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Annals of the Academy of Medicine,... Feb 2022To date, there have only been 2 systematic reviews, and 1 systematic review and meta-analysis on high-intensity focused ultrasound (HIFU) for benign thyroid nodules. The... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
To date, there have only been 2 systematic reviews, and 1 systematic review and meta-analysis on high-intensity focused ultrasound (HIFU) for benign thyroid nodules. The present systematic review and meta-analysis seeks to evaluate the efficacy and safety of HIFU in the treatment of benign thyroid nodules.
METHODS
Pubmed, Embase and Cochrane databases were searched for relevant studies from 1990 to 2021. Nine studies were included in the systematic review and 6 in the meta-analysis. Pooled volume reduction rates (VRRs) at 3, 6 and 24 months after HIFU were assessed.
RESULTS
This systematic review and meta-analysis showed that pooled VRRs at 3, 6, and 24 months after HIFU were 42.14 (95% confidence interval [CI] 28.66-55.62, I2=91%), 53.51 (95% CI 36.78-70.25, I2=97%) and 46.89 (95% CI 18.87-74.92, I2=99%), respectively. There was significant heterogeneity in the pooled VRRs at 3, 6 and 24 months after HIFU. No studies recorded complete disappearance of the nodules. Common side effects included pain, skin changes and oedema. There were no major complications except for transient vocal cord paralysis and voice hoarseness (0.014%) and transient Horner syndrome (0.5%).
CONCLUSION
HIFU may be an effective and safe alternative treatment modality for benign thyroid nodules. Larger clinical trials with longer follow-up are needed to evaluate the effectiveness of HIFU in treating benign thyroid nodules.
Topics: Humans; High-Intensity Focused Ultrasound Ablation; Pain; Thyroid Nodule; Treatment Outcome
PubMed: 35224606
DOI: 10.47102/annals-acadmedsg.2021260 -
Journal of Voice : Official Journal of... Mar 2017We analyzed different methods used to process autologous fat tissues for vocal fold injection (VFI). VFI is a safe procedure that preserves the folds' original... (Review)
Review
OBJECTIVES
We analyzed different methods used to process autologous fat tissues for vocal fold injection (VFI). VFI is a safe procedure that preserves the folds' original elasticity and vibration properties and rarely triggers foreign-body reactions, but is often a temporary treatment due to fat reabsorption. To avoid it, selecting a technique that provides as many viable implantable adipocytes as possible is mandatory.
STUDY DESIGN
This is a systematic review.
METHODS
Data were collected from PubMed, Embase, Ovid, and Cochrane Library. Authors systematically reviewed databases for papers on autologous fat tissue processing methods involving human injections in vocal folds and vocalization outcomes that evolved the acoustic analysis of the voice before and after the surgical procedure, independently of the follow-up time.
RESULTS
Nine out of the 517 articles met selection criteria for analysis. No standardized technique was found.
CONCLUSION
There is no standardized technique for processing fat tissue for vocal fold injection. Further research is needed to point out the best available technique.
Topics: Acoustics; Adipose Tissue; Elasticity; Humans; Injections; Laryngoplasty; Lipectomy; Recovery of Function; Speech Acoustics; Time Factors; Tissue and Organ Harvesting; Transplantation, Autologous; Treatment Outcome; Vibration; Vocal Cords; Voice Disorders; Voice Quality
PubMed: 27665267
DOI: 10.1016/j.jvoice.2016.08.012 -
American Journal of Speech-language... Mar 2021Purpose This systematic review aims to identify, classify, and evaluate existing information regarding treatment for benign vocal fold lesions in children and to...
Purpose This systematic review aims to identify, classify, and evaluate existing information regarding treatment for benign vocal fold lesions in children and to identify gaps and limitations that may limit effective pediatric voice treatment. Method A literature search was performed using electronic databases (PubMed and Google Scholar) as well as reference lists from previous reviews, studies, and books. Included in the present review are studies that described behavioral treatment for children with benign vocal fold lesions presumed to be phonotraumatic (vocal fold nodules and edema). Results Twenