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Logopedics, Phoniatrics, Vocology Jul 2021Unilateral vocal folds paralysis is a disorder that affects a patient's quality-of-life by disturbing their phonation, breathing, and swallowing activities. This... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Unilateral vocal folds paralysis is a disorder that affects a patient's quality-of-life by disturbing their phonation, breathing, and swallowing activities. This systematic review aimed to estimate the efficacy of voice treatment on the vocal fold motility in adult patients with unilateral vocal folds paralysis.
METHODS
PubMed, CINAHL, CENTRAL, and Web of Science were searched for retrospective and prospective cohort, case-control, and cross-sectional with comparative studies with adults that were published between 1 January 2008 to 31 December 2018. After applying the inclusion and exclusion criteria a total of 10 studies containing morpho-functional evaluation results were included in the analysis. Pooled data analysis of the motility of the vocal folds before and after voice therapy allowed inferring about the efficacy of voice therapy intervention in patients with unilateral vocal folds paralysis. A random-effect model was used to estimate the effect size. Publication bias was considered.
RESULTS
The pooled data analysis of the visual-perceptual measures revealed that vocal fold motility improved in 72% (95% CI: 64.0-80.0) of all patients after the therapeutic interventions. The inconsistency index ( = 18.35%) of the studies included in this meta-analysis revealed an extremely low heterogeneity. Funnel plot and Cochran's Q test showed no publication bias. The systematic review was limited to only English language articles.
CONCLUSION
This meta-analysis supports the evidence that voice therapy intervention can have a positive effect on the vocal fold motility, that is, they can improve the glottal gap closure, irrespective of the exercises and techniques used.
Topics: Adult; Cross-Sectional Studies; Humans; Language Therapy; Outcome Assessment, Health Care; Prospective Studies; Retrospective Studies; Speech; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords; Voice Quality
PubMed: 32406287
DOI: 10.1080/14015439.2020.1762730 -
European Archives of... Jan 2024To evaluate the efficacy of platelet-rich plasma (PRP) in benign vocal fold lesions. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To evaluate the efficacy of platelet-rich plasma (PRP) in benign vocal fold lesions.
METHODS
MEDLINE, Cochrane Central, Web of Science, and Scopus databases were searched in April 2023 for relevant clinical trials. Inclusion criteria were clinical trials evaluating the efficacy of PRP in benign vocal fold lesions. We conducted a comparative double-arm analysis using the pooled mean difference (MD) and 95% confidence interval (CI). Outcomes of interest included the vocal handicap index (VHI), the Jitter and Shimmer percentages, and the noise-to-harmonic ratio (NHR).
RESULTS
Six studies matched the inclusion criteria. The pooled analysis shows that PRP was associated with significantly lower VHI scores compared with the control (MD = - 5.06, p < 0.01). Regarding the Jitter percentage, the PRP group was not superior to the control group at 2 and 4 weeks. However, the results revealed that PRP significantly reduced the Jitter percentage at 3 months (MD = - 0.61, p = 0.0008). The overall analysis favored the PRP arm significantly (p < 0.001). As for the Shimmer percentage, the combined effect estimate favored the PRP group (MD = - 1.22, p = 0.002). Subgroup analysis according to the time did not reveal any significant differences between studies at 2 weeks, 4 weeks, and 3 months. The analysis of the NHR outcome revealed a significant difference between both groups (MD = -1.09, p = 0.01). However, at 4 weeks, the treatment group had a significantly lower NHR % compared to the control group (MD = - 0.61, p = 0.02). There was no significant difference at 3 months (MD = - 2.14, p = 0.14).
CONCLUSIONS
Platelet-rich plasma is effective in reducing VHI scores, Jitter and Shimmer percentages, and NHR values. This effect is more evident after follow-up, especially 3 months.
Topics: Humans; Vocal Cords; Platelet-Rich Plasma; Treatment Outcome
PubMed: 37709923
DOI: 10.1007/s00405-023-08226-z -
Brazilian Journal of Otorhinolaryngology 2024To assess the safety and effectiveness of bilateral axillo-breast approach robotic thyroidectomy in thyroid tumor. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess the safety and effectiveness of bilateral axillo-breast approach robotic thyroidectomy in thyroid tumor.
METHODS
Bilateral axillo-breast approach robotic thyroidectomy and other approaches (open thyroidectomy, transoral robotic thyroidectomy, and bilateral axillo-breast approach endoscopic thyroidectomy) were compared in studies from 6 databases.
