SUMMARY
Objectives
To investigate the added value of steroid injection following office-based blue laser
therapy of benign lesions of the vocal folds.
Study design
Retrospective cohort analysis.
Methods
The medical records and video-recordings of patients with benign lesions of the vocal
folds who underwent office-based blue laser therapy in a tertiary referral center
between February 2020 and October 2022 were reviewed. Patients were divided into two
subgroups, those who underwent office-based blue laser therapy alone (n = 23) and those who underwent office-based blue laser therapy with steroid injection
(n = 19). Disease regression and voice outcome measures included Voice Handicap Index-10
score, perceptual voice evaluation using the GRB grading, jitter, shimmer, noise to
harmonic ratio, voice turbulence index, and maximum phonation time were reviewed.
Results
A total of 42 patients were included. The mean age was 54.7 ± 10.1 years. Lesions
included polyps (n = 21), Reinke's edema (n = 19), and cysts (n = 2). There was partial or complete disease regression in all patients who presented
for follow-up (n = 37). In patients who underwent blue laser therapy alone (n = 19), 42.1% had complete regression and 57.9% had partial regression. In those who
underwent blue laser therapy followed by steroid injection (n = 18), 77.7% had complete disease regression and 22.3% had partial regression. The
difference in disease regression between the two subgroups was statistically significant
(P = 0.027). The decrease in the mean Voice Handicap Index-10 score was also statistically
significant with a higher mean being noted in the subgroup who underwent blue laser
therapy followed by steroid injection (-10.5 ± 6.9 vs. -17.3 ± 11.8, P = 0.031). There was no significant difference in the decrease in the perceptual evaluation
scores nor in the decrease in jitter, shimmer, noise to harmonic ratio, and voice
turbulence index between the two subgroups. There was also no significant increase
in the maximum phonation time.
Conclusion
Steroid injection after blue laser therapy improves disease regression and voice outcome
of laser therapy.
KEY WORDS
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REFERENCES
- Vocal nodules and edema may be due to vibration-induced rises in capillary pressure.Laryngoscope. 2008; 118: 748-752https://doi.org/10.1097/MLG.0b013e31815fdeee
- Mechanical stress in phonation.J Voice. 1994; 8: 99-105https://doi.org/10.1016/s0892-1997(05)80302-9
- The clinicopathologic spectrum of benign mass lesions of the vocal fold due to vocal abuse.Int J Surg Pathol. 2011; 19: 583-587https://doi.org/10.1177/1066896911411480
- A nomenclature paradigm for benign midmembranous vocal fold lesions.Laryngoscope. 2012; 122: 1335-1341https://doi.org/10.1002/lary.22421
- Medial microflap for excision of benign vocal fold lesions.Laryngoscope. 1997; 107: 340-344https://doi.org/10.1097/00005537-199703000-00012
- Laryngeal mini-microflap: a new technique and reassessment of the microflap saga.J Voice. 1995; 9: 198-204https://doi.org/10.1016/s0892-1997(05)80253-x
- In-office laryngeal surgery with the 585nm pulsed dye laser (PDL).Otolaryngol Head Neck Surg. 2007; 137: 477-481https://doi.org/10.1016/j.otohns.2007.02.003
- Office-based laryngeal laser surgery: a review of 443 cases using three wavelengths.Otolaryngol Head Neck Surg. 2007; 137: 146-151https://doi.org/10.1016/j.otohns.2007.02.041
- Office-based pulsed-dye laser surgery for laryngeal lesions: a retrospective review.J Voice. 2014; 28: 262.e9-262.e12https://doi.org/10.1016/j.jvoice.2013.08.010
- Feasibility and associated limitations of office-based laryngeal surgery using carbon dioxide lasers.JAMA Otolaryngol Head Neck Surg. 2017; 143: 485-491https://doi.org/10.1001/jamaoto.2016.4129
