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Gartling G, Nakamura R, Sayce L, Kimball EE, Wilson A, Schneeberger S, Zimmerman Z, Garabedian MJ, Branski RC, Rousseau B. Acute Effects of Systemic Glucocorticoids on the Vocal Folds in a Pre-Clinical Model. Ann Otol Rhinol Laryngol 2024; 133:87-96. [PMID: 37497827 PMCID: PMC10818023 DOI: 10.1177/00034894231188571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES/HYPOTHESIS Systemic glucocorticoids (GC)s are employed to treat various voice disorders. However, GCs have varying pharmacodynamic properties with adverse effects ranging from changes in epithelial integrity, skeletal muscle catabolism, and altered body weight. We sought to characterize the acute temporal effects of systemic dexamethasone and methylprednisolone on vocal fold (VF) epithelial glucocorticoid receptor (GR) nuclear translocation, epithelial tight junction (ZO-1) expression, thyroarytenoid (TA) muscle fiber morphology, and body weight using an established pre-clinical model. We hypothesized dexamethasone and methylprednisolone will elicit changes in VF epithelial GR nuclear translocation, epithelial ZO-1 expression, TA muscle morphology, and body weight compared to placebo-treated controls. METHODS Forty-five New Zealand white rabbits received intramuscular injections of methylprednisolone (4.5 mg; n = 15), dexamethasone (450 µg; n = 15), or volume matched saline (n = 15) into the iliocostalis/longissimus muscle for 6 consecutive days. Vocal folds from 5 rabbits from each treatment group were harvested at 1-, 3-, or 7 days following the final injection and subjected to immunohistochemistry for ZO-1 and GR as well as TA muscle fiber cross-sectional area (CSA) measures. RESULTS Dexamethasone increased epithelial GR nuclear translocation and ZO-1 expression 1-day following injections compared to methylprednisolone (P = .024; P = .012). Dexamethasone and methylprednisolone increased TA CSA 1-day following injections (P = .011). Methylprednisolone decreased body weight 7 days following injections compared to controls (P = .004). CONCLUSIONS Systemic dexamethasone may more efficiently activate GR in the VF epithelium with a lower risk of body weight loss, suggesting a role for more refined approaches to GC selection for laryngeal pathology.
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Affiliation(s)
- Gary Gartling
- Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
- Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Ryosuke Nakamura
- Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Lea Sayce
- Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily E. Kimball
- Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA
- Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Azure Wilson
- Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven Schneeberger
- Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Zachary Zimmerman
- Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael J. Garabedian
- Microbiology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Urology, NYU Grossman School of Medicine, New York, NY, USA
| | - Ryan C. Branski
- Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Bernard Rousseau
- Doisy College of Health Sciences, Saint Louis University, St. Louis, MO, USA
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McCoul ED, Megwalu UC, Joe S, Gray R, O'Brien DC, Ference EH, Lee VS, Patel PS, Figueroa-Morales MA, Shin JJ, Brenner MJ. Systemic Steroids for Otolaryngology-Head and Neck Surgery Disorders: An Evidence-Based Primer for Clinicians. Otolaryngol Head Neck Surg 2023; 168:643-657. [PMID: 35349383 DOI: 10.1177/01945998221087664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/26/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To offer pragmatic, evidence-informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders. DATA SOURCES PubMed, Cochrane Library, and American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guidelines. REVIEW METHODS A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings. CONCLUSIONS Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High-level evidence supports SCS use for Bell's palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Ménière's disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss. IMPLICATIONS FOR PRACTICE Clinicians should bring an evidence-informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long-term effects. Alternate routes of corticosteroid administration-such as sprays, drops, inhalers, and intralesional injections-may be preferable for many disorders, particularly those that are self-limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication-related adverse effects. Clinicians who are conversant with high-level evidence can achieve optimal outcomes and stewardship when prescribing SCS.