RESULTS
Twenty-two studies (8830 individuals) were included. Bilateral axillo-breast approach robotic thyroidectomy had longer operation time, greater cosmetic satisfaction, and reduced transient hypoparathyroidism than conventional open thyroidectomy. Compared to bilateral axillo-breast approach endoscopic thyroidectomy, bilateral axillo-breast approach robotic thyroidectomy had greater amount of drainage, lower chances of transient vocal cord palsy and permanent hypothyroidism, and better surgical completeness (postopertive thyroblobulin level and lymph node removal). Bilateral axillo-breast approach robotic thyroidectomy induced greater postoperative drainage and greater patient dissatisfaction than transoral robotic thyroidectomy.
CONCLUSION
Bilateral axillo-breast approach robotic thyroidectomy is inferior to transoral robotic thyroidectomy in drainage and cosmetic satisfaction but superior to bilateral axillo-breast approach endoscopic thyroidectomy in surgical performance. Its operation time is longer, but its cosmetic satisfaction is higher than open thyroidectomy.
Topics: Humans; Thyroidectomy; Robotic Surgical Procedures; Neck Dissection; Breast; Thyroid Neoplasms; Retrospective Studies; Treatment Outcome; Postoperative Complications
PubMed: 38228051
DOI: 10.1016/j.bjorl.2023.101376 -
Frontiers in Neurology 2024To systematically review vagus nerve stimulation (VNS) studies to present data on the safety and efficacy on motor recovery following stroke, traumatic brain injury...
OBJECTIVE
To systematically review vagus nerve stimulation (VNS) studies to present data on the safety and efficacy on motor recovery following stroke, traumatic brain injury (TBI), and spinal cord injury (SCI).
METHODS
Data sources: PubMed, EMBASE, SCOPUS, and Cochrane.
STUDY SELECTION
Clinical trials of VNS in animal models and humans with TBI and SCI were included to evaluate the effects of pairing VNS with rehabilitation therapy on motor recovery.
DATA EXTRACTION
Two reviewers independently assessed articles according to the evaluation criteria and extracted relevant data electronically.
DATA SYNTHESIS
Twenty-nine studies were included; 11 were animal models of stroke, TBI, and SCI, and eight involved humans with stroke. While there was heterogeneity in methods of delivering VNS with respect to rehabilitation therapy in animal studies and human non-invasive studies, a similar methodology was used in all human-invasive VNS studies. In animal studies, pairing VNS with rehabilitation therapy consistently improved motor outcomes compared to controls. Except for one study, all human invasive and non-invasive studies with controls demonstrated a trend toward improvement in motor outcomes compared to sham controls post-intervention. However, compared to non-invasive, invasive VNS, studies reported severe adverse events such as vocal cord palsy, dysphagia, surgical site infection, and hoarseness of voice, which were found to be related to surgery.
CONCLUSION
Our review suggests that VNS (non-invasive or invasive) paired with rehabilitation can improve motor outcomes after stroke in humans. Hence, VNS human studies are needed in these populations (referring to SCI and TBI?) or just SCI. There are risks related to device implantation to deliver invasive VNS compared to non-invasive VNS. Future human comparison studies are required to study and quantify the efficacy vs. risks of paired VNS delivered via different methods with rehabilitation, which would allow patients to make an informed decision.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=330653.
PubMed: 38872818
DOI: 10.3389/fneur.2024.1390217 -
Head & Neck Jan 2022Surgical traineeship is essential but must be safe for patients. In thyroid surgery, surgeon volume correlates with improved clinical/economic outcomes. However, it is... (Meta-Analysis)
Meta-Analysis Review
Surgical traineeship is essential but must be safe for patients. In thyroid surgery, surgeon volume correlates with improved clinical/economic outcomes. However, it is presently unclear how far does trainee participation affect post-thyroidectomy complication rates in real-world and randomized data. We systematically searched four databases for associations of trainee participation with any post-thyroidectomy outcome. We conducted univariate meta-analyses, sensitivity analyses, and assessed publication bias qualitatively and quantitatively. We included 1 randomized and 15 observational studies from 3755 records, comprising 34 774 thyroid surgical patients. Trainee participation was associated with 12 min longer operative time, but not higher complication rates (hypoparathyroidism, recurrent laryngeal nerve palsy, hematoma, blood loss, return to operating room, hospitalization duration, readmission, and mortality). Sensitivity, publication bias, and multivariate analyses did not change our findings. Real-world and limited randomized data suggest that trainee participation in thyroid surgery is safe, given adequate consultant supervision and appropriate case selection.
