago, Illinois, USA
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Hirano S, Kawamoto A, Tateya I, Mizuta M, Kishimoto Y, Hiwatashi N, Kawai Y, Tsuji T, Suzuki R, Kaneko M, Naito Y, Kagimura T, Nakamura T, Kanemaru SI. A phase I/II exploratory clinical trial for intracordal injection of recombinant hepatocyte growth factor for vocal fold scar and sulcus. J Tissue Eng Regen Med 2017; 12:1031-1038. [PMID: 29084372 DOI: 10.1002/term.2603] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/08/2017] [Accepted: 10/19/2017] [Indexed: 12/31/2022]
Abstract
Vocal fold scar and sulcus are intractable diseases with no effective established treatments. Hepatocyte growth factor (HGF) has preclinically proven to have potent antifibrotic and regenerative effects on vocal fold scar. The current Phase I/II clinical trial aims to examine the safety and effectiveness of intracordal injection of a recombinant human HGF drug for patients with vocal fold scar or sulcus. This is an open-label, dose-escalating, first-in-human clinical trial. Eighteen patients with bilateral vocal fold scar or sulcus were enrolled and divided into three groups: Step I received 1 μg of HGF per vocal fold; Step II received 3 μg of HGF; and Step III received 10 μg of HGF. Injections were administered once weekly for 4 weeks. The protocol treatment was performed starting with Step I and escalating to Step III. Patients were followed for 6 months post-treatment. Local and systemic safety aspects were examined as primary endpoints, and therapeutic effects were assessed as secondary endpoints using voice handicap index-10; maximum phonation time; vocal fold vibratory amplitude; grade, rough, breathy, asthenic, strained scale; and jitter. The results indicated no serious drug-related adverse events in either the systemic or local examinations. In whole-subject analysis, voice handicap index-10, vocal fold vibratory amplitude, and grade, rough, breathy, asthenic, strained scale were significantly improved at 6 months, whereas maximum phonation time and jitter varied. There were no significant differences in phonatory data between the step groups. In conclusion, intracordal injection of a recombinant human HGF drug was safe, feasible, and potentially effective for human patients with vocal fold scar or sulcus.
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Affiliation(s)
- Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuhiko Kawamoto
- Unit of Regenerative Medicine, Institute of Biomedical Research and Innovation/Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Ichiro Tateya
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University, Kyoto, Japan
| | - Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University, Kyoto, Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University, Kyoto, Japan
| | - Nao Hiwatashi
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University, Kyoto, Japan
| | - Yoshitaka Kawai
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University, Kyoto, Japan
| | - Takuya Tsuji
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University, Kyoto, Japan
| | - Ryo Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University, Kyoto, Japan
| | - Mami Kaneko
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasushi Naito
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tatsuo Kagimura
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Tatsuo Nakamura
- Department of Biomaterials, Field of Tissue Engineering, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
| | - Shin-Ichi Kanemaru
- Department of Otolaryngology, Kitano Hospital, Osaka, Japan.,Institute of Biomedical Research and Innovation, Kobe, Japan
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Tsunoda K, Fujimaki Y, Nito T, Yamasoba T, Tayama N, Makiyama K, Murofushi T, Tsunoda A, Ohshima K, Nishiyama K, Kano S, Niimi S. Patients' perceptions of vocal problems: results from a survey in the Tokyo area. Acta Otolaryngol 2015; 135:532-5. [PMID: 25719500 DOI: 10.3109/00016489.2014.999873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Laryngoscopy in cases of sulcus vocalis reveals bowed vocal folds, resulting in a spindle-shaped chink with glottal incompetence. The anatomic and functional problems and resulting incomplete glottal closure during phonation lead to the presenting symptoms of breathy hoarseness, decrease in maximum phonation time (MPT), and vocal fatigue. These symptoms, however, have been reported from the physician's viewpoint, not the patient's. Furthermore, no standardized guidelines for the treatment of sulcus vocalis have been established. Because the general attitude toward sulcus vocalis appears to have become 'It is only a vocal problem and does not significantly affect the patient's well-being,' knowledge of sulcus vocalis has decreased and knowledge about choices of therapy remain limited. We therefore conducted an epidemiological questionnaire survey on this pathological condition in voice clinics in seven hospitals in the Tokyo area to establish preliminary guidelines for the management of sulcus vocalis, in reference to the opinion of the patients. Here we report the summary of our preliminary study 'a survey for sulcus vocalis' and suggest guidelines for the management of such pathological conditions. Although these management guidelines may result in improvement in the symptoms of sulcus vocalis, patients and physicians should be aware that treatment of this condition is difficult and improvement is not guaranteed.
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Affiliation(s)
- Koichi Tsunoda
- Department of Artificial Organs and Medical Device Creation and Otolaryngology, National Hospital Organization, National Tokyo Medical Center, National Institute of Sensory Organs , Tokyo , Japan
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