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Cardiothoracic Patients with Unilateral Vocal Fold Paralysis: Pneumonia Rates Following Injection Laryngoplasty.
Ann Otol Rhinol Laryngol. 2020 Jun 08 [Online ahead of print]AO

Abstract

OBJECTIVE

Recurrent laryngeal nerve injury is a potential complication of cardiothoracic surgery and cause of unilateral vocal fold paralysis (UVFP). Injection laryngoplasty (IL) is an intervention offered to patients with UVFP to alleviate symptoms including dysphagia, dysphonia and weak cough. There is no definitive evidence that IL prevents pneumonia. In this study, we compare rates of pneumonia in patients with UVFP secondary to cardiothoracic surgery who did or did not undergo IL.

METHODS

A retrospective chart review identified patients diagnosed with UVFP by an otolaryngologist using flexible laryngoscopy following cardiothoracic surgery from January 1, 2008 to December 31, 2017. Each subject was grouped by IL status and assessed for subsequent pneumonia within 6 months of their diagnosis of UVFP. The association of IL with pneumonia was evaluated using Cox proportional hazards regression.

RESULTS

Of 92 patients who met inclusion criteria, 35 (38%) underwent IL and 57 (62%) did not. Twenty patients developed pneumonia, four who had undergone IL and 16 who had not; 12 patients developed aspiration pneumonia including two having undergone IL and 10 who had not. Those who had IL were less likely to develop total pneumonia compared to those who had not (HR = 0.33, P = .045). The protective effect of IL was not as clearly sustained when measuring for aspiration pneumonia, specifically (HR = 0.34; P = .10).

DISCUSSION

Injection laryngoplasty may reduce the risk of pneumonia in patients with UVFP secondary to cardiothoracic surgery; however, further research is needed to quantify the potential protective nature of IL in this patient population.

LEVEL OF EVIDENCE

3 (A retrospective cohort study).

Authors+Show Affiliations

Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32506947

Citation

Barnes, Jason H., et al. "Cardiothoracic Patients With Unilateral Vocal Fold Paralysis: Pneumonia Rates Following Injection Laryngoplasty." The Annals of Otology, Rhinology, and Laryngology, 2020, p. 3489420933650.
Barnes JH, Orbelo DM, Armstrong MF, et al. Cardiothoracic Patients with Unilateral Vocal Fold Paralysis: Pneumonia Rates Following Injection Laryngoplasty. Ann Otol Rhinol Laryngol. 2020.
Barnes, J. H., Orbelo, D. M., Armstrong, M. F., Bayan, S. L., Lohse, C. M., & Ekbom, D. C. (2020). Cardiothoracic Patients with Unilateral Vocal Fold Paralysis: Pneumonia Rates Following Injection Laryngoplasty. The Annals of Otology, Rhinology, and Laryngology, 3489420933650. https://doi.org/10.1177/0003489420933650
Barnes JH, et al. Cardiothoracic Patients With Unilateral Vocal Fold Paralysis: Pneumonia Rates Following Injection Laryngoplasty. Ann Otol Rhinol Laryngol. 2020 Jun 8;3489420933650. PubMed PMID: 32506947.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiothoracic Patients with Unilateral Vocal Fold Paralysis: Pneumonia Rates Following Injection Laryngoplasty. AU - Barnes,Jason H, AU - Orbelo,Diana M, AU - Armstrong,Michael F, AU - Bayan,Semirra L, AU - Lohse,Christine M, AU - Ekbom,Dale C, Y1 - 2020/06/08/ PY - 2020/6/9/entrez KW - Cymetra KW - aspiration KW - cardiothoracic surgery KW - injection laryngoplasty SP - 3489420933650 EP - 3489420933650 JF - The Annals of otology, rhinology, and laryngology JO - Ann. Otol. Rhinol. Laryngol. N2 - OBJECTIVE: Recurrent laryngeal nerve injury is a potential complication of cardiothoracic surgery and cause of unilateral vocal fold paralysis (UVFP). Injection laryngoplasty (IL) is an intervention offered to patients with UVFP to alleviate symptoms including dysphagia, dysphonia and weak cough. There is no definitive evidence that IL prevents pneumonia. In this study, we compare rates of pneumonia in patients with UVFP secondary to cardiothoracic surgery who did or did not undergo IL. METHODS: A retrospective chart review identified patients diagnosed with UVFP by an otolaryngologist using flexible laryngoscopy following cardiothoracic surgery from January 1, 2008 to December 31, 2017. Each subject was grouped by IL status and assessed for subsequent pneumonia within 6 months of their diagnosis of UVFP. The association of IL with pneumonia was evaluated using Cox proportional hazards regression. RESULTS: Of 92 patients who met inclusion criteria, 35 (38%) underwent IL and 57 (62%) did not. Twenty patients developed pneumonia, four who had undergone IL and 16 who had not; 12 patients developed aspiration pneumonia including two having undergone IL and 10 who had not. Those who had IL were less likely to develop total pneumonia compared to those who had not (HR = 0.33, P = .045). The protective effect of IL was not as clearly sustained when measuring for aspiration pneumonia, specifically (HR = 0.34; P = .10). DISCUSSION: Injection laryngoplasty may reduce the risk of pneumonia in patients with UVFP secondary to cardiothoracic surgery; however, further research is needed to quantify the potential protective nature of IL in this patient population. LEVEL OF EVIDENCE: 3 (A retrospective cohort study). SN - 1943-572X UR - https://www.unboundmedicine.com/medline/citation/32506947/Cardiothoracic_Patients_with_Unilateral_Vocal_Fold_Paralysis:_Pneumonia_Rates_Following_Injection_Laryngoplasty L2 - https://journals.sagepub.com/doi/10.1177/0003489420933650?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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