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JAMA Jun 2021The benefits and harms of adding long-acting muscarinic antagonists (LAMAs) to inhaled corticosteroids (ICS) and long-acting β2-agonists (LABAs) for moderate to severe... (Comparative Study)
Comparative Study Meta-Analysis
IMPORTANCE
The benefits and harms of adding long-acting muscarinic antagonists (LAMAs) to inhaled corticosteroids (ICS) and long-acting β2-agonists (LABAs) for moderate to severe asthma remain unclear.
OBJECTIVE
To systematically synthesize the outcomes and adverse events associated with triple therapy (ICS, LABA, and LAMA) vs dual therapy (ICS plus LABA) in children and adults with persistent uncontrolled asthma.
DATA SOURCES
MEDLINE, Embase, CENTRAL, ICTRP, FDA, and EMA databases from November 2017, to December 8, 2020, without language restriction.
STUDY SELECTION
Two investigators independently selected randomized clinical trials (RCTs) comparing triple vs dual therapy in patients with moderate to severe asthma.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently extracted data and assessed risk of bias. Random-effects meta-analyses, including individual patient-level exacerbation data, were used. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to assess certainty (quality) of the evidence.
MAIN OUTCOMES AND MEASURES
Severe exacerbations, asthma control (measured using the Asthma Control Questionnaire [ACQ-7], a 7-item list with each item ranging from 0 [totally controlled] to 6 [severely uncontrolled]; minimal important difference, 0.5), quality of life (measured using the Asthma-related Quality of Life [AQLQ] tool; score range, 1 [severely impaired] to 7 [no impairment]; minimal important difference, 0.5), mortality, and adverse events.
RESULTS
Twenty RCTs using 3 LAMA types that enrolled 11 894 children and adults (mean age, 52 years [range, 9-71 years]; 57.7% female) were included. High-certainty evidence showed that triple therapy vs dual therapy was significantly associated with a reduction in severe exacerbation risk (9 trials [9932 patients]; 22.7% vs 27.4%; risk ratio, 0.83 [95% CI, 0.77 to 0.90]) and an improvement in asthma control (14 trials [11 230 patients]; standardized mean difference [SMD], -0.06 [95% CI, -0.10 to -0.02]; mean difference in ACQ-7 scale, -0.04 [95% CI, -0.07 to -0.01]). There were no significant differences in asthma-related quality of life (7 trials [5247 patients]; SMD, 0.05 [95% CI, -0.03 to 0.13]; mean difference in AQLQ score, 0.05 [95% CI, -0.03 to 0.13]; moderate-certainty evidence) or mortality (17 trials [11 595 patients]; 0.12% vs 0.12%; risk ratio, 0.96 [95% CI, 0.33 to 2.75]; high-certainty evidence) between dual and triple therapy. Triple therapy was significantly associated with increased dry mouth and dysphonia (10 trials [7395 patients]; 3.0% vs 1.8%; risk ratio, 1.65 [95% CI, 1.14 to 2.38]; high-certainty evidence), but treatment-related and serious adverse events were not significantly different between groups (moderate-certainty evidence).
CONCLUSIONS AND RELEVANCE
Among children (aged 6 to 18 years) and adults with moderate to severe asthma, triple therapy, compared with dual therapy, was significantly associated with fewer severe asthma exacerbations and modest improvements in asthma control without significant differences in quality of life or mortality.
Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adrenergic beta-2 Receptor Agonists; Adult; Anti-Asthmatic Agents; Asthma; Child; Drug Therapy, Combination; Forced Expiratory Volume; Humans; Muscarinic Antagonists; Nebulizers and Vaporizers; Quality of Life; Severity of Illness Index; Symptom Flare Up; Xerostomia
PubMed: 34009257
DOI: 10.1001/jama.2021.7872 -
Anesthesia and Analgesia Apr 2021Laryngeal injury from intubation can substantially impact airway, voice, and swallowing, thus necessitating multidisciplinary interventions. The goals of this systematic... (Meta-Analysis)
Meta-Analysis
Laryngeal injury from intubation can substantially impact airway, voice, and swallowing, thus necessitating multidisciplinary interventions. The goals of this systematic review were (1) to review the types of laryngeal injuries and their patient-reported symptoms and clinical signs resulting from endotracheal intubation in patients intubated for surgeries and (2) to better understand the overall the frequency at which these injuries occur. We conducted a search of 4 online bibliographic databases (ie, PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature [CINAHL], and The Cochrane Library) and ProQuest and Open Access Thesis Dissertations (OPTD) from database inception to September 2019 without restrictions for language. Studies that completed postextubation laryngeal examinations with visualization in adult patients who were endotracheally intubated for surgeries were included. We excluded (1) retrospective studies, (2) case studies, (3) preexisting laryngeal injury/disease, (4) patients with histories of or surgical interventions that risk injury to the recurrent laryngeal nerve, (5) conference abstracts, and (6) patient populations with nonfocal, neurological impairments that may impact voice and swallowing function, thus making it difficult to identify isolated postextubation laryngeal injury. Independent, double-data extraction, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Collaboration's criteria. Twenty-one articles (1 cross-sectional, 3 cohort, 5 case series, 12 randomized controlled trials) representing 21 surgical studies containing 6140 patients met eligibility criteria. The mean patient age across studies reporting age was 49 (95% confidence interval [CI], 45-53) years with a mean intubation duration of 132 (95% CI, 106-159) minutes. Studies reported no injuries in 80% (95% CI, 69-88) of patients. All 21 studies presented on type of injury. Edema was the most frequently reported mild injury, with a prevalence of 9%-84%. Vocal fold hematomas were the most frequently reported moderate injury, with a prevalence of 4% (95% CI, 2-10). Severe injuries that include subluxation of the arytenoids and vocal fold paralysis are rare (<1%) outcomes. The most prevalent patient complaints postextubation were dysphagia (43%), pain (38%), coughing (32%), a sore throat (27%), and hoarseness (27%). Overall, laryngeal injury from short-duration surgical intubation is common and is most often mild. No uniform guidelines for laryngeal assessment postextubation from surgery are available and hoarseness is neither a good indicator of laryngeal injury or dysphagia. Protocolized screening for dysphonia and dysphagia postextubation may lead to improved identification of injury and, therefore, improved patient outcomes and reduced health care utilization.
Topics: Airway Extubation; Anesthesia; Female; Humans; Intubation, Intratracheal; Larynx; Male; Middle Aged; Postoperative Complications; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 33196479
DOI: 10.1213/ANE.0000000000005276 -
International Journal of Pediatric... Dec 2020Aim of this review is to evaluate the relation between reflux (either laryngopharyngeal or gastroesophageal) and dysphonia in children. (Review)
Review
OBJECTIVE
Aim of this review is to evaluate the relation between reflux (either laryngopharyngeal or gastroesophageal) and dysphonia in children.
DATA SOURCES
PubMed, Scopus, Embase.
REVIEW METHODS
A literature search was conducted over a period from January 1990 to March 2020. The following search words were used either individually or in combination: voice disorders, laryngopharyngeal reflux, and gastroesophageal reflux. The search was conducted over a period of a month: April 2020.
RESULTS
Five clinical research were selected based on our objectives and selection criteria. Four studies were of level III evidence. Altogether, a total of 606 patients were pooled with male predominance of 63%. In all studies, reflux was suggested to have strong relation with dysphonia. Majority of cases used 24-h pH monitoring to confirm reflux which yielded positive results in 69%. The top three most common endoscopic findings include: interarytenoid erythema and edema (32/38), vocal cord erythema and edema (160/231) and postglottic edema (141/337). Vocal cord nodules were found in 28% of our patients. Acoustic analysis and perceptual assessment of voice was performed in only 1 study. No complication from any procedure was mentioned in any of the studies. Outcome of treatment was mentioned in 1 study, whereby after 4.5 months of follow-up, 68% of children showed improvement in symptoms.
