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Adkins DM, Fritz MA. Airway Complications Following Vocal Fold Injection Augmentation: A Case Series and Review of Literature. J Voice 2024:S0892-1997(24)00058-4. [PMID: 38584028 DOI: 10.1016/j.jvoice.2024.02.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE This case series seeks to describe three specific airway complications following vocal fold injection augmentation procedures, involving carboxymethylcellulose gel. The literature review focused on adverse events linked to carboxymethylcellulose within the field of otolaryngology as well as beyond. STUDY DESIGN Case series. METHODS This series reviews the management of three patients who suffered severe airway complications following vocal fold injection augmentations from December 2020 to August 2021 RESULTS: All three of these patients received the RENÚ brand carboxymethylcellulose injection material. All three patients developed respiratory distress and stridor shortly following the injections, two before leaving the operating room and the third in the postanesthesia care unit. Both patients re-intubated in the operating room were found to have supraglottic edema upon direct laryngoscopy. All three patients required prompt re-intubation, and one patient required a temporary tracheostomy. None of these three patients were known to have a history of angioedema or anaphylaxis. CONCLUSIONS Vocal fold injection augmentation has long been considered a safe and effective means to improve glottic closure and treat dysphonia in patients with anatomic deficiencies of the vocal folds. While the listed ingredients are consistent between Prolaryn (Merz Pharmaceuticals, Raleigh, NC) and RENÚ (Inhealth Technologies, Carpinteria CA), studies directly comparing the two materials have only been performed in animals. This case series recognizes an important cluster of complications worth further study and postmarket surveillance.
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Affiliation(s)
| | - Mark A Fritz
- University of Kentucky College of Medicine, Lexington, Kentucky.
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Kim DW, Lee H, Ji JY, Mohammad RT, Huh G, Jeong WJ, Cha W. Superior Laryngeal Nerve Block in Transcutaneous Vocal Fold Injection: A Pilot Study. J Voice 2023:S0892-1997(23)00108-X. [PMID: 37164832 DOI: 10.1016/j.jvoice.2023.03.015] [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] [Received: 02/05/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Topical lidocaine remains the mainstay for anesthesia in transcutaneous vocal fold injection (VFI). While using topical lidocaine, laryngologists sometimes encounter uncontrolled reflexes or poor compliance. Superior laryngeal nerve block (SLNB) provides deep and rapid anesthesia on the larynx above the vocal folds and abolishes the glottic closure reflex. Herein, we present a pilot study to evaluate the feasibility and safety of SLNB for transcutaneous VFI and explored its usefulness. METHODS Fifty-nine patients were prospectively anesthetized with SLNB during transcutaneous VFI for unilateral vocal fold paralysis. In the SLNB group, 0.5 to 1 mL of 2% lidocaine was infiltrated on bilateral SLNs through the thyrohyoid membrane. As the control group, we included previous 47 patients who underwent VFI with topical lidocaine. In the control group, 10% lidocaine spray was applied to the laryngopharyngeal mucosa. Demographic data, laryngeal exposure, patient compliance, procedural interruption, and complications were investigated. Patient compliance was evaluated based on the frequency of cough and swallowing during VFI procedures. RESULTS SLNB enabled endoscopic contact on the epiglottis and pharyngeal wall without gag reflex and provided good exposure of the procedure field on the vocal folds. In the SLNB group, the laryngeal exposure is significantly better than in the control (P = 0.005). The frequency of cough and swallowing was significantly lower in the SLNB group than in the control (P < 0.001). The number of procedural interruptions was lower in the SLNB group than in the control (P < 0.001). There was no acute or delayed complication related to SLNB such as bleeding, hematoma, delayed sensory/swallowing problems, or unscheduled hospital visits. CONCLUSIONS SLNB might be safe and effective for anesthesia in transcutaneous VFI. SLNB could be a good anesthetic option for patients with poor compliance despite the sufficient application of topical lidocaine. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Do Won Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hanju Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jeong-Yeon Ji
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Otorhinolaryngology-Head & Neck Surgery, Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ramla Talib Mohammad
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Gene Huh
