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Current trends in practices in the treatment of pediatric unilateral vocal fold immobility: A survey on injections, thyroplasty and nerve reinnervation.
Int J Pediatr Otorhinolaryngol. 2018 Jun; 109:115-118.IJ

Abstract

INTRODUCTION

The objective of this study was to poll pediatric otolaryngologists with a special interest in pediatric laryngology on their experience with injection medialization laryngoplasty (IML), thyroplasty, and reinnervation procedures in order to reflect on changing clinical practices.

METHOD

A 10-items questionnaire was designed to inquire about current management practices in the treatment of symptomatic UVFI. The 59 members of an ASPO pediatric laryngology working group received the anonymous online survey. A 47% (28/59) response rate was obtained over a 2 weeks period.

RESULTS

Carboxymethylcellulose gel (Prolaryn) is the most popular injectable material used in the setting of IMLs (preferred by 46%; 13 respondents). Most clinicians perform IMLs in the operating room. However, 14% (4/28) of respondents currently perform office-based injections on older patients. When faced with the case of a young child with longstanding iatrogenic VFP, most respondents (41%; 11/27) would perform an IML alone as a first step for management. 37% (10/27) of respondents would inject and perform a laryngeal EMG while 22% (6/27) would offer reinnervation and concomitant IML. When faced with the case of a teenager with long-standing VFP, the polled physicians' opinions were divided: 37% (10/27) favored reinnervation and concomitant IML, while 26% (7/27) would proceed to an IML only. The remaining 37% (10/27) would first assess for vocal atrophy through LEMG or visual inspection.

CONCLUSIONS

Two significant shifts in practice seem to have occurred. First, ansa-RLN reinnervation procedures are now being considered as a first line treatment for a subset of patients in whom only IML was considered in the past. In fact, more than 20% of respondents did consider this route of management. Second, there is an increased use of in-office augmentations for older pediatric patients.

Authors+Show Affiliations

Department of Pediatric Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St., Boston, MA, 02114, USA. Electronic address: sarah_bouhabel@meei.harvard.edu.Department of Pediatric Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St., Boston, MA, 02114, USA. Electronic address: christopher_hartnick@meei.harvard.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29728162

Citation

Bouhabel, Sarah, and Christopher J. Hartnick. "Current Trends in Practices in the Treatment of Pediatric Unilateral Vocal Fold Immobility: a Survey On Injections, Thyroplasty and Nerve Reinnervation." International Journal of Pediatric Otorhinolaryngology, vol. 109, 2018, pp. 115-118.
Bouhabel S, Hartnick CJ. Current trends in practices in the treatment of pediatric unilateral vocal fold immobility: A survey on injections, thyroplasty and nerve reinnervation. Int J Pediatr Otorhinolaryngol. 2018;109:115-118.
Bouhabel, S., & Hartnick, C. J. (2018). Current trends in practices in the treatment of pediatric unilateral vocal fold immobility: A survey on injections, thyroplasty and nerve reinnervation. International Journal of Pediatric Otorhinolaryngology, 109, 115-118. https://doi.org/10.1016/j.ijporl.2018.03.027
Bouhabel S, Hartnick CJ. Current Trends in Practices in the Treatment of Pediatric Unilateral Vocal Fold Immobility: a Survey On Injections, Thyroplasty and Nerve Reinnervation. Int J Pediatr Otorhinolaryngol. 2018;109:115-118. PubMed PMID: 29728162.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current trends in practices in the treatment of pediatric unilateral vocal fold immobility: A survey on injections, thyroplasty and nerve reinnervation. AU - Bouhabel,Sarah, AU - Hartnick,Christopher J, Y1 - 2018/03/28/ PY - 2018/03/01/received PY - 2018/03/24/revised PY - 2018/03/27/accepted PY - 2018/5/6/entrez PY - 2018/5/8/pubmed PY - 2018/8/29/medline KW - Ansa reinnervation procedure KW - Injection laryngoplasty KW - Injection medialization KW - Thyroplasty KW - Unilateral vocal fold paralysis SP - 115 EP - 118 JF - International journal of pediatric otorhinolaryngology JO - Int. J. Pediatr. Otorhinolaryngol. VL - 109 N2 - INTRODUCTION: The objective of this study was to poll pediatric otolaryngologists with a special interest in pediatric laryngology on their experience with injection medialization laryngoplasty (IML), thyroplasty, and reinnervation procedures in order to reflect on changing clinical practices. METHOD: A 10-items questionnaire was designed to inquire about current management practices in the treatment of symptomatic UVFI. The 59 members of an ASPO pediatric laryngology working group received the anonymous online survey. A 47% (28/59) response rate was obtained over a 2 weeks period. RESULTS: Carboxymethylcellulose gel (Prolaryn) is the most popular injectable material used in the setting of IMLs (preferred by 46%; 13 respondents). Most clinicians perform IMLs in the operating room. However, 14% (4/28) of respondents currently perform office-based injections on older patients. When faced with the case of a young child with longstanding iatrogenic VFP, most respondents (41%; 11/27) would perform an IML alone as a first step for management. 37% (10/27) of respondents would inject and perform a laryngeal EMG while 22% (6/27) would offer reinnervation and concomitant IML. When faced with the case of a teenager with long-standing VFP, the polled physicians' opinions were divided: 37% (10/27) favored reinnervation and concomitant IML, while 26% (7/27) would proceed to an IML only. The remaining 37% (10/27) would first assess for vocal atrophy through LEMG or visual inspection. CONCLUSIONS: Two significant shifts in practice seem to have occurred. First, ansa-RLN reinnervation procedures are now being considered as a first line treatment for a subset of patients in whom only IML was considered in the past. In fact, more than 20% of respondents did consider this route of management. Second, there is an increased use of in-office augmentations for older pediatric patients. SN - 1872-8464 UR - https://www.unboundmedicine.com/medline/citation/29728162/Current_trends_in_practices_in_the_treatment_of_pediatric_unilateral_vocal_fold_immobility:_A_survey_on_injections_thyroplasty_and_nerve_reinnervation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-5876(18)30153-8 DB - PRIME DP - Unbound Medicine ER -