Young William G, Hoffman Matthew R, Koszewski Ian J, Whited Chad W, Ruel Brienne N, Dailey Seth H
Proliance Eastside Ear Nose and Throat, Kirkland, Washington, USA.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.
Otolaryngol Head Neck Surg. 2016 Nov;155(5):820-828. doi: 10.1177/0194599816654899. Epub 2016 Aug 9.
Persistent dysphonia from vocal fold scar remains a clinical challenge, with current therapies providing inconsistent outcomes. We evaluated voice outcomes after a single office-based steroid injection.
Case series with chart review.
Academic medical center.
This study was based on pre- and postoperative analysis of patient-reported, perceptual, acoustic, aerodynamic, and videostroboscopic parameters. The sample comprised 25 patients undergoing office-based dexamethasone injection into the superficial lamina propria for mild/moderate vocal fold scar. Average follow-up was 13.7 ± 4.4 weeks; patients completed 3.5 ± 2.3 sessions of voice therapy between assessments. Complete data sets were not available for each parameter; sample size is noted with results.
Voice handicap index (n = 24; P < .001) and glottal function index (n = 22; P < .001) decreased after injection. Total GRBAS score (grade, roughness, breathiness, asthenia, strain) decreased (n = 25; P < .001). Fundamental frequency range increased (n = 24; P = .024). Phonation threshold pressure decreased (n = 14; P = .017). Videostroboscopic parameters of vocal fold edge (P = .004), glottic closure (P = .003), and right mucosal wave (P = .016) improved after injection.
Office-based steroid injection combined with voice therapy for mild/moderate vocal fold scar is associated with improved patient-reported and functional voice measures. These findings provide preliminary support for this approach. Importantly, the procedure is low risk and can be performed in the office, thus offering a simple treatment alternative to patients with a disorder that has traditionally been difficult to manage. Prospective studies evaluating the effects of multiple injections are warranted.
声带瘢痕导致的持续性发音障碍仍是一项临床挑战,目前的治疗效果并不一致。我们评估了在门诊单次注射类固醇后的嗓音结果。
病例系列研究并进行病历回顾。
学术医疗中心。
本研究基于对患者报告的、感知的、声学的、空气动力学的和频闪喉镜检查参数的术前和术后分析。样本包括25例因轻度/中度声带瘢痕在门诊接受地塞米松注射至固有层浅层的患者。平均随访时间为13.7±4.4周;患者在两次评估之间完成了3.5±2.3次嗓音治疗课程。并非每个参数都有完整的数据集;结果中标明了样本量。
注射后嗓音障碍指数(n = 24;P <.001)和声门功能指数(n = 22;P <.001)下降。GRBAS总分(分级、粗糙度、气息声、无力感、紧张度)下降(n = 25;P <.001)。基频范围增加(n = 24;P =.024)。发声阈压力下降(n = 14;P =.017)。注射后声带边缘(P =.004)、声门闭合(P =.003)和右侧黏膜波(P =.016)的频闪喉镜检查参数有所改善。
门诊类固醇注射联合嗓音治疗用于轻度/中度声带瘢痕,与患者报告的嗓音改善和功能性嗓音指标相关。这些发现为这种方法提供了初步支持。重要的是,该手术风险低且可在门诊进行,因此为患有这种传统上难以治疗的疾病的患者提供了一种简单的治疗选择。有必要进行前瞻性研究以评估多次注射的效果。