- Department of Otorhinolaryngology-Head & neck Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Otorhinolaryngology-Head & Neck Surgery, Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Otorhinolaryngology-Head & Neck Surgery, Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Kruse CM, Hoffman MR, Hennessy BN, Schoeff SS, Dailey SH. Voice Outcomes Following Serial Office-Based Steroid Injections and Voice Therapy for Vocal Fold Scar. J Voice 2023:S0892-1997(23)00093-0. [PMID: 37076383 DOI: 10.1016/j.jvoice.2023.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Previous studies indicate that certain voice outcomes can improve following a single office-based steroid injection with voice therapy for vocal fold scar. We evaluated voice outcomes after a series of three timed office-based steroid injections with voice therapy. STUDY DESIGN Retrospective case series with chart review. SETTING Academic medical center. METHODS We evaluated pre-and postprocedural patient-reported, perceptual, acoustic, aerodynamic, and videostroboscopic parameters. We evaluated 23 patients who underwent three office-based dexamethasone injections into the superficial lamina propria one month apart. All patients pursued voice therapy. RESULTS Voice Handicap Index (n = 19; P= .030) decreased after injection series. Total GRBAS score (grade, roughness, breathiness, asthenia, strain) decreased (n = 23; P = 0.001). Dysphonia severity index score improved (n = 20; P = 0.041). Phonation threshold pressure did not decrease significantly (n = 22; P = 0.536). Videostroboscopic parameters of vocal fold edge (P = 0.023), right mucosal wave (P = 0.023) improved or normalized after injection series. Glottic closure (P = 0.134) did not improve. CONCLUSIONS Series of three office-based steroid injections combined with voice therapy for vocal fold scar does not appear to provide further benefit than one injection. Despite lack of improvements of PTP and other parameters, injection series is likewise unlikely to worsen dysphonia. A partially negative study provides value in investigation of less invasive treatment alternatives for a disorder that is challenging to treat. Future studies exploring effects of voice therapy alone without other intervention and consideration of sham injection versus steroid injection are warranted.
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Affiliation(s)
- Chelsea M Kruse
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Matthew R Hoffman
- Department of Otolaryngology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Brienne N Hennessy
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | | | - Seth H Dailey
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
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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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Panossian H, Pasick LJ, Sataloff RT. Anatomical Study of Two Cricothyroid Approaches to the Cadaver Larynx. J Voice 2020; 35:360-364. [PMID: 31889649 DOI: 10.1016/j.jvoice.2019.11.007] [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] [Received: 09/16/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to measure the angle and depth at which the vocal folds are accessed via transcutaneous injection through two different approaches through the cricothyroid membrane. METHODS Twenty-five cadavers preserved with formalin were studied. The larynges were bisected through the thyroid notch, and the skin and soft tissue were removed. A 27-gauge needle was inserted through the cricothyroid membrane, once from just inferior to the thyroid cartilage and once from just superior to the cricoid cartilage, and advanced to the midpoint of the musculomembranous vocal fold (determined as the halfway point from anterior commissure to vocal process), immediately lateral to the vocalis muscle without penetrating the epithelium. The angle of approach was determined after taking multiple measurements with a Castroviejo caliper. The depth of the needle was measured. RESULTS Ten male and 15 female cadavers were studied. Their average age was 85.5 ± 12.4 years. The mean distance from midline for an injection performed with 0° of lateral angle was 5.7 ± 0.7 mm for the males, which was significantly greater than for females (4.8 ± 0.8 mm, P = 0.012). The insertion angle for the infrathyroid approach was 22.2 ± 6.9°, which was significantly different from the supracricoid angle, which was 33.0 ± 5.2° (P < 0.001). The mean insertion depth of the subthyroid approach was 11.3 ± 1.8 mm (range 8.0-15.5 mm), which was significantly less than the depth for the supracricoid approach (18.2 ± 2.4 mm, range 11.0-22.0 mm, P < 0.001.). The infrathyroid approach angle for males was 26.0 ± 8.5°, which was significantly greater than the angle for females (19.3 ± 3.4°, P = 0.016.). The supracricoid approach angle for males was 37.5 ± 2.4°, which was significantly greater than the angle for females (29.7 ± 4.1°, P < 0.001.). The insertion depth for males was 19.6 ± 1.4 mm, which was significantly greater than that for females (17.2 ± 2.6 mm, P = 0.021). CONCLUSIONS Comparison of a supracricoid and infrathyroid approach through the cricothyroid membrane to the middle third of the vocal folds demonstrated significant differences in angle of approach. We also identified a significant difference in the angle of entry between male and female larynges in both approaches, as well as an increased depth of insertion required in males for the supracricoid approach.
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Affiliation(s)
- Haig Panossian
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Luke J Pasick
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
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Singh SK, Gupta SK. Vocal Fold Insufficiency: How Effective is Injection Laryngoplasty? Short Term Clinical Outcomes. Indian J Otolaryngol Head Neck Surg 2019; 71:960-966. [PMID: 31742102 DOI: 10.1007/s12070-019-01642-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/15/2019] [Accepted: 04/03/2019] [Indexed: 11/28/2022] Open
Abstract
Office based Injection Laryngoplasty has become a common and feasible method of addressing vocal fold insufficiency (VFI) resulting from a plethora of aetiologies. Contemporary to various injectates, Calcium Hydroxylapatite has met with great success across usage with various techniques. But, irrespective of the technique and injectate material, the burning question in mind of "realistic" clientele remains, "How soon will I have by voice back?". Aim of this study is to evaluate the short term (3 months postoperative) effects of Injection Laryngoplasty in cases of VFI using Calcium Hydroxylapatite via trans cricothyroid route, in terms of both objective and subjective parameters. 12 patients with mean age of 35.67 years underwent vocal fold injections (via transnasal flexible fibreoptic laryngoscopic guided trans-cricothyroid membrane approach using CaHA) for VFI. The pre injection and 1, 2- and 3-months post injection scores' changes in outcome measures in form of videostroboscopic parameters, Voice Handicap Index scores and acoustic analysis were compiled and analysed. 91.6% of patients showed statistically significant benefit after 3 months post injection. 0.1% patients showed loss of benefit of the CaHA material even 3 months post injection. Average length of benefit was 1-month post injection. No significant complication was observed in any patient. We conclude that the objective evidence of structural and functional improvement may be seen immediately post injection laryngoplasty, minimum of 3 months is required for evident improvement in patient's perception of his own voice in terms of Quality of Life parameters.
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Affiliation(s)
- S K Singh
- 1Department of ENT & HNS, Army Hospital (Research and Referral), Delhi Cantt, Delhi 110010 India
| | - Salil Kumar Gupta
- 2Department of ENT & HNS, Command Hospital (Eastern Command), Kolkata, West Bengal 700027 India
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7
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van den Broek EMJM, Heijnen BJ, Hendriksma M, van de Kamp-Lam VAH, Langeveld APM, van Benthem PPG, Sjögren EV. Bilateral vocal fold injection with autologous fat in patients with vocal fold atrophy with or without sulcus. Eur Arch Otorhinolaryngol 2019; 276:2007-2013. [PMID: 31134359 PMCID: PMC6581917 DOI: 10.1007/s00405-019-05479-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/16/2019] [Indexed: 11/20/2022]
Abstract
Purpose To evaluate voice outcome after bilateral vocal fold injection with autologous fat in patients with non-paralytic glottic insufficiency due to vocal fold atrophy with or without sulcus. Methods This is a retrospective cohort study from September 2012 to December 2017 including 23 patients undergoing bilateral vocal fold injection with autologous fat (24 procedures) for vocal fold atrophy (15 procedures) or atrophy with sulcus (Ford type II or III) (9 procedures). Voice data were collected and analyzed for the preoperative and the 3- and 12-month postoperative time points according to a standardized protocol, including Voice Handicap Index (VHI)-30 and perceptive, acoustic and aerodynamic parameters. Failure rate was defined as non-relevant improvement (< 10 points) in VHI-30 at 12 months and number of revisions within 12 months. Results There was a clinically relevant (≥ 15 points) and statistically significant improvement in the VHI-30 (preoperative: 49.1 points; postoperative at 12 months: 29.7 points). Change in dynamic range was also statistically significant over time (p = 0.028). There were no differences in voice parameters between patients with atrophy only and atrophy with sulcus, although grade tended to be lower in patients with atrophy only over all time points. Conclusion This study shows that bilateral vocal fold injection with autologous fat is a beneficial treatment not only for patients with atrophy but also for patients with sulcus. A comparison of the results with those reported from other forms of sulcus surgery confirmed this finding. However, there is a need for further prospective studies comparing the short- and long-term effects of different techniques.