CONCLUSION
Current evidence shows that there is strong relation between reflux and dysphonia in children. Most common laryngoscopic findings suggestive of reflux includes interarytenoid erythema and edema, vocal cord erythema and edema and postglottic edema.
Topics: Child; Dysphonia; Hoarseness; Humans; Laryngopharyngeal Reflux; Laryngoscopy; Male; Vocal Cords
PubMed: 33137676
DOI: 10.1016/j.ijporl.2020.110473 -
American Journal of Otolaryngology 2023Dysphonia is a common symptom due to the coronavirus disease of the 2019 (COVID-19) infection. Nonetheless, it is often underestimated for its impact on human's health.... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Dysphonia is a common symptom due to the coronavirus disease of the 2019 (COVID-19) infection. Nonetheless, it is often underestimated for its impact on human's health. We conducted this first study to investigate the global prevalence of COVID-related dysphonia as well as related clinical factors during acute COVID-19 infection, and after a mid- to long-term follow-up following the recovery.
METHODS
Five electronic databases including PubMed, Embase, ScienceDirect, the Cochrane Library, and Web of Science were systematically searched for relevant articles until Dec, 2022, and the reference of the enrolled studies were also reviewed. Dysphonia prevalence during and after COVID-19 infection, and voice-related clinical factors were analyzed; the random-effects model was adopted for meta-analysis. The one-study-removal method was used for sensitivity analysis. Publication bias was determined with funnel plots and Egger's tests.
RESULTS
Twenty-one articles comprising 13,948 patients were identified. The weighted prevalence of COVID-related dysphonia during infection was 25.1 % (95 % CI: 14.9 to 39.0 %), and male was significantly associated with lower dysphonia prevalence (coefficients: -0.116, 95 % CI: -0.196 to -0.036; P = .004) during this period. Besides, after recovery, the weighted prevalence of COVID-related dysphonia declined to 17.1 % (95 % CI: 11.0 to 25.8 %). 20.1 % (95 % CI: 8.6 to 40.2 %) of the total patients experienced long-COVID dysphonia.
CONCLUSIONS
A quarter of the COVID-19 patients, especially female, suffered from voice impairment during infection, and approximately 70 % of these dysphonic patients kept experiencing long-lasting voice sequelae, which should be noticed by global physicians.
Topics: Humans; Male; Female; Dysphonia; Post-Acute COVID-19 Syndrome; COVID-19; Voice; Voice Training
PubMed: 37354724
DOI: 10.1016/j.amjoto.2023.103950 -
American Journal of Otolaryngology 2022The larynx is the most common site of localized head and neck amyloidosis. Our study aimed to review the clinical features, treatments, and outcomes associated with... (Review)
Review
OBJECTIVE
The larynx is the most common site of localized head and neck amyloidosis. Our study aimed to review the clinical features, treatments, and outcomes associated with localized laryngeal amyloidosis (LA). We also compared these features between two different time periods to evaluate the evolution of LA management.
METHODS
A literature search using PubMed, CINAHL, Embase, and Cochrane Library identified cases of LA published between 1891 and 2021. Biopsy-proven cases of localized LA were included. Non-English studies, animal studies, and reviews were excluded.
RESULTS
282 patients (1891-1999: 142 patients, 2000-2021: 140 patients) from 129 studies were included. Results are reported as 1891-2000 vs. 2000-2021: Mean age was 48.5 years (range, 8-90 years) vs. 46.0 years (range, 9-84 years). The most common presenting symptoms were dysphonia (n = 30, 95 % vs. n = 127, 96 %) and difficulty breathing (n = 37, 27 % vs. n = 35, 27 %). A total of 62 (44 %) vs. 46 (33 %) lesions were found in the true vocal folds and 35 (25 %) vs. 59 (42 %) were found in the false vocal folds. 133 (94 %) vs. 137 (98 %) patients underwent surgical interventions to investigate and/or treat LA. Recurrent LA was reported in 27 (19 %) vs. 33 (24 %) patients with a mean time to recurrence of 25.4 months (range, 0.3-132 months) vs. 34.5 months (range, 0.8-144 months). Of cases reporting survival rate, 104 (97 %) vs. 107 (99 %) were alive at source study endpoints.
