Department of ENT and Head and Neck Surgery, Université catholique de Louvain, CHU UCL Namur, Avenue du Dr Gaston Therasse 1, 5530, Yvoir, Belgium.
Institut de Recherche Expérimentale et Clinique (IREC), Centre de Technologies Moléculaires Appliquées, Université Catholique de Louvain, Brussels, Belgium.
Eur Arch Otorhinolaryngol. 2022 Sep;279(9):4465-4472. doi: 10.1007/s00405-022-07409-4. Epub 2022 May 19.
Spasmodic dysphonia (SD) or laryngeal dystonia is as a rare vocal disorder characterized by involuntary action-induced endolaryngeal contraction. In the last decade, botulin toxin injection has become the standard treatment in adductor spasmodic dysphonia necessitating repetitive injections. The purpose of this study is to analyze retrospectively data from patients treated with the minimal-invasive transoral radiofrequency-induced thermotherapy (RFITT) of the terminal branches of the recurrent nerve.
Between 2009 and 2015, 11 patients (six females and five males aged from 32 to 91 years) with adductor SD were treated with RFITT. Pre-operative and post-operative vocal assessments (VHI-30, GRBASI, and acoustic-aerodynamics measurements), number of surgical revisions, delay between procedures, and post-operative complications were recorded. Statistical analyses were carried out on the first vocal assessment performed 2-8 weeks after the first procedure.
Based on available data from ten patients, voice handicap index (VHI) showed improvement with a mean value of -17.7 points (p-value (pval) = 0.014, adjusted p-value (adj pval) = 0.21); instability has also revealed improvement in six patients (pval = 0.05, adj pval = 0.31). Four patients underwent only one procedure including one patient showing still long-term beneficial results after 5 years of follow-up. Other patients required one to three new procedures with an average time between procedures of 15.3 months. Over 24 surgeries performed on a total of 11 patients, one definitive treatment-related severe adverse event was reported.
Thanks to long-lasting effect, repetitive treatments are less frequent compared to botulin toxin therapy. In our opinion, RFITT is a promising alternative to botulin toxin as a second-step procedure in case of toxin resistance or patient's lack of compliance.
痉挛性发音障碍（SD）或喉肌痉挛是一种罕见的声带疾病，其特征是不自主的动作引起的内喉收缩。在过去的十年中，肉毒毒素注射已成为治疗内收性痉挛性发音障碍的标准方法，需要重复注射。本研究的目的是回顾性分析接受微创经口射频诱导热疗（RFITT）治疗的终末支返喉神经的患者数据。
2009 年至 2015 年间，11 例（6 名女性，5 名男性，年龄 32-91 岁）接受 RFITT 治疗的内收性 SD 患者。记录术前和术后的嗓音评估（VHI-30、GRBASI 和声学空气动力学测量）、手术修订次数、手术间隔时间和术后并发症。对首次手术后 2-8 周进行的第一次嗓音评估进行统计学分析。
基于 10 例患者的可用数据，嗓音障碍指数（VHI）显示改善，平均分值为-17.7 分（p 值（pval）=0.014，调整后 p 值（adj pval）=0.21）；6 例患者的不稳定性也有所改善（pval=0.05，adj pval=0.31）。4 例患者仅接受了一次手术，其中 1 例在 5 年随访后仍长期受益。其他患者需要 1-3 次新手术，两次手术的平均间隔时间为 15.3 个月。在总共 11 例患者的 24 次手术中，仅报告了 1 例与治疗相关的严重不良事件。
与肉毒毒素治疗相比，由于疗效持久，重复治疗的频率较低。在我们看来，RFITT 是肉毒毒素的一种有前途的替代方法，可作为对毒素耐药或患者不依从的二线治疗方法。
