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Journal of Voice : Official Journal of... Jan 2024Platelet rich plasma (PRP) and platelet poor plasma (PPP) are regenerative therapies that offer the potential for improving care for disorders of the larynx. The... (Review)
Review
BACKGROUND
Platelet rich plasma (PRP) and platelet poor plasma (PPP) are regenerative therapies that offer the potential for improving care for disorders of the larynx. The laryngeal applications of these substances have been examined in both animals and humans. The goal of this systematic review is to examine the various applications of PRP and PPP in laryngology, assess the protocols for preparation and application of these substances and evaluate the outcomes and complications in both humans and animals.
METHODS
A search of PUBMED was conducted in April 2021 using combinations of keywords of "platelet rich plasma" and "platelet poor plasma" with keywords such as "larynx," "vocal folds," "laryngology," and others. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) guidelines were followed. Articles were reviewed by two independent coauthors and included based on selection criteria pertinent to the goals of this study. The risk of bias in the included studies was assessed by two independent co-authors using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials and JBI Critical Appraisal Checklist for Quasi-Experimental Studies. Data regarding the pathologies treated using PRP and PPP, PRP, and PPP preparation protocols, application protocols, human voice outcomes, histopathological animal outcomes, and complications were extracted from each of the studies and presented in tables.
RESULTS
Seven studies were included based on the selection criteria. PRP or PPP were used for vocal fold scar, sulcus, atrophy and palsy; acute vocal fold injury; glottic insufficiency, and graft healing. PRP or PPP were derived from autologous blood in a one- or two-step centrifugation process and administered via injection, soaking of cartilage grafts or topical application. Mean and median voice handicap index-10 (VHI-10) and voice handicap index (VHI) scores decreased following PRP or PPP injections in two human studies and one human study showed a similar VHI-10 score before and after PRP treatment. Videostroboscopy showed the absence of injection site reactions and at least temporary improvement in glottic gap or vibratory function following treatment in some patients. Other objective measures of voice outcomes in human studies showed improved phonatory function in the one-to-four-month period following PRP or PPP injections, with some patients experiencing a subjective decrease or return to baseline in phonatory function following the initial improvement period. Animal studies found elevated levels of growth factors, organized collagen deposition, decreased granulation tissue, increased vascularization, and increased cartilage proliferation in PRP treated laryngeal tissue.
DISCUSSION
PRP and PPP might have the potential to be safely used in the larynx and at least temporarily influence wound healing and vocal function. Further study using comparable outcome measurement tools is required to assess their role and efficacy in treating acute vocal fold injury, chronic vocal fold pathologies, graft healing, and other laryngeal applications.
Topics: Animals; Humans; Platelet-Rich Plasma; Wound Healing; Vocal Cords; Glottis; Cicatrix; Treatment Outcome
PubMed: 34384663
DOI: 10.1016/j.jvoice.2021.07.007 -
Otolaryngology--head and Neck Surgery :... Mar 2024We aim to systematically review the literature addressing perioperative practices for optimal use of the CO laser in laryngeal transoral laser microsurgery (TOLMS), with... (Review)
Review
OBJECTIVE
We aim to systematically review the literature addressing perioperative practices for optimal use of the CO laser in laryngeal transoral laser microsurgery (TOLMS), with a focus on safety.
DATA SOURCES
A systematic review of publications indexed in Medline, Embase, and EBM reviews-Cochrane Central Register of Controlled Trials which evaluated perioperative strategies for the use of CO laser in laryngeal TOLMS was conducted.
REVIEW METHODS
Records obtained from the search strategy were assessed for eligibility in a 2-step process by 2 independent researchers using the Covidence software.
RESULTS
Among 2143 identified records, 103 were included in this study. The majority of studies (n = 25) focused on the use of the CO laser in oncologic resection, while 20 addressed the treatment of vocal cord paralysis, 16 discussed the treatment of pediatric or congenital pathologies, 11 detailed the management of benign lesions, and 31 studies tackled other surgical indications. Strategies for safe CO TOLMS were highly heterogeneous across studies and included preoperative measures (ie, related to the environment, staff preparation, patient protection, and ventilation), intraoperative precautions (ie, protection of nontarget structures, technical considerations, topical and systemic medications), and postoperative strategies (ie, related to airway protection, oral intake, vocal rest, hospitalization duration, drug regimen, and consultant follow-up).
CONCLUSION
The results provided in this study can be used as a framework to guide the creation of laser safety protocols across institutions, guide quality improvement initiatives, the development of simulation training activities, and as a tool to facilitate resident teaching and skill assessment.