CONCLUSION
LA typically exhibits an indolent course; therefore, early intervention may address longstanding symptoms. Recurrent disease poses a clinical challenge in patients with LA.
Topics: Amyloidosis; Hoarseness; Humans; Laryngeal Diseases; Larynx; Vocal Cords
PubMed: 35917657
DOI: 10.1016/j.amjoto.2022.103550 -
Acta Otorhinolaryngologica Italica :... Dec 2022
Review
Topics: Humans; Laryngeal Neoplasms; Cricoid Cartilage; Chondrosarcoma
PubMed: 36654516
DOI: 10.14639/0392-100X-N1912 -
Journal of Voice : Official Journal of... Jan 2021The study aimed to verify the relation between autonomic nervous system (ANS) dysfunctions, voice, and dysphonia. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The study aimed to verify the relation between autonomic nervous system (ANS) dysfunctions, voice, and dysphonia.
STUDY DESIGN
The study is a systematic review.
METHODS
According to the PRISMA flowchart, a search on Pubmed/Medline, SciELO, RCAAP, LILACS, Cochrane Library, PEDro, and Isi Web of Knowledge was performed up to April 2019 using the following key words: autonomic nervous system and voice or dysphonia. Inclusion criteria were full-text articles published in French, English, Portuguese, or Spanish, exploring the relationship between ANS and voice or dysphonia, in human adults. Exclusion criteria were additional treatments for voice disorders, literature reviews and meta-analysis, case studies, and opinion articles. All studies were analyzed using a modified version of the Newcastle-Ottawa scale.
RESULTS
Nine papers met the inclusion criteria, all with high methodological quality. The review shows that ANS is related to voice and dysphonia. Individuals with dysphonia tend to show more symptoms of ANS dysfunction concurrent with laryngeal muscles activation and that heartbeat modulates the F0 of human voice.
CONCLUSION
Changes in ANS function are associated with voice as well as with dysphonia.
Topics: Adult; Autonomic Nervous System; Dysphonia; Heart Rate; Hoarseness; Humans; Voice
PubMed: 31473075
DOI: 10.1016/j.jvoice.2019.07.022 -
Journal of Voice : Official Journal of... Sep 2022The aim of this study was to review systematically the literature and to investigate the effects of electrical stimulation in treating dysphonia. (Review)
Review
OBJECTIVES
The aim of this study was to review systematically the literature and to investigate the effects of electrical stimulation in treating dysphonia.
STUDY DESIGN
This is a systematic review.
METHODS
The publications indexed on the MEDLINE, LILACS, PubMed, Web of Science, and SciELO databases were searched. Original articles with experimental, clinical trial and randomized studies involving a control group and approaching dysphonia treatment with electrical stimulation in humans, regardless of age, gender, or race were included. Those excluded were theses, editorials, comments and opinions, reflexive articles, case studies, experimental studies with animals, models, projects, reports and technical reports, and review articles, as well as articles approaching other alterations, not related to dysphonia.
RESULTS
Eleven articles were found and it evaluated the effects of neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation on dysphonia caused by vocal fold paralysis, spasmodic dysphonia, behavioral dysphonia, and in patients with vocal fold nodules. The methodological analysis of the articles through the PEDro scale resulted in a mean score of 5.18; the studies were classified as either high quality (N = 3) or fair quality (N = 8). The results indicated that electrical stimulation had a therapeutic effect on various aspects of dysphonia. However, due to the high risk of bias and the heterogeneity of the studies, it is not possible to state the effectiveness of electrical stimulation in treating dysphonia.
CONCLUSION
Using electrical stimulation as an evidence-based conventional rehabilitation therapy in the treatment of dysphonia cannot yet be done.
