Lee Sang-Hyuk, Yeo Jang-Ok, Choi Jeong-Im, Jin Hee-Jin, Kim Jin-Pyeong, Woo Seung-Hoon, Jin Sung-Min
Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyeong-dong, Jongno-gu, Seoul, South Korea.
Arch Otolaryngol Head Neck Surg. 2011 Oct;137(10):1011-6. doi: 10.1001/archoto.2011.168.
To analyze the usefulness and safety of a steroid injection into vocal nodules via the cricothyroid membrane. Local administration of steroid directly into the larynx has been reported in many laryngeal diseases with different methods.
Prospective case series at an academic tertiary care hospital.
Eighty patients with vocal nodules were enrolled between December 2008 and May 2010.
Triamcinolone acetonide was injected through the cricothyroid membrane with a transnasal flexible laryngoscope to patients in a sitting position.
Vocal nodules were evaluated before and 2 and 4 weeks after the injection; improvement was assessed both objectively and subjectively.
The nodules disappeared in 35 patients by the fourth week after the injection (44%), and 39 patients showed improvement (49%). Jitter, shimmer, maximum phonation time, and mean voice handicap index also improved significantly after the steroid injection (P < .05 for all). Six patients with voice-related occupations showed improvement at the second week (8%), but the nodules had recurred after 4 weeks. Four patients experienced mild vocal fold atrophy, and 2 patients showed a white plaque formation on the vocal fold that resolved spontaneously 1 to 2 months after the injection.
A local steroid injection via the cricothyroid membrane is a useful and safe treatment option for vocal nodules. However, vocal nodules are caused mainly by excessive voice use; therefore, nodules can recur unless the voice use pattern changes. Further study of this treatment technique, including long-term follow-up, is needed.
分析经环甲膜注射类固醇治疗声带小结的有效性和安全性。已有多种方法将类固醇直接局部应用于喉部治疗多种喉部疾病的报道。
在一家学术性三级医疗中心进行的前瞻性病例系列研究。
2008年12月至2010年5月期间纳入80例声带小结患者。
患者取坐位，通过经鼻可弯曲喉镜经环甲膜注射曲安奈德。
在注射前以及注射后2周和4周对声带小结进行评估；从客观和主观两方面评估改善情况。
注射后第4周，35例患者的小结消失（44%），39例患者病情改善（49%）。类固醇注射后，微扰、振幅微扰、最长发声时间和平均嗓音障碍指数也有显著改善（均P < .05）。6例从事与嗓音相关职业的患者在第2周时病情改善（8%），但4周后小结复发。4例患者出现轻度声带萎缩，2例患者声带出现白色斑块，注射后1至2个月自行消退。
经环甲膜局部注射类固醇是治疗声带小结的一种有效且安全的选择。然而，声带小结主要由过度用嗓引起；因此，除非改变用嗓方式，小结可能复发。需要对该治疗技术进行进一步研究，包括长期随访。