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Affiliation(s)
- Emke M J M van den Broek
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-box 9600, 2300 RC, Leiden, The Netherlands.
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Centre, Utrecht, The Netherlands.
| | - Bas J Heijnen
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-box 9600, 2300 RC, Leiden, The Netherlands
| | - Martine Hendriksma
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-box 9600, 2300 RC, Leiden, The Netherlands
| | - Vivienne A H van de Kamp-Lam
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-box 9600, 2300 RC, Leiden, The Netherlands
| | - Antonius P M Langeveld
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-box 9600, 2300 RC, Leiden, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-box 9600, 2300 RC, Leiden, The Netherlands
| | - Elisabeth V Sjögren
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-box 9600, 2300 RC, Leiden, The Netherlands
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Cha W, Jang JY, Wang SG, Kang JH, Jo MG. Liquid-type Botulinum Toxin Type A in Adductor Spasmodic Dysphonia: A Prospective Pilot Study. J Voice 2017; 31:378.e19-24. [PMID: 27520509 DOI: 10.1016/j.jvoice.2016.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Botulinum toxin (BTX) has been widely used to treat adductor spasmodic dysphonia (ADSD). Most commercially available forms of BTX require reconstitution before use, which may increase the risk of contamination and requires careful titration. Recently, a liquid-type BTX type A (BTX-A) has been developed, which should simplify the procedure and enhance its efficacy. Herein, we present a prospective pilot study to investigate the efficacy and safety of liquid-type BTX-A in the treatment of ADSD. METHODS Twenty-six consecutive liquid-type BTX-A injections were performed in 12 patients with ADSD. We included as a control group 34 consecutive patients with ADSD who had previously undergone 52 vocal fold injection procedures with freeze-dried-type BTX-A. RESULTS All patients in both groups had improvement of symptoms related to ADSD and period of normal voice. Most patients experienced breathiness, and the onset time, the peak response time, and the duration of breathiness were similar in both groups. The duration of effect (days) was 96.96 ± 18.91 and 77.38 ± 18.97 in the freeze-dried-type and the liquid-type groups, and the duration of benefit (days) was 80.02 ± 18.24 and 62.69 ± 19.73 in the freeze-dried-type and the liquid-type groups. To compare the efficacy between the freeze-dried-type and the liquid-type BTX-A, the sessions of the unilateral vocal fold injection were included and were categorized as group A (1 ~ 2 units BTX-A) and group B (2 ~ 3 units BTX-A), according to the dose per vocal fold. There was no significant difference of effect time between freeze-dried-type and liquid-type BTX-A groups. No adverse events related to BTX or vocal fold injection were reported. CONCLUSIONS Liquid-type BTX-A is safe and effective for the treatment of spasmodic dysphonia. With the advantages of simple preparation, storage, and reuse and animal protein-free constituents, liquid-type BTX-A may be a good option in the treatment of spasmodic dysphonia.