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Affiliation(s)
- Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Stephanie Joe
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Raluca Gray
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel C O'Brien
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Victoria S Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Prayag S Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Marco A Figueroa-Morales
- Department of Otolaryngology-Head and Neck Surgery, Mexican Social Security Institute, Mexico City, Mexico
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Murphy Estes C, Chadwick K, Sadoughi B, Andreadis K, Sussman S, Sulica L. Performers' Perceptions of Vocal Function During Oral Steroid Treatment of Vocal Fold Edema. Laryngoscope 2022; 132:2434-2441. [PMID: 35218020 DOI: 10.1002/lary.30072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Acute vocal fold edema (VFE) is often a consequence of illness, allergy, or voice overuse, causing dysphonia. Although VFE typically resolves with voice rest and treatment of predisposing causes, oral glucocorticoids are often considered for performers with imminent performance demands. There are limited data about performers' perceptions of vocal change during treatment and how this relates to their ability to perform. This study aims to examine performers' self-perceptions of vocal function with steroid treatment. METHODS Fifty-five performers (34 F; 21 M) diagnosed with VFE who chose treatment with a 6-day methylprednisolone taper were prospectively assessed. They completed the Evaluation of the Ability to Sing Easily (EASE) and reported on their voice use, regimen, performance obligations, and ability to perform. Findings were compared between Day 1 and Day 6 using paired t-tests and nonparametric Wilcoxon signed-rank tests. RESULTS Nearly all subjects completed scheduled performances without interruption. Following treatment, all subscales of the EASE were decreased at Day 6 (Vocal Function 29.78-20.59; Pathologic Risk Indicator 26.60-17.33; Vocal Concerns 6.10-4.20). These differences were statistically significant (p < 0.0001) and greater in subjects with performances scheduled and subjects who consistently completed vocal warmups. These findings demonstrate significant improvement in several facets of performers' self-perception of function. CONCLUSION Subjects reported significant improvement in vocal function with oral steroid treatment and were able to meet performance obligations. It remains important that steroids are not prescribed without laryngeal examination. Examination should be repeated when dysphonia persists, recurs swiftly, or when patients seek repeated treatment, as there may be increased risk of adverse outcomes, and continued steroid use may mask underlying chronic pathology that is best treated by other means. LEVEL OF EVIDENCE 4 Laryngoscope, 132:2434-2441, 2022.
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Affiliation(s)
- Christine Murphy Estes
- The Sean Parker Institute for the Voice, Department of Otolaryngology - Head & Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Keith Chadwick
- Division of Otolaryngology - Head & Neck Surgery, Stony Brook University, Stony Brook, New York, USA
| | - Babak Sadoughi
- The Sean Parker Institute for the Voice, Department of Otolaryngology - Head & Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Katerina Andreadis
- The Sean Parker Institute for the Voice, Department of Otolaryngology - Head & Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Scott Sussman
- The Sean Parker Institute for the Voice, Department of Otolaryngology - Head & Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Lucian Sulica
- The Sean Parker Institute for the Voice, Department of Otolaryngology - Head & Neck Surgery, Weill Cornell Medical College, New York, New York, USA
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Murphy Estes C, Chadwick K, Sadoughi B, Andreadis K, Sussman S, Sulica L. Prospective Evaluation of Safety of Singing on Steroids: Testing the Truth of Received Wisdom. Laryngoscope 2021; 131:2298-2304. [PMID: 33605442 DOI: 10.1002/lary.29437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Performing while on steroids is widely considered to increase risk of vocal injury. This study aims to determine incidence and type of injury, and changes in performers' voices after treatment of vocal fold edema (VFE) with glucocorticoids. STUDY DESIGN Prospective Cohort. METHODS Fifty-five performers (34 female; 21 male) treated for acute VFE with short-course oral glucocorticoids were prospectively evaluated pre- and post-treatment. Subjects underwent videostroboscopy, acoustic/aerodynamic assessment, and functional assessment with the Singing Voice Handicap Index-10 (SVHI-10) and Evaluation of the Ability to Sing Easily (EASE). Blinded reviewers rated videostroboscopic examinations and performed audio-perceptual assessment. Chi-square tests and Wilcoxon signed rank tests were applied for analyses of treatment changes. RESULTS Following glucocorticoid treatment, two instances of vocal fold hemorrhage (3.6%) and three instances of glottic thrush (5.5%) were observed. These resolved without consequence. Mucosal wave dynamics and edema improved. Nearly all subjects completed scheduled performances, and significant improvement was noted on the EASE, reflecting improved function after treatment. These were further supported by statistically significant improvements in CAPE-V and some acoustic and aerodynamic outcomes (semitone pitch range for females, airflow measures for males). CONCLUSIONS Oral glucocorticoids appear to be generally safe for performers presenting with acute VFE. The incidence of adverse effects, specifically hemorrhage and thrush, was low and the effects transient. Vocal fold examination should be considered obligatory before prescribing glucorticoids to working performers. A treatment strategy for acute VF edema incorporating glucocorticoids when appropriate appears to result in significant improvements in measures of glottal function including videostroboscopic appearance, subject perception, and auditory perception. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Christine Murphy Estes
- The Sean Parker Institute for the Voice, Department of Otolaryngology - Head & Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
| | - Keith Chadwick
- The Sean Parker Institute for the Voice, Department of Otolaryngology - Head & Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
| | - Babak Sadoughi
- The Sean Parker Institute for the Voice, Department of Otolaryngology - Head & Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
| | - Katerina Andreadis
- The Sean Parker Institute for the Voice, Department of Otolaryngology - Head & Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
| | - Scott Sussman
- The Sean Parker Institute for the Voice, Department of Otolaryngology - Head & Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
| | - Lucian Sulica
- The Sean Parker Institute for the Voice, Department of Otolaryngology - Head & Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
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Hegde S, Shetty S, Rai S, Dodderi T. A Survey on Machine Learning Approaches for Automatic Detection of Voice Disorders. J Voice 2018; 33:947.e11-947.e33. [PMID: 30316551 DOI: 10.1016/j.jvoice.2018.07.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/06/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
The human voice production system is an intricate biological device capable of modulating pitch and loudness. Inherent internal and/or external factors often damage the vocal folds and result in some change of voice. The consequences are reflected in body functioning and emotional standing. Hence, it is paramount to identify voice changes at an early stage and provide the patient with an opportunity to overcome any ramification and enhance their quality of life. In this line of work, automatic detection of voice disorders using machine learning techniques plays a key role, as it is proven to help ease the process of understanding the voice disorder. In recent years, many researchers have investigated techniques for an automated system that helps clinicians with early diagnosis of voice disorders. In this paper, we present a survey of research work conducted on automatic detection of voice disorders and explore how it is able to identify the different types of voice disorders. We also analyze different databases, feature extraction techniques, and machine learning approaches used in these research works.
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Affiliation(s)
- Sarika Hegde
- NMAM Institute of Technology, Udupi, Karnataka, India.
| | | | - Smitha Rai
- NMAM Institute of Technology, Udupi, Karnataka, India
| | - Thejaswi Dodderi
- Nitte Institute of Speech & Hearing, Mangaluru, Karnataka, India
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Nemr K, Di Carlos Silva A, Rodrigues DDA, Zenari MS. Medications and Adverse Voice Effects. J Voice 2017; 32:515.e29-515.e39. [PMID: 28822620 DOI: 10.1016/j.jvoice.2017.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To identify the medications used by patients with dysphonia, describe the voice symptoms reported on initial speech-language pathology (SLP) examination, evaluate the possible direct and indirect effects of medications on voice production, and determine the association between direct and indirect adverse voice effects and self-reported voice symptoms, hydration and smoking habits, comorbidities, vocal assessment, and type and degree of dysphonia. STUDY DESIGN This is a retrospective cross-sectional study. METHODS Fifty-five patients were evaluated and the vocal signs and symptoms indicated in the Dysphonia Risk Protocol were considered, as well as data on hydration, smoking and medication use. We analyzed the associations between type of side effect and self-reported vocal signs/symptoms, hydration, smoking, comorbidities, type of dysphonia, and auditory-perceptual and acoustic parameters. RESULTS Sixty percent were women, the mean age was 51.8 years, 29 symptoms were reported on the screening, and 73 active ingredients were identified with 8.2% directly and 91.8% indirectly affecting vocal function. There were associations between the use of drugs with direct adverse voice effects, self-reported symptoms, general degree of vocal deviation, and pitch deviation. CONCLUSIONS The symptoms of dry throat and shortness of breath were associated with the direct vocal side effect of the medicine, as well as the general degree of vocal deviation and the greater pitch deviation. Shortness of breath when speaking was also associated with the greatest degree of vocal deviation.