Topics: Hematoma; Humans; Hypoparathyroidism; Postoperative Complications; Thyroid Gland; Thyroidectomy; Vocal Cord Paralysis
PubMed: 34708904
DOI: 10.1002/hed.26900 -
The Laryngoscope May 2024Unilateral vocal fold paralysis or paresis (UVFP) is a condition that causes significant morbidity due to dysphonia, dysphagia, and aspiration. Type I medialization... (Review)
Review
INTRODUCTION
Unilateral vocal fold paralysis or paresis (UVFP) is a condition that causes significant morbidity due to dysphonia, dysphagia, and aspiration. Type I medialization thyroplasty (MT) is the current mainstay surgical treatment for UVFP. Though widely considered a safe procedure, concerns exist over possible airway complications which can lead to overnight observation. Herein, we report a systematic review of the safety and adverse events of MT to aid in determining the safety of same-day discharge.
DATA SOURCES
PubMed and Embase databases.
REVIEW METHODS
Our search identified studies investigating complications associated with MT. Articles were selected if published between January 1, 1989 and March 15, 2023. Abstracts were screened, and data were extracted from included studies. Only Type I MT procedures were included; case reports were excluded. Participant characteristics, intervention details, results, and adverse events were extracted.
RESULTS
The database query identified 751 abstracts, of which 46 studies met eligibility criteria. A total of 2426 patients underwent MT. The most common implant was Silastic (n = 898, 37.0%) followed by Gore-Tex (n = 664, 27.4%). There were 254 (10.5%) total complications reported; 110 (4.5%) were considered major. The most common complication was nonobstructive hematoma (n = 59, 2.4%) followed by hemorrhage (n = 36, 1.5%). Implant extrusion (n = 24, 0.99%) or displacement (n = 15, 0.62%) occurred mostly in Silastic and Gore-Tex implants. Same-day discharge occurred with 429 patients and was not associated with adverse events.
CONCLUSIONS
UVFP can be reliably improved by MT with a low risk of complications. Outpatient MT is a promising treatment with a favorable safety profile. Laryngoscope, 134:1994-2004, 2024.
Topics: Humans; Laryngoplasty; Dimethylpolysiloxanes; Vocal Cord Paralysis; Polytetrafluoroethylene; Treatment Outcome
PubMed: 37916789
DOI: 10.1002/lary.31141 -
Ear, Nose, & Throat Journal Mar 2023Myoepithelial carcinoma of the head and neck is a rare malignant tumor that usually arises from the salivary glands but rarely from the larynx. Here, we describe 11...
Myoepithelial carcinoma of the head and neck is a rare malignant tumor that usually arises from the salivary glands but rarely from the larynx. Here, we describe 11 cases (one treated by us and 10 previously published) of laryngeal myoepithelial carcinoma. Our patient was a 60-year-old male who initially presented with hoarseness and throat pain. The patient had suffered from continuing hoarseness and throat pain for one month before he consulted an otorhinolaryngologist. Computed tomography (CT) scan showed a polypoid tumor involving the right vocal cords. Biopsy was performed, and the disease was pathologically diagnosed as myoepithelial carcinoma of the larynx by hematoxylin-eosin and immunohistochemical staining. The total follow-up period was 15 months. Repeated laryngoscopies or CT scans revealed no recurrence or residual lesion during the post-surgical course.
PubMed: 36931828
DOI: 10.1177/01455613231165156 -
Gland Surgery Dec 2021The most common complication of thyroid anesthesia is recurrent laryngeal nerve injury, and anesthesia drugs affect the intraoperative recurrent laryngeal nerve...
BACKGROUND
The most common complication of thyroid anesthesia is recurrent laryngeal nerve injury, and anesthesia drugs affect the intraoperative recurrent laryngeal nerve monitoring indicators, especially nerve blockers, which can cause muscle relaxation and affect vocal cord contraction. The purpose of this study was to investigate the optimal dose of rocuronium during general anesthesia (GA) during thyroid surgery by meta-analysis.
METHODS
Chinese and English databases were searched by the combination of "thyroid", "general anesthesia", and "rocuronium bromide". Publications which took double dose rocuronium GA surgery as the double group and normal dose rocuronium GA surgery as the normal group were included, and Review Manager 5.3 (Rev Man 5.3) was employed for meta-analysis.
RESULTS
A total of fifteen publications were included in the meta-analysis and an overall heterogeneity test was conducted to obtain the results. Comparison of the operation time between the double group and the normal group showed the mean difference (MD): 20.93, 95% confidence interval (CI): (11.48, 30.39) min, Z=4.34, I=94%, and P<0.0001, while that of bleeding volume between the double group and the normal group showed the MD: -24.34, 95% CI: (-28.11, -20.58) mL, Z=12.67, I=91%, and P<0.0001. Comparison of drainage volume between the double group and the normal group showed the MD: 24.40, 95% CI: (19.84, 28.96) mL, Z=10.49, I=68%, and P<0.0001, and between hospitalization days between the double group and the normal group showed the MD: -13.50, 95% CI: (-18.02, -8.97) days, Z=5.85, I=99%, and P<0.0001. Finally, comparison of satisfaction between the double group and the normal group showed risk ratio (RR): 2.16%, 95% CI: (1.88%, 2.48%), Z=10.91, I=0, and P<0.0001. Rev Man 5.3 was employed to obtain the funnel chart of each observation indicator, and the circles of some publications were concentrated on the midline and symmetrical, indicating the research accuracy was high and there was no bias in the publications.
