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Medications treating or affecting the larynx
Laryngeal Mucosal Reaction during Bronchial Histamine Challenge Test Visualized by Videolaryngostroboscopy
To examine the changes in the larynx, as well as self-reported voice and throat symptoms, among patients undergoing a histamine challenge test. Thus, to understand the possible clinical effects of histamine on the larynx.Inhaled Corticosteroids and Voice Problems. What Is New?
Voice problems are the most common and most annoying local side effect of inhaled corticosteroids (ICS), affecting not only patients' treatment compliance but also their quality of life. The literature is very poor regarding prevalence, mechanism, prevention, and management of voice problems attributed to ICS use and especially for the new ICS, ciclesonide. Prevalence of dysphonia seems to be less common with the use of ciclesonide and beclomethasone dipropionate.Effects of Radioactive Iodine Ablation Therapy on Voice Quality
The goal of this study was to evaluate the effects of radioactive iodine ablation therapy on voice quality of patients diagnosed with well-differentiated thyroid carcinoma.The Risk of Vocal Fold Atrophy after Serial Corticosteroid Injections of the Vocal Fold
The aim of this study was to illustrate the risk of vocal fold atrophy in patients who receive serial subepithelial steroid injections for vocal fold scar.Botulinum Toxin A for Treatment of Contact Granuloma
Contact granuloma has been associated with voice abuse, laryngopharyngeal reflux, and habitual throat clearing. It has a high propensity for persistence and recurrence. Treatment options included voice therapy and antireflux measures. Surgical excision has been considered in patients who do not respond to medical management. In this research, we aimed to present our experience with botulinum toxin injection only.Laryngeal Side Effects of Tyrosine Kinase Inhibitors
Tyrosine kinase inhibitors (TKIs) are common targeted drugs, used in the treatment of hematological and solid malignancies. These drugs present a multitude of potential adverse effects. Laryngeal manifestations, including laryngeal edema, secondary to TKIs treatment have not been well studied, despite their potential lethality.The Use of the Quadrivalent Human Papillomavirus Vaccine (Gardasil) as Adjuvant Therapy in the Treatment of Recurrent Respiratory Papilloma
To examine the effect of the quadrivalent human papillomavirus vaccine, Gardasil, on the disease course of patients with recurrent respiratory papillomatosis (RRP).Pyridostigmine for Reversal of Severe Sequelae From Botulinum Toxin Injection
Botulinum toxin is used to treat a wide range of dystonias in the head and neck. Occasionally, patients receiving laryngeal botulinum toxin experience severe dysphagia, dyspnea, or even distant and autonomic symptoms. Rarely, these patients may require hospitalization with possible intubation and placement of nasogastric tubes. Botulinum antitoxin is not readily available and ineffective once symptoms have progressed, so patients must wait until the toxin wears off over weeks to months. Pyridostigmine prevents the breakdown of acetylcholine at the neuromuscular junction, thus making more neurotransmitter available for the muscles.Glucocorticoids for Vocal Fold Disease: A Survey of Otolaryngologists
Glucocorticoids (GCs) are commonly used in the treatment of laryngeal disorders despite the absence of clear guidelines regarding their use. We sought to assess clinical practice patterns regarding GC use for various vocal fold diseases and to ascertain factors underlying the selection of particular GCs for different vocal fold pathology.The Effect of Oral Topical Anesthesia on the Characteristics of Voice
Although oral topical anesthesia is used routinely before rigid laryngeal endoscopy, no study has determined whether oral topical anesthesia changes voice quality. Our goal was to determine the effects of topical anesthesia on voice.Botulinum Toxin in the Management of Laryngeal Tics
The objective of the study was to demonstrate the utility of botulinum toxin (BTX; Botox: Allergan Pharmaceuticals, Irvine, CA) type A injections for symptom reduction in laryngeal tics. The study consisted of case studies and literature review. Case histories of two patients with laryngeal tics are presented. Treatment was administered using BTX type A injected into the thyroarytenoid muscles using electromyographic guidance or via direct laryngoscopy. Treatment outcomes were measured using clinical rating scales with a range from 0 (no response) to 4 (maximal response).Cytotoxic Agents in the Treatment of Laryngeal Sarcoidosis: A Case Report and Review of the Literature