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Affiliation(s)
- Kátia Nemr
- Faculdade de Medicina-Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, Brazil.
| | - Ariana Di Carlos Silva
- Faculdade de Medicina-Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, Brazil
| | - Danilo de Albuquerque Rodrigues
- Faculdade de Medicina-Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, Brazil
| | - Marcia Simões Zenari
- Faculdade de Medicina-Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, Brazil
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Abstract
PURPOSE OF REVIEW This article discusses the relationship between inhaled corticosteroids and dysphonia, with discussion of the therapeutic use of inhaled steroids in laryngeal disease and a review of negative laryngeal effects of this class of medication in patients with reactive airway disease. RECENT FINDINGS Although prescribed for their anti-inflammatory effects (predominantly for pulmonary disease and less often for laryngeal conditions), corticosteroid inhalers can cause laryngeal inflammation. This may relate to chemical irritation from the inhaler itself as well as fungal inflammation related to opportunistic candidiasis that may accompany inhaler use. Patients who suffer from dysphonia because of inhaler use may improve if switched to another inhaler. Studies suggest that ciclesonide metered-dose inhaler may have less oropharyngeal deposition and therefore be associated with reduced oropharyngeal candidiasis and dysphonia compared with other inhaled corticosteroids. SUMMARY Corticosteroid inhalers are a common cause of dysphonia and their use should be investigated in any patient with laryngeal complaints.
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Sahrawat R, Robb MP, Kirk R, Beckert L. Effects of inhaled corticosteroids on voice production in healthy adults. LOGOP PHONIATR VOCO 2013; 39:108-16. [PMID: 23570418 DOI: 10.3109/14015439.2013.777110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The isolated effects of inhaled corticosteroids (ICS) on voice production were examined in 30 healthy adults with no known pre-existing airway disease. All participants followed a daily ICS treatment regime of 500 μg in the morning and evening over a 6-day period. Sustained vowels and connected speech samples were audio recorded before, during, and after the ICS regime. Each participant's audio recorded samples were acoustically analysed. Results revealed that ICS has a short-term detrimental effect on various acoustic properties of voice. These effects were more evident in connected speech compared to isolated vowel productions. All acoustic parameters returned to normalcy after discontinuing the ICS. The study provides insight as to the influence of ICS on healthy voice production.
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Affiliation(s)
- Ramesh Sahrawat
- University of Canterbury, Health Sciences Centre , Private Bag 4800, Christchurch, 8140 New Zealand
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de Souza AMV, de Campos Duprat A, Costa RC, de Oliveira Pimenta J, de Sá Andrade FF, da Silva FF. Use of inhaled versus oral steroids for acute dysphonia. Braz J Otorhinolaryngol 2013; 79:196-202. [PMID: 23670326 PMCID: PMC9443858 DOI: 10.5935/1808-8694.20130035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/29/2012] [Indexed: 11/30/2022] Open
Abstract
Acute dysphonia is a frequent condition in clinical practice. Its treatment, especially in adults, is not well established in the literature. Steroids are the most recommended drug treatment. However, the existing studies are not enough to establish superiority among the different steroids and the best route of administration. Objective This prospective clinical study aimed at comparing the effect of inhaling steroids as a dry powder with the effect of oral steroids to treat acute dysphonia. Method We assessed 32 adult patients, broken down into two groups of 16 patients in each one of the treatments, before and seven days after the use of the medication. The patients were submitted to videolaryngoscopy and perceptive and acoustic voice assessment. Result Oral and inhalation treatment significantly reduced hyperemia and edema, and improved the muco-ondulatory movement; nonetheless, edema reduction was statistically more significant (p = 0.012) in the patients treated with the inhalation form of the drug. However, comparing the values of the auditory perceptive analysis and the acoustic measures after treatment between the groups was not statistically significant. Conclusion There was a significant improvement in the acute laryngitis concerning the assessments carried out in all the patients assessed, concerning the two treatments. The inhalation steroid treatment was significantly more effective in reducing the edema.