- Office-based and microlaryngeal applications of a fiber-based thulium laser.Ann Otol Rhinol Laryngol. 2006; 115: 891-896https://doi.org/10.1177/000348940611501206
- Application of thulium laser as office-based procedure in patients with vocal fold polyps.J Voice. 2020; 34: 140-144https://doi.org/10.1016/j.jvoice.2018.08.016
- Un-sedated office-based application of blue laser in vocal fold lesions.J Voice. 2021; (S0892-1997(21)00126-0)https://doi.org/10.1016/j.jvoice.2021.03.031
- Applications of office-based 445 nm blue laser transnasal flexible laser surgery: a case series and review of practice.Ear Nose Throat J. 2021; 100: 105S-112Shttps://doi.org/10.1177/0145561320960544
- Steroid injection for Reinke's edema using fiberoptic laryngeal surgery.Acta Otolaryngol. 2003; 123: 417-420https://doi.org/10.1080/00016480310001321
- Steroid injection to vocal nodules using fiberoptic laryngeal surgery under topical anesthesia.Eur Arch Otorhinolaryngol. 2004; 261: 489-492https://doi.org/10.1007/s00405-003-0720-x
- Office steroid injections of the larynx.Laryngoscope. 2006; 116: 1735-1739https://doi.org/10.1097/01.mlg.0000231455.19183.8c
- Efficacy of percutaneous vocal fold injections for benign laryngeal lesions: prospective multicenter study.Acta Otolaryngol. 2011; 131: 1326-1332https://doi.org/10.3109/00016489.2011.620620
- Comparison of benign lesion regression following vocal fold steroid injection and vocal hygiene education.Laryngoscope. 2014; 124: 510-515https://doi.org/10.1002/lary.24328
- Comprehensive outcome researches of intralesional steroid injection on benign vocal fold lesions.J Voice. 2015; 29: 578-587https://doi.org/10.1016/j.jvoice.2014.11.002
- Glucocorticoid-induced formation of tight junctions in mouse mammary epithelial cells in vitro.Proc Natl Acad Sci U S A. 1992; 89: 9069-9073https://doi.org/10.1073/pnas.89.19.9069
- Efficacy of intralesional steroid injection in small benign vocal fold lesions.J Voice. 2019; 33: 767-772https://doi.org/10.1016/j.jvoice.2018.04.008
- Validity and reliability of the reflux symptom score.The Laryngoscope. 2020; 130: E98-107
- Development and validation of the voice handicap index-10.Laryngoscope. 2004; 114: 1549-1556https://doi.org/10.1097/00005537-200409000-00009
- GRBAS” scale for evaluating the hoarse voice & frequency range of phonation.Clin Exam Voice. 1981; 5: 83-84
- Unsedated office-based blue laser therapy in female patients with Reinke's edema: a retrospective review of 8 cases [published online ahead of print, 2022 Oct 8].J Voice. 2022; (S0892-1997(22)00266-1)https://doi.org/10.1016/j.jvoice.2022.08.025
- Patient factors related to voice therapy attendance and outcomes.J Voice. 2010; 24: 694-701https://doi.org/10.1016/j.jvoice.2009.03.004
- Impact of patient-related factors on the outcomes of office-based injection laryngoplasty.Laryngoscope. 2016; 126: 1806-1809https://doi.org/10.1002/lary.25764
- Efficacy and safety of adjunctive steroid injection after microsurgical removal of benign vocal fold lesions.J Voice. 2017; 31: 615-620https://doi.org/10.1016/j.jvoice.2017.01.003
- Histomorphometric and laryngeal videostroboscopic analysis of the effects of corticosteroids on microflap healing in the dog larynx.Ann Otol Rhinol Laryngol. 1999; 108: 119-127https://doi.org/10.1177/000348949910800203
- Histologic study of acute vocal fold wound healing after corticosteroid injection in a rabbit model.Ann Otol Rhinol Laryngol. 2010; 119: 133-139https://doi.org/10.1177/000348941011900211
- Exudative lesions of Reinke's space: a terminology proposal.Eur Arch Otorhinolaryngol. 2009; 266: 869-878https://doi.org/10.1007/s00405-008-0863-x
Article info
Publication history
Published online: March 14, 2023
Accepted:
February 10,
2023
Publication stage
In Press Corrected ProofFootnotes
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
