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The efficacy of injection laryngoplasty in managing unilateral vocal fold paralysis
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
8:16 AM Vocal Quality of Life Improves with Treatment of Laryngopharyngeal Reflux Mary Es A Beaver, MD; Scott M Kaszuba, MD (presenter); Michael G Stewart, MD MPH; C Richard Stasney, MD Houston TX; Pearland TX; Houston TX; Houston TX
Objectives: To determine if vocal quality of life improves with treatment of laryngopharyngeal reflux disease (LPRD). Methods: A prospective case series study was performed on patients with a diagnosis of laryngopharyngeal reflux disease at a tertiary center of laryngology from 6/01 to 12/03. Pre- and posttreatment reflux symptoms, physical examination scores, and vocal quality of life scores were assessed using validated and standardized instruments (Voice Handicap Inventory-10 [VHI-10], Reflux Symptom Index [RSI], and Laryngopharyngeal Reflux Disease Index [LRDI]). Results: A significant improvement in posttreatment vocal quality of life as measured by the VHI-10 was noted (mean score, 8.3) as compared to pretreatment (mean score 13.48,
P ⬍ 0.001). This improvement correlated significantly with improvement in the RSI (posttreatment 12.56 vs pretreatment 18.10, P ⬍ 0.001, Pearson correlation coefficient 0.359). Physical examination score as measured by the LRDI improved with treatment but the degree of improvement did not correlate with improvement in the VHI-10 or the RSI. Conclusions: Treatment of LPRD significantly improves vocal quality of life. Laryngeal reflux symptoms improve with treatment and this improvement correlates with improvement in vocal quality of life.
8:30 AM The Efficacy of Injection Laryngoplasty in Managing Unilateral Vocal Fold Paralysis Siew Shuen Chao, FRCS (presenter); Scott M Graham, MD; Lucy Karnell, PhD; Alexander PM Jay, MD; Henry T Hoffman, MD Singapore Singapore; Iowa City IA; Iowa City IA; Iowa City IA; Iowa City IA
Objectives: To determine the efficacy of injection laryngoplasty with collagen, autologous fat, and gelfoam in patients with unilateral vocal fold paralysis using vocal and swallowing outcome measures. Methods: This retrospective study investigated patients who received injection laryngoplasty for their unilateral vocal fold paralysis. The outcome measures included the GRBAS voice assessment scale (0 ⫽ normal, 3 ⫽ severely abnormal) and patient-reported impact of disease on life (0 ⫽ none, 6 ⫽ severe) and improvement in swallowing function (yes, no). Results: Forty-seven patients (average age, 59.5 years; 28 male) received 58 injections that had pretreatment and posttreatment vocal assessments (with 1 through 5 injections received by 42, 12, 2, 1, and 1, respectively). The first injection was collagen for 74%, fat for 19%, and gelfoam for 7%. The median duration between treatment and follow-up assessment was 42 days. The mean scores of all parameters improved after treatment, with greatest improvement in grade (2.19 ⫾ 0.63 to 0.98 ⫾ 0.68, P ⫽ 0.02), breathiness (1.78 ⫾ 0.91 to 0.49 ⫾ 0.68, P ⫽ 0.03) and asthenia (1.46 ⫾ 0.94 to 0.44 ⫾ 0.60, P ⫽ 0.08). Scores improved in 86% of patients for grade, 45% for roughness, 76% for breathiness, 64% for asthenia, and 73% for impact. Among the 26 patients (55%) who presented with swallowing problems, 70% improved after treatment. Statistical analysis suggested no significant differences in outcome between the various materials injected. Conclusions: This study provides evidence that injection laryngoplasty is an effective treatment for patients with unilateral vocal fold paralysis. Improvements were demonstrated in all 5 vocal parameters and in swallowing following treatment, with the changes in grade and breathiness being significant.
WEDNESDAY
recommended provide only temporary relief. Oral malodor is primarily the result of microbial metabolism. The mouth is home to hundreds of bacterial species with various nutritional preferences. These organisms enjoy proteins, as they digest proteins several fetid substances arise. The role of volatile sulfur compounds (VSC) producing bacteria colonizing over the tongue as a main cause for halitosis was recently understood. Detection of VSC such as methylmercaptan and hydrogen sulfite by utilizing organoleptic and objective methods, one can identify the source. Methods: We developed a rational effective approach to the care of the patient with oral malodor. Following comprehensive evaluation for possible cause for halitosis, most patients seen in an ENT practice were found to have the tongue as the origin. Oral malodor from the overgrowth of proteolytic, anaerobic gram negative bacteria on the crevices of the tongue dorsum can be successfully diagnosed and treated. Results: Bacteriologic analysis from the biofilm and scraped specimens obtained from the tongue dorsum or other oral sites can identify the VSC producing bacteria. Porphyromonas, Prevotella, Actinobacillus and Fusobacterium species were the most common organisms identified from cultures. These sites were primarily the tongue dorsum, gingival pockets, and tonsil crypts. Conclusions: Halitosis is an oral phenomenon, research suggests that almost no cases originate below the tonsils. Halitosis arising from the tongue dorsum from overpopulated VSC producing bacteria can be successfully managed with combination of mechanical cleansing using tongue brushes or scrapes and various chemical solutions. Various chemicals containing essential oils, zinc chloride, and cetylpyridium chloride were found effective in reducing VSC.
Scientific Session—Wednesday P213
8:16 AM Vocal Quality of Life Improves with Treatment of Laryngopharyngeal Reflux Mary Es A Beaver, MD; Scott M Kaszuba, MD (presenter); Michael G Stewart, MD MPH; C Richard Stasney, MD Houston TX; Pearland TX; Houston TX; Houston TX
Objectives: To determine if vocal quality of life improves with treatment of laryngopharyngeal reflux disease (LPRD). Methods: A prospective case series study was performed on patients with a diagnosis of laryngopharyngeal reflux disease at a tertiary center of laryngology from 6/01 to 12/03. Pre- and posttreatment reflux symptoms, physical examination scores, and vocal quality of life scores were assessed using validated and standardized instruments (Voice Handicap Inventory-10 [VHI-10], Reflux Symptom Index [RSI], and Laryngopharyngeal Reflux Disease Index [LRDI]). Results: A significant improvement in posttreatment vocal quality of life as measured by the VHI-10 was noted (mean score, 8.3) as compared to pretreatment (mean score 13.48,
P ⬍ 0.001). This improvement correlated significantly with improvement in the RSI (posttreatment 12.56 vs pretreatment 18.10, P ⬍ 0.001, Pearson correlation coefficient 0.359). Physical examination score as measured by the LRDI improved with treatment but the degree of improvement did not correlate with improvement in the VHI-10 or the RSI. Conclusions: Treatment of LPRD significantly improves vocal quality of life. Laryngeal reflux symptoms improve with treatment and this improvement correlates with improvement in vocal quality of life.
8:30 AM The Efficacy of Injection Laryngoplasty in Managing Unilateral Vocal Fold Paralysis Siew Shuen Chao, FRCS (presenter); Scott M Graham, MD; Lucy Karnell, PhD; Alexander PM Jay, MD; Henry T Hoffman, MD Singapore Singapore; Iowa City IA; Iowa City IA; Iowa City IA; Iowa City IA
Objectives: To determine the efficacy of injection laryngoplasty with collagen, autologous fat, and gelfoam in patients with unilateral vocal fold paralysis using vocal and swallowing outcome measures. Methods: This retrospective study investigated patients who received injection laryngoplasty for their unilateral vocal fold paralysis. The outcome measures included the GRBAS voice assessment scale (0 ⫽ normal, 3 ⫽ severely abnormal) and patient-reported impact of disease on life (0 ⫽ none, 6 ⫽ severe) and improvement in swallowing function (yes, no). Results: Forty-seven patients (average age, 59.5 years; 28 male) received 58 injections that had pretreatment and posttreatment vocal assessments (with 1 through 5 injections received by 42, 12, 2, 1, and 1, respectively). The first injection was collagen for 74%, fat for 19%, and gelfoam for 7%. The median duration between treatment and follow-up assessment was 42 days. The mean scores of all parameters improved after treatment, with greatest improvement in grade (2.19 ⫾ 0.63 to 0.98 ⫾ 0.68, P ⫽ 0.02), breathiness (1.78 ⫾ 0.91 to 0.49 ⫾ 0.68, P ⫽ 0.03) and asthenia (1.46 ⫾ 0.94 to 0.44 ⫾ 0.60, P ⫽ 0.08). Scores improved in 86% of patients for grade, 45% for roughness, 76% for breathiness, 64% for asthenia, and 73% for impact. Among the 26 patients (55%) who presented with swallowing problems, 70% improved after treatment. Statistical analysis suggested no significant differences in outcome between the various materials injected. Conclusions: This study provides evidence that injection laryngoplasty is an effective treatment for patients with unilateral vocal fold paralysis. Improvements were demonstrated in all 5 vocal parameters and in swallowing following treatment, with the changes in grade and breathiness being significant.
WEDNESDAY
recommended provide only temporary relief. Oral malodor is primarily the result of microbial metabolism. The mouth is home to hundreds of bacterial species with various nutritional preferences. These organisms enjoy proteins, as they digest proteins several fetid substances arise. The role of volatile sulfur compounds (VSC) producing bacteria colonizing over the tongue as a main cause for halitosis was recently understood. Detection of VSC such as methylmercaptan and hydrogen sulfite by utilizing organoleptic and objective methods, one can identify the source. Methods: We developed a rational effective approach to the care of the patient with oral malodor. Following comprehensive evaluation for possible cause for halitosis, most patients seen in an ENT practice were found to have the tongue as the origin. Oral malodor from the overgrowth of proteolytic, anaerobic gram negative bacteria on the crevices of the tongue dorsum can be successfully diagnosed and treated. Results: Bacteriologic analysis from the biofilm and scraped specimens obtained from the tongue dorsum or other oral sites can identify the VSC producing bacteria. Porphyromonas, Prevotella, Actinobacillus and Fusobacterium species were the most common organisms identified from cultures. These sites were primarily the tongue dorsum, gingival pockets, and tonsil crypts. Conclusions: Halitosis is an oral phenomenon, research suggests that almost no cases originate below the tonsils. Halitosis arising from the tongue dorsum from overpopulated VSC producing bacteria can be successfully managed with combination of mechanical cleansing using tongue brushes or scrapes and various chemical solutions. Various chemicals containing essential oils, zinc chloride, and cetylpyridium chloride were found effective in reducing VSC.
Scientific Session—Wednesday P213