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Affiliation(s)
- Andréa Moreira Veiga de Souza
- MD MSc - Otorhinolaryngologist - Espaço da voz - MG - Brazil
- Send correspondence to: André de Campos Duprat. Av. 9 de Julho, nº 5519, cj 71. Jardim Europa. São Paulo - SP. Brazil. CEP: 01407-200. Fax: (11) 3168-6644
| | - André de Campos Duprat
- MD PhD - Otorhinolaryngologist. Professor at the Medical School of the Santa Casa - São Paulo
| | - Rejane Cardoso Costa
- MD Otorhinolaryngologist - Insttuto de Otorrinolaringologia de Minas Gerais - Brazil
| | - Janaína de Oliveira Pimenta
- MSc - Speech and Hearing Therapist - Espaço da voz - MG - Brazil. Irmandade da Santa Casa de Misericórdia de São Paulo
| | | | - Fernanda Ferreira da Silva
- MSc - Speech and Hearing Therapist - Espaço da voz - MG - Brazil. Irmandade da Santa Casa de Misericórdia de São Paulo
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Branski RC, Verdolini K, Sandulache V, Rosen CA, Hebda PA. Vocal Fold Wound Healing: A Review for Clinicians. J Voice 2006; 20:432-42. [PMID: 16324825 DOI: 10.1016/j.jvoice.2005.08.005] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 08/10/2005] [Indexed: 11/30/2022]
Abstract
SUMMARY The basic science of wound healing is largely omitted from the curriculum of many voice clinicians. This fact is relatively disheartening as most therapeutic manipulation in the realm of laryngology and voice disorders deals with injured tissue. Therefore, the selection of therapeutic tasks for persons with vocal injury should ideally be informed by basic science in wound healing. Recently, several investigators have initiated lines of research to determine the course of vocal fold wound healing and the potential role of therapeutic agents, including behavioral agents. The current review seeks to provide a foundation of basic wound healing science and present the most current data regarding the wound healing process in the vocal folds.
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Affiliation(s)
- Ryan C Branski
- Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Bhat AL, Chow DW, DePalma MJ, Garvan C, Chou L, Lenrow D, Slipman CW. Incidence of Vocal Cord Dysfunction After Fluoroscopically Guided Steroid Injections in the Axial Skeleton. Arch Phys Med Rehabil 2005; 86:1330-2. [PMID: 16003659 DOI: 10.1016/j.apmr.2004.11.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To report on the incidence of dysphonia and/or associated throat symptoms after steroid injections in the axial skeleton. DESIGN A prospective cohort study. SETTING Academic spine center. PARTICIPANTS Patients (N = 100) undergoing a diagnostic injection followed by a therapeutic injection in the axial skeleton. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Presence or absence of dysphonia and/or associated throat symptoms, as determined by completion of a predetermined 10-item questionnaire. This questionnaire was administered before participation in the study and at specific intervals after a diagnostic injection and, again, after a therapeutic spinal injection. RESULTS There was a 12% incidence of transient dysphonia and/or associated throat symptoms in this study population after a therapeutic injection. CONCLUSIONS Throat symptoms are a potential, albeit transient side effect, after an epidural space corticosteroid injection. The mechanism through which dysphonia or other throat symptoms develop is unknown but appears to be mediated by a systemic steroid effect.
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Affiliation(s)
- Atul L Bhat
- Orthopaedic Surgical Associates of Lowell PC, Lowell, MA, USA
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