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Bothe C, López M, Quer M, León X, García J, Lop J. [Aetiology and treatment of vocal fold paralysis: retrospective study of 108 patients]. Acta Otorrinolaringol Esp 2014; 65:225-30. [PMID: 24780305 DOI: 10.1016/j.otorri.2014.02.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 02/05/2014] [Accepted: 02/09/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To review the aetiology and treatment of laryngeal paralysis diagnosed at our hospital and to describe the available therapeutic options. METHODS Retrospective review of medical records of 108 patients diagnosed with unilateral and bilateral vocal fold paralysis between 2000 and 2012, identifying the cause of paralysis and its treatment. RESULTS Of the 108 cases analysed, 70% had unilateral vocal fold immobility and 30% bilateral immobility. The most frequent aetiology in both cases was trauma (represented mainly by surgical injury), followed by tumours in unilateral paralysis and medical causes in bilateral paralysis. Half of the patients with unilateral paralysis (38) were treated surgically, with medialization thyroplasty. In bilateral vocal fold immobility, the treatment consisted of tracheostomy in patients with threatened airway (40%). We planned to widen the air passage in 9 patients (27%), performing cordectomy in most of them. CONCLUSIONS The aetiology observed in our patients is similar to that described in the literature. In cases of unilateral vocal fold paralysis, we believe thyroplasty is the procedure of choice. In bilateral paralysis, it is possible to perform cordectomy in selected patients once the airway has been secured.
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Affiliation(s)
- Carolina Bothe
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Joan Lop
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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Clary MS, Milam BM, Courey MS. Office-based vocal fold injection with the laryngeal introducer technique. Laryngoscope 2014; 124:2114-7. [PMID: 24577997 DOI: 10.1002/lary.24659] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 12/30/2013] [Accepted: 02/14/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS There are numerous techniques for awake laryngeal injection, each with its limitations and technical challenges. We demonstrate a modification to the thyrohyoid approach for injection that stabilizes needle introduction and allows for consistent placement in a wide variety of larynges. STUDY DESIGN Retrospective review at a tertiary care institution. METHODS A retrospective review was performed of the charts for patients consecutively undergoing awake vocal fold injection laryngoplasty in 2013 for glottic insufficiency due to unilateral vocal fold paralysis, vocal fold atrophy, or sulcus vocalis using the laryngeal introducer technique. The consistency of needle placement, ease of technique, and patient tolerance was assessed. The technique utilizes a curved 1.5-inch 18-gauge needle as a laryngeal introducer through the thyroid notch. Laryngeal injection augmentation is then performed using a curved 3.5-inch 25-gauge spinal needle through the introducer. RESULTS Twenty-one patients were identified who underwent awake vocal fold injection laryngoplasty for glottic insufficiency. All 21 injections were successfully placed. Five of seven injections attempted by resident physicians were able to be completed without attending assistance. Patient experience data demonstrated good tolerance, with a preference for the awake procedure as compared to that performed under general anesthesia. CONCLUSIONS The laryngeal introducer technique is a novel way of performing awake laryngeal injections. It provides a high rate of success, the ability to be consistently performed by inexperienced clinicians, and is well tolerated by patients.
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Affiliation(s)
- Matthew S Clary
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
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Mallur PS, Rosen CA. Vocal fold injection: review of indications, techniques, and materials for augmentation. Clin Exp Otorhinolaryngol 2010; 3:177-82. [PMID: 21217957 DOI: 10.3342/ceo.2010.3.4.177] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 11/11/2010] [Indexed: 11/27/2022] Open
Abstract
Vocal fold injection is a procedure that has over a 100 year history but was rarely done as short as 20 years ago. A renaissance has occurred with respect to vocal fold injection due to new technologies (visualization and materials) and new injection approaches. Awake, un-sedated vocal fold injection offers many distinct advantages for the treatment of glottal insufficiency (vocal fold paralysis, vocal fold paresis, vocal fold atrophy and vocal fold scar). A review of materials available and different vocal fold injection approaches is performed. A comparison of vocal fold injection to laryngeal framework surgery is also undertaken. With proper patient and material selection, vocal fold injection now plays a major role in the treatment of many patients with dysphonia.
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