Topics: Dysphonia; Electric Stimulation; Hoarseness; Humans; Randomized Controlled Trials as Topic; Treatment Outcome; Voice Training
PubMed: 32868145
DOI: 10.1016/j.jvoice.2020.08.002 -
Journal of Voice : Official Journal of... Mar 2021This is a systematic literature review to identify vocal and laryngeal symptoms and associated factors in adult wind instrumentalists.
OBJECTIVE
This is a systematic literature review to identify vocal and laryngeal symptoms and associated factors in adult wind instrumentalists.
METHOD
The authors performed a systematic review in the electronic databases Science Direct, Scopus, Web of Science, PubMed and LILACS, gray literature, and manual search. There were no language or publication time limitations, as recommended by the preferred reporting items for systematic reviews and meta-analyses. They also performed title and abstract analysis followed by full-text analysis, risk of bias assessment (Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies), and result synthesis. Two researchers conducted the research independently.
RESULTS
Although six articles met the eligibility criteria, none of them fulfilled all the criteria for the methodological quality analysis. According to the six studies selected for this review, the main vocal symptoms in wind instrumentalists are dysphonia, altered vocal quality, hoarseness, and voice failures; and laryngeal symptoms are dryness, sore throat, throat irritation, throat clearing, discomfort, and tension. The associated factors identified for those symptoms were shorter working time, intense use of the instrument, and individual vocal issues.
CONCLUSION
The several vocal and laryngeal symptoms found in wind instrumentalists in the selected studies were associated with individual factors (prior vocal alteration, inappropriate vocal habits) and organizational factors (working time, intense use, and instrument type and technique). Although wind instrumentalists' vocal health is recognized in the literature, and vocal and laryngeal symptoms are identified and associated with playing a musical instrument, broadening studies with precise methodologies and analyses is necessary.
Topics: Adult; Cross-Sectional Studies; Dysphonia; Humans; Larynx; Voice Quality; Wind
PubMed: 31623947
DOI: 10.1016/j.jvoice.2019.08.024 -
World Neurosurgery Oct 2023There are no systematic evidence-based medical data on the complications of endoscopic cervical spinal surgery. This narrative analysis compiled data from various... (Review)
Review
BACKGROUND
There are no systematic evidence-based medical data on the complications of endoscopic cervical spinal surgery. This narrative analysis compiled data from various studies that examined endoscopic complications, such as cervical disc herniation and foraminal stenosis. This study aimed to investigate the efficacy and safety of endoscopic surgery in cervical radiculopathy.
METHODS
We searched the PubMed/MEDLINE databases to identify articles on endoscopic spinal surgery, and keywords were set as "endoscopic cervical spinal surgery", "endoscopic cervical discectomy", "endoscopic cervical foraminotomy", and "percutaneous endoscopic cervical discectomy". We analyzed the evidence level and classified the prescribed complications according to the literature. Endoscopic cervical surgery was divided into three categories: full endoscopic anterior, endoscopic posterior, and unilateral biportal approaches. We excluded duplicate publications, studies without full text, studies without complications or incomplete information, and studies that did not provide the necessary data for extraction, animal experiments, or reviews.
RESULTS
Difficulties in swallowing, hematoma, and hoarseness are common complications associated with the anterior cervical approach. In contrast, complications of the posterior approach include nerve root injury, hematoma, and dysesthesia. However, endoscopic cervical spinal surgery, including the full endoscopic anterior, posterior, and unilateral biportal approaches, is a safe and effective treatment for cervical radiculopathy.
CONCLUSIONS
Complications of full endoscopic cervical spinal surgery differ significantly depending on the anterior and posterior approaches. In the anterior approach, swallowing difficulty, recurrent disc, hematoma, and dysphonia are the common complications. In contrast, transient dysesthesia, dural tears, upper limb motor deficits, and persistent arm pain are commonly reported with the posterior approach.
Topics: Humans; Radiculopathy; Paresthesia; Cervical Vertebrae; Endoscopy; Intervertebral Disc Displacement; Diskectomy; Hematoma; Treatment Outcome; Retrospective Studies
PubMed: 37479028
DOI: 10.1016/j.wneu.2023.07.058