PubMed: 38529664
DOI: 10.1002/ohn.734 -
American Journal of Otolaryngology 2024Sulcus Vocalis (SV) is a voice disorder characterized by the parallel invagination of the vocal fold epithelium that adheres to the vocal ligament. This condition... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sulcus Vocalis (SV) is a voice disorder characterized by the parallel invagination of the vocal fold epithelium that adheres to the vocal ligament. This condition disrupts the vibratory function, leading to glottal incompetence, hoarseness, and vocal impairment. Despite various proposed surgical techniques, a standardized treatment approach remains elusive.
METHODS
We conducted a comprehensive search across PubMed/Medline, Embase, Web of Science, Scholar, and the Cochrane Library for studies on SV treatment. The inclusion criteria comprised original studies comparing pre- and post-treatment vocal outcomes in SV patients, published in English. We excluded case reports, reviews, studies without continuous data, and patients with vocal scar/atrophy.
RESULTS
Fifteen observational studies were included (361 patients, 53.73 % male, average age 41.64 years). 80 % of these studies employed self-reported outcomes, while 81.25 % analyzed acoustic/aerodynamic data. The follow-up period varied from 4 to 44 months. All techniques significantly improved Voice Handicap Index (VHI) scores (p < 0.001). Dissective and combined techniques exhibited greater reductions in VHI-30/10 (p < 0.001). Maximum Phonation Time (MPT) improved significantly across all techniques (p < 0.001), with dissective techniques demonstrating superior MPT outcomes (p < 0.001). Jitter improved significantly for dissective and injective techniques (p < 0.001), as did Shimmer for all techniques (p < 0.001). Notably, combined techniques displayed the most significant reductions (p < 0.001).
CONCLUSIONS
Surgical treatments significantly improve subjective, aerodynamic, and acoustic outcomes in SV patients. Dissective and combined dissective/injective techniques appear to yield better perceptual and phonatory outcomes compared to injective techniques alone. Further research is necessary to establish the optimal treatment approach for SV.
Topics: Humans; Acoustics; Treatment Outcome; Vocal Cords; Voice Disorders; Voice Quality
PubMed: 38071789
DOI: 10.1016/j.amjoto.2023.104131 -
Diagnostic Pathology Aug 2023Primary pulmonary hyalinizing clear cell carcinoma (HCCC) is a low-grade salivary gland-type carcinoma. Until now, 23 cases of pulmonary HCCC have been reported.
BACKGROUND
Primary pulmonary hyalinizing clear cell carcinoma (HCCC) is a low-grade salivary gland-type carcinoma. Until now, 23 cases of pulmonary HCCC have been reported.
CASE PRESENTATION
Here, we present a patient with primary pulmonary HCCC along with vocal-cord squamous cell carcinoma (SCC) revealed by biopsy examination. The patient underwent radiotherapy for vocal-cord SCC, followed by right upper lobectomy and lymph node dissection 10 months later. Histology revealed polygonal cells with eosinophilic or clear cytoplasm in the myxoid matrix together with hyaline degeneration. The tumor involved the whole layer of the segmental bronchus and regionally involved the alveolar tissue along with one intrapulmonary lymph node. Targeted RNA sequencing revealed Ewing Sarcoma Breakpoint Region 1 (EWSR1)- activating transcription factor 1 (ATF1) fusion. We analyzed the data on pulmonary malignant tumors between 2000 and 2019 in the Surveillance, Epidemiology, and End Results (SEER) database and reviewed all cases of pulmonary HCCC with EWSR1 fusion by searching PubMed. The results showed that head and neck (HN) adenoid cystic carcinoma (ACC) (47.89%) and HNSCC (22.54%) were the most common carcinomas occurring with pulmonary salivary gland-type malignant tumors. Screening of 24 cases of pulmonary HCCC with EWSR1 fusion revealed that five cases demonstrated lymph node metastases and only two had documented tumor recurrences. HCCC is rare and easily misdiagnosed as SCC, but the treatment regimen differs between pulmonary HCCC and SCC.
CONCLUSIONS
Hence, pulmonary tumors with clear cells must be diagnosed with caution. Next-generation sequencing (NGS) may be useful for diagnosis, especially in cases with a history of squamous cell carcinoma (SCC).
Topics: Humans; Adenocarcinoma, Clear Cell; Carcinoma, Squamous Cell; Head and Neck Neoplasms; Laryngeal Neoplasms; Lung Neoplasms; Neoplasm Recurrence, Local; Salivary Gland Neoplasms
PubMed: 37553667
DOI: 10.1186/s13000-023-01376-y -
Journal of Robotic Surgery Mar 2024Minimally invasive thyroidectomy (MIT) is increasingly being used for the thyroid tumors. The comparison of bilateral axillo-breast approach robotic thyroidectomy... (Meta-Analysis)
Meta-Analysis Review
Perioperative outcomes of bilateral axillo-breast approach robotic thyroidectomy (BABART) versus minimally invasive thyroidectomy (MIT): a systematic review and meta-analysis.
Minimally invasive thyroidectomy (MIT) is increasingly being used for the thyroid tumors. The comparison of bilateral axillo-breast approach robotic thyroidectomy (BABART) with other MIT has not yet led to a unified conclusion with regard to surgical outcomes. To conduct a systematic review and meta-analysis of the literature on the surgical outcomes of BABART compared with MIT. We performed a systematic search in PubMed, Web of Science, Embase and Cochrane Library database for randomized control trials (RCTs) and non-RCTs that compare BABART to MIT. The primary outcomes included perioperative, postoperative complications. The odds ratio (OR) and mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CIs). Nine studies, comprising 3645 patients, were included in the meta-analysis. Our findings indicated that there were no significant differences in hospital stay, number of retrieved lymph nodes, recurrent laryngeal nerve (RLN) injury, and vocal cord dysfunction between BABRT and MIT. However, BABART was associated with a shorter operation time (MD = - 21.45 min, 95% CI [- 47.27, 4.38], p = 0.1) and lower rate of permanent hypoparathyroidism (OR = 0.42, 95% CI [0.20, 0.88], p = 0.02). Additionally, the MIT group had reduced postoperative pain score (MD = 0.45, 95% CI [0.02, 0.88], p = 0.04) and lower rate of hypocalcemia (OR = 2.31, 95% CI [1.04, 5.13], p = 0.04) than the BABART group. In comparison with MIT, BABART exhibits better results in terms of operative time and the rate of permanent hypoparathyroidism, with no significant difference in hospital stay, number of retrieved lymph nodes, RLN injury, and vocal cord dysfunction. However, the postoperative pain score and the rate of hypocalcemia of MIT are slightly better that of BABART.
Topics: Humans; Thyroidectomy; Robotic Surgical Procedures; Hypocalcemia; Postoperative Complications; Pain, Postoperative; Hypoparathyroidism; Vocal Cord Dysfunction
PubMed: 38520624
DOI: 10.1007/s11701-024-01891-0 -
Sleep Medicine Reviews Jun 2024Catathrenia is a loud expiratory moan during sleep that is a social embarrassment and is sometimes confused with central apnea on polysomnography. It affects about 4% of...
Catathrenia is a loud expiratory moan during sleep that is a social embarrassment and is sometimes confused with central apnea on polysomnography. It affects about 4% of adults, but cases are rarely referred to sleep centers. Catathrenia affects males and females, children and adults, who are usually young and thin. A "typical" catathrenia begins with a deep inhalation, followed by a long, noisy exhalation, then a short, more pronounced exhalation, followed by another deep inhalation, often accompanied by arousal. The many harmonics of the sound indicate that it is produced by the vocal cords. It is often repeated in clusters, especially during REM sleep and at the end of the night. It does not disturb the sleepers, but their neighbors, and is associated with excessive daytime sleepiness in one-third of cases. The pathophysiology and treatment of typical catathrenia are still unknown. Later, a more atypical catathrenia was described, consisting of episodes of short (2 s), regular, semi-continuous expiratory moans during NREM sleep (mainly in stages N1 and N2) and REM sleep, often in people with mild upper airway obstruction. This atypical catathrenia is more commonly reduced by positive airway pressure and mandibular advancement devices that promote vertical opening.
Topics: Adult; Child; Female; Humans; Male; Parasomnias; Polysomnography; Respiratory Sounds; Sleep Apnea, Central; Sleep Stages; Sleep, REM
PubMed: 38718707
DOI: 10.1016/j.smrv.2024.101944 -
Updates in Surgery Jan 2024The optimal surgical procedure(s) for unilateral multifocal papillary thyroid carcinomas is currently controversial. As such, the present study aimed to compare the... (Meta-Analysis)
Meta-Analysis
The optimal surgical procedure(s) for unilateral multifocal papillary thyroid carcinomas is currently controversial. As such, the present study aimed to compare the efficacies of total thyroidectomy and lobectomy in patients with unilateral multifocal papillary thyroid carcinoma. A literature search of the PubMed/Medline, Embase, Web of Science, Cochrane Library, Wan Fang, and Zhi Wang databases for relevant studies, published from inception to October 31, 2022, was performed. Two researchers independently extracted data from the included studies. Lymph node metastasis, vocal fold paralysis, parathyroid injury, postoperative recurrence, and disease-free survival were evaluated. The meta-analysis included 7 studies comprising 1540 patients, of whom 496 and 1044 underwent lobectomy and total thyroidectomy, respectively. Compared with lobectomy, total thyroidectomy resulted in more vocal cord paralysis (odds ratio [OR] 0.35 [95% confidence interval (CI) 0.13 to 0.96]; P = 0.04) and parathyroid injury (OR 0.11 [95% CI 0.03-0.39]; P = 0.001) but with better disease-free survival (OR 0.21 [95% CI 0.09-0.49]; P = 0.000), although vocal cord paralysis and parathyroid injury, in large part, resolved within 1 year after surgery. In addition, there was no difference in postoperative lymph nodes metastasis (OR 0.74 [95% CI 0.13-4.21]; P = 0.737) and postoperative recurrence (OR 2.37 [95% CI 0.42-13.38]; P = 0.33). Excluding studies that deviated from the general trend, total thyroidectomy was beneficial in reducing recurrence. Compared with lobectomy, total thyroidectomy was beneficial in reducing recurrence and disease-free survival and may be considered a more optimal approach for unilateral multifocal papillary thyroid carcinoma.
Topics: Humans; Carcinoma, Papillary; Lymphatic Metastasis; Neoplasm Recurrence, Local; Retrospective Studies; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroidectomy; Vocal Cord Paralysis
PubMed: 38127193
DOI: 10.1007/s13304-023-01726-x -
Endocrine May 2024To evaluate the safety and efficacy of radiofrequency ablation (RFA) in treating locoregional recurrent thyroid cancer (LRTC) after a 2-year follow-up time.
PURPOSE
To evaluate the safety and efficacy of radiofrequency ablation (RFA) in treating locoregional recurrent thyroid cancer (LRTC) after a 2-year follow-up time.
METHODS
PubMed, Embase and Cochrane Library were searched from inception until 20 September 2022 to find studies reporting the safety and efficacy of RFA in LRTC patients after a 2-year follow-up. Two radiologists performed the data extraction and methodological quality assessment according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
We analyzed 6 studies, 229 LRTC patients with 319 locally recurrent tumors were treated with RFA. The mean follow-up time of each study was ≥24 months. The pooled changes in the largest diameter and volume were 7.22 mm (95% confidence interval (CI), 6.35-8.09 mm) and 164.28 mm (95% CI, 87.78-240.77 mm), respectively; the pooled volume reduction rate was 95.03% (95% CI, 87.56-102.49%). The total complete disappearance rate after treatment was 92% (95% CI, 83-100%). The pooled decrease of serum thyroglobulin levels was 0.02 ng/ml (95% CI, -0.00-0.04 ng/ml). The pooled proportion of recurrence rate was 6% (95% CI, 0-13%). The pooled complication rate was 5% (95% CI, 0-10%). The major complications were voice change and hoarseness, only one patient developed permanent vocal cord paralysis; minor complications were cough and pain.
CONCLUSIONS
Ultrasound-guided RFA is an effective and safe treatment for LRTC based on 2-year follow-up results.
PubMed: 38801598
DOI: 10.1007/s12020-023-03660-9 -
Endocrinology and Metabolism (Seoul,... Feb 2024Active surveillance (AS) has been introduced as a management strategy for low-risk papillary thyroid carcinoma (PTC) due to its typically indolent nature. Despite this,...
BACKGRUOUND
Active surveillance (AS) has been introduced as a management strategy for low-risk papillary thyroid carcinoma (PTC) due to its typically indolent nature. Despite this, the widespread adoption of AS has encountered several challenges. The aim of this systematic review was to evaluate the safety of AS related to disease progression and its benefits compared with immediate surgery (IS).
METHODS
Studies related to AS in patients with low-risk PTC were searched through the Ovid MEDLINE, Embase, Cochrane Library, and KoreaMed databases. Studies on disease progression, surgical complication, quality of life (QoL), and cost-effectiveness were separately analyzed and narratively synthesized.
RESULTS
In the evaluation of disease progression, the proportions of cases with tumor growth ≥3 mm and a volume increase >50% were 2.2%-10.8% and 16.0%-25.5%, respectively. Newly detected lymph node metastasis was identified in 0.0%-1.4% of patients. No significant difference was found between IS and delayed surgery in surgical complications, including vocal cord paralysis and postoperative hypoparathyroidism. AS was associated with better QoL than IS. Studies on the cost-effectiveness of AS reported inconsistent data, but AS was more cost-effective when quality-adjusted life years were considered.
CONCLUSION
AS is an acceptable management option for patients with low-risk PTC based on the low rate of disease progression and the absence of an increased mortality risk. AS has additional benefits, including improved QoL and greater QoL-based cost-effectiveness.
Topics: Humans; Thyroid Cancer, Papillary; Thyroid Neoplasms; Quality of Life; Thyroidectomy; Watchful Waiting; Disease Progression
PubMed: 38417830
DOI: 10.3803/EnM.2023.1794