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Transnasal endoscopic steroid injection: a practical and effective alternative treatment for benign vocal fold disorders.
Laryngoscope. 2013 Jun; 123(6):1464-8.L

Abstract

OBJECTIVES/HYPOTHESIS

Emerging literature has documented the effectiveness of intralesional steroid injection as an alternative treatment for benign vocal fold disorders. However, clinical application is frequently limited by the associated technical demands for adequate anesthesia and precise needle placement. This study investigated the applicability and effectiveness of the more practical and less technically demanding method of transnasal endoscopic steroid injection (TESI).

STUDY DESIGN

Prospective case series.

METHODS

This study recruited 30 patients with vocal nodules and polyps. Dexamethasone was injected into the Reinke's space under local anesthesia via the operating channel of a transnasal flexible laryngoscope in an office setting. Treatment outcome were measured before, 1 month after, and 3 months after the injection, using videolaryngostroboscopy (VLS), maximal phonation time (MPT), 10-item voice handicap index (VHI-10), acoustic analysis, and perceptual evaluation.

RESULTS

VLS examinations at 3 months post-treatment demonstrated that vocal lesions of 10 and 19 patients were resolved or reduced, respectively. Objective measurements showed increased MPT and decreased VHI-10 (P < .05 and P < .01, respectively). Acoustic analysis revealed significant decrease in jitter and shimmer (P < .05). Perceptual evaluation using the GRB (grade, roughness, breathiness) scale also showed improved voice quality (P < .01). Treatment outcomes were similar between vocal nodules and polyps (P > .05). Mild vocal hematoma occurred in three patients following TESI, but resolved spontaneously within 1 month.

CONCLUSIONS

TESI is a simple and practical office-based treatment modality for benign vocal fold lesions, suitable for most otolaryngologists. Treatment outcomes showed significant subjective and objective improvements that were comparable to the results of other injection procedures reported in the literature.

LEVEL OF EVIDENCE

4.

Authors+Show Affiliations

Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23494523

Citation

Wang, Chi-Te, et al. "Transnasal Endoscopic Steroid Injection: a Practical and Effective Alternative Treatment for Benign Vocal Fold Disorders." The Laryngoscope, vol. 123, no. 6, 2013, pp. 1464-8.
Wang CT, Lai MS, Liao LJ, et al. Transnasal endoscopic steroid injection: a practical and effective alternative treatment for benign vocal fold disorders. Laryngoscope. 2013;123(6):1464-8.
Wang, C. T., Lai, M. S., Liao, L. J., Lo, W. C., & Cheng, P. W. (2013). Transnasal endoscopic steroid injection: a practical and effective alternative treatment for benign vocal fold disorders. The Laryngoscope, 123(6), 1464-8. https://doi.org/10.1002/lary.23715
Wang CT, et al. Transnasal Endoscopic Steroid Injection: a Practical and Effective Alternative Treatment for Benign Vocal Fold Disorders. Laryngoscope. 2013;123(6):1464-8. PubMed PMID: 23494523.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transnasal endoscopic steroid injection: a practical and effective alternative treatment for benign vocal fold disorders. AU - Wang,Chi-Te, AU - Lai,Mei-Shu, AU - Liao,Li-Jen, AU - Lo,Wu-Chia, AU - Cheng,Po-Wen, Y1 - 2013/03/14/ PY - 2012/06/03/received PY - 2012/07/17/revised PY - 2012/08/10/accepted PY - 2013/3/16/entrez PY - 2013/3/16/pubmed PY - 2013/7/24/medline SP - 1464 EP - 8 JF - The Laryngoscope JO - Laryngoscope VL - 123 IS - 6 N2 - OBJECTIVES/HYPOTHESIS: Emerging literature has documented the effectiveness of intralesional steroid injection as an alternative treatment for benign vocal fold disorders. However, clinical application is frequently limited by the associated technical demands for adequate anesthesia and precise needle placement. This study investigated the applicability and effectiveness of the more practical and less technically demanding method of transnasal endoscopic steroid injection (TESI). STUDY DESIGN: Prospective case series. METHODS: This study recruited 30 patients with vocal nodules and polyps. Dexamethasone was injected into the Reinke's space under local anesthesia via the operating channel of a transnasal flexible laryngoscope in an office setting. Treatment outcome were measured before, 1 month after, and 3 months after the injection, using videolaryngostroboscopy (VLS), maximal phonation time (MPT), 10-item voice handicap index (VHI-10), acoustic analysis, and perceptual evaluation. RESULTS: VLS examinations at 3 months post-treatment demonstrated that vocal lesions of 10 and 19 patients were resolved or reduced, respectively. Objective measurements showed increased MPT and decreased VHI-10 (P < .05 and P < .01, respectively). Acoustic analysis revealed significant decrease in jitter and shimmer (P < .05). Perceptual evaluation using the GRB (grade, roughness, breathiness) scale also showed improved voice quality (P < .01). Treatment outcomes were similar between vocal nodules and polyps (P > .05). Mild vocal hematoma occurred in three patients following TESI, but resolved spontaneously within 1 month. CONCLUSIONS: TESI is a simple and practical office-based treatment modality for benign vocal fold lesions, suitable for most otolaryngologists. Treatment outcomes showed significant subjective and objective improvements that were comparable to the results of other injection procedures reported in the literature. LEVEL OF EVIDENCE: 4. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/23494523/Transnasal_endoscopic_steroid_injection:_a_practical_and_effective_alternative_treatment_for_benign_vocal_fold_disorders_ L2 - https://doi.org/10.1002/lary.23715 DB - PRIME DP - Unbound Medicine ER -