DISCUSSION
This meta-analysis confirmed that a double dose of rocuronium can meet the needs of anesthesia induction and GA during thyroid surgery.
PubMed: 35070884
DOI: 10.21037/gs-21-618 -
Otolaryngology--head and Neck Surgery :... Feb 2021To examine and compare the outcomes of various types of glottic widening surgery (GWS) for initial management of bilateral vocal fold paralysis (BVFP) in children, the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To examine and compare the outcomes of various types of glottic widening surgery (GWS) for initial management of bilateral vocal fold paralysis (BVFP) in children, the outcomes of different GWS procedures in children who underwent initial tracheostomy, and the rate of decannulation in children who underwent tracheostomy alone versus tracheostomy followed by GWS.
DATA SOURCES
PubMed, Web of Science, Cochrane Library, and Embase were searched following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) on September 9, 2019, with no date restriction.
REVIEW METHODS
Articles focusing on GWS or tracheostomy for initial management of BVFP were included. Articles describing patients who received no surgical intervention for BVFP were excluded.
RESULTS
A total of 5989 articles were reviewed: 67 articles met inclusion criteria, and 240 patients were incorporated into the analysis. Patients who underwent primary GWS had an eventual tracheostomy rate of 6.0% (5/83). There were no statistically significant differences in the rate of tracheostomy, reoperation, or mortality among cricoid split, suture lateralization, and cordectomy/cordotomy. Patients who underwent primary tracheostomy failed to achieve decannulation in 36.9% (58/157) of cases. Decannulation was more likely in tracheostomized children who received GWS than those who did not (odds ratio, 6.336; < .0001).
CONCLUSIONS
Most children who undergo primary GWS for BVFP avoid tracheostomy or reoperation. These data demonstrated no differences in surgical outcomes among the most common types of GWS for BVFP. For children who receive a tracheostomy as their first intervention for BVFP, GWS is associated with a significantly improved rate of decannulation.
Topics: Child; Humans; Laryngoscopy; Vocal Cord Paralysis; Vocal Cords; Voice Quality
PubMed: 32689890
DOI: 10.1177/0194599820944892 -
Dysphagia Dec 2022Glottal incompetence caused by unilateral vocal fold paralysis (UVFP) is a common cause of dysphagia and aspiration. Treatments targeted at reducing glottal incompetence...
Glottal incompetence caused by unilateral vocal fold paralysis (UVFP) is a common cause of dysphagia and aspiration. Treatments targeted at reducing glottal incompetence by injection augmentation or medialization thyroplasty are well established at improving voice outcomes, but improvements in swallowing function are less clear. The objective of this systematic review was to determine the impact of vocal fold medialization on dysphagia outcomes. Six electronic bibliographic databases and one clinical trial registry were searched on 3/13/2020. Our patient population were adult patients with verified UVFP that underwent vocal fold medialization. We limited review to prospective studies that had formal dysphagia assessment both before and after medialization. Nine studies met selection criteria (7 prospective case series and 2 prospective cohort studies) totaling 157 patients. The most common etiology of UVFP was iatrogenic (74/157; 47%). The majority of patients underwent injection augmentation (92/157; 59%), and the remaining underwent medialization thyroplasty. A variety of methods were used to assess changes in dysphagia including patient-reported outcome measures, flexible endoscopic evaluation of swallowing, videofluoroscopic swallow study, and high-resolution manometry. 7/9 studies demonstrated clinically significant improvement in swallowing function following medialization; 4/9 studies demonstrated statistically significant improvement, and three studies did not show statistically significant improvement after intervention. Study participants and outcome measures evaluating swallowing function in this review were heterogeneous. Moreover, the reviewed studies are concerning for multiple risks of bias impacting their conclusions. Taken together, this systematic review demonstrates limited evidence that injection augmentation and medialization thyroplasty improve swallowing function and/or safety.
Topics: Adult; Humans; Deglutition; Vocal Cords; Prospective Studies; Deglutition Disorders; Vocal Cord Paralysis; Treatment Outcome
PubMed: 35412149
DOI: 10.1007/s00455-022-10441-5