Sarcoidosis is a multisystem disease with various clinical manifestations. It is characterized primarily on a histopathologic basis by the presence of noncaseating granulomata. Laryngeal involvement reportedly occurs in 3–5% of cases, and it is typically localized to the supraglottic region. Patients often present with hoarseness, dysphagia, stridor, or dyspnea. Laryngoscopy typically demonstrates a pale, edematous epiglottis studded with nodules.1 Tissue biopsy reveals the classic noncaseating granuloma; however, the finding is not diagnostic.Inhaled Corticosteroids: Hazardous Effects on Voice—An Update
Inhaled corticosteroids (ICS) have become the prevalent treatment in asthmatics. Hazards to voice are under-recognized. A total of 38 patients with voice complaints associated with the use of ICS were assessed by 79 strobovideolaryngoscopy (SVL) examinations, 24 single and 14 multiple SVL. Hoarseness and dysphonia were the primary reasons for referral. The ICS initially used most frequently was Advair Diskus (fluticasone propionate and salmeterol-inhalation powder-[IP]) in 22 patients, followed by Flovent (fluticasone propionate inhalation aerosol-pressurized metered-dose inhaler-[PMDI]) in 11.Double-Blind Study on the Effects of Topical Anesthesia on Laryngeal Secretions
The application of topical anesthesia to the oropharynx is a common clinical practice during oral and nasal laryngoscopy. Clinically, questions have been raised about whether topical anesthesia alters laryngeal secretions, which distorts clinical impressions. A double-blind, placebo controlled design was employed to address this issue. Ten premenopausal women with healthy vocal folds and 10 premenopausal women with phonotraumatic lesions underwent oral videolaryngoscopic examinations on subsequent days under both anesthesia and placebo conditions, in counterbalanced order.Recurrent Dysphonia and Acitretin
We report the case of a woman complaining of dysphonia while she was treated by acitretin. Her symptoms totally regressed after drug withdrawal and reappeared when acitretin was reintroduced. To our knowledge, this is the first case of acitretin-induced dysphonia. This effect may be related to the pharmacological effect of this drug on mucous membranes.Efficacy of cidofovir injection for the treatment of recurrent respiratory papillomatosis
To evaluate the efficacy of intralesional cidofovir injection for the treatment of recurrent respiratory papillomatosis (RRP). It is a prospective, open-label study design. This prospective study included 16 RRP patients, ages 9 to 68 years, who were treated with intralesional injections of cidofovir combined with surgical excision of RRP. The disease states of the patients pretreatment and posttreatment were assessed by assigning RRP severity scores, examining the need for any surgical excision of RRP, and evaluating the presence of RRP upon long-term follow-up.Voice problems as side effects of inhaled corticosteroids in asthma patients—a prevalence study
Voice disturbances in asthma patients may be caused by inhaled corticosteroids. In order to study the prevalence of such voice disturbances, a questionnaire was delivered to asthma patients at three asthma and allergy departments in Stockholm. The questionnaire consisted of 25 questions concerning the asthma disease symptoms, medication, voice function, and voice disturbances. A total of 350 questionnaires were delivered. Response frequency was 80%. There was a significant positive correlation between inhalation of cortison and voice disturbances.Indole-3-Carbinol for recurrent respiratory papillomatosis: long-term results
We report the results of a clinical study using Indole-3-Carbinol (I3C) for the treatment of recurrent respiratory papillomatosis (RRP). I3C is abundant in cruciferous vegetables and has been shown to decrease papillomatous growth in cell cultures and be effective in an animal model of RRP. This is a prospective, open-label study design. Patients with RRP were enrolled from September 1996 to August 2001 and treated with I3C (adult dose of 200 mg PO BID). All patients underwent complete surgical removal and then started I3C.Response of Asthma-Related Voice Dysfunction to Allergen Immunotherapy: A Case Report of Confirmation by Methacholine Challenge
Professional singers and other serious voice users are particularly susceptible to alterations in their vocal apparatus. As the support for vocalization, lung function is an essential element of the production of speech and song. Patients have been described who presented with voice complaints along with minimal or no abnormalities on spirometry, but responded to conventional bronchodilator and other asthma therapy. It was proposed that this represented an exercise-induced asthmalike condition, brought on by the hyperventilation associated with performing.Dysphonia associated with inhaled steroids
The use of inhaled steroids in the treatment of asthma is not without its complications. In some studies up to 50% of such patients complain of oropharyngeal and voice problems. We present the findings in 22 patients complaining of dysphonia who underwent videostrobolaryngoscopy (VSL) and computerized speech analysis. A number of abnormalities were identified. On VSL, these included mucosal changes (noted in 58%), apposition abnormalities (noted in 43%), and supraglottic hyperfunction (noted in 40%).“Alternative medical therapy” use among singers: Prevalence and implications for the medical care of the singer
Singers are extremely conscious of health problems that affect their voices and well-being and often take an active role in seeking care for these problems. They frequently seek treatment from providers or with modalities considered “alternative” to traditional medical care. A survey of singers was completed to elucidate their attitudes and practices regarding “alternative modalities” of medical care. Frequently singers will self-medicate or take advice from people not well versed in the special needs of a professional voice user.The treatment of essential voice tremor with botulinum toxin A: A longitudinal case report
The purpose of this study was to evaluate the effects of bilateral botulinum toxin injection into the thyroarytenoid (TA) muscles of a patient with essential voice tremor. Acoustic and aerodynamic data were collected weekly over a 16-week period. Flexible nasolaryngoscopy was performed prior to injection and 2, 6, 10, and 16 weeks postinjection. Perceptual analyses of the acoustic and nasolaryngoscopic data were performed. A reduction in frequency tremor and, to a lesser extent, amplitude tremor was observed during the 1–10 week period.Botulinum toxin injection in the treatment of vocal fold paralysis associated with multiple sclerosis: A case report
Botulinum toxin has been demonstrated clinically to be an effective treatment for a variety of laryngeal problems, most notably spasmodic dysphonia. As in other movement disorders, the theory behind the injection of this substance in the larynx has been a weakening of the vocal fold musculature to relieve uncoordinated and spasmodic movement of the vocal folds, presumably rebalancing the forces within the intralaryngeal musculature. Recently, this concept was applied to help reposition the arytenoid cartilage in acute and long-standing anteromedial cricoarytenoid dislocations.Does botulinum toxin alter laryngeal secretionsand mucociliary transport?
Localized botulinum toxin injection disrupts cholinergic transmissionand has potential to cause focal dysautonomia. Mucociliary transport and laryngeal secretions are thought to be mediated in part by autonomic, cholinergic transmission. We questioned whether patients who receive Botox® injection for adductor spasmodic dysphonia (ADSD) report postinjection symptoms possibly related to altered mucociliary clearance or laryngeal secretions. Medical histories, audiotaped interviews, and symptom ratings were retrospectively examined for 29 patients with ADSD who were followed after one or more Botox injections.Vocal fundamental frequency measures as a reflection of tumor response to chemotherapy in patients with advanced laryngeal cancer
The fundamental frequency (F0) characteristics of 19 male patients with advanced laryngeal cancer, treated with cisplatin-based chemotherapy as part of a Larynx Preservation Protocol (LPP), were measured before each of three cycles of chemotherapy received before definitive radiotherapy (RT). In these select patients, for whom chemotherapy resulted in ⩾50% decrease in the tumor bulk, it was found that mean F0 was essentially unaffected by the disease and did not change over the course of chemotherapy, although the cycle of their treatment could be differentiated by both speaking F0 variability (pitch sigma) and F0 perturbation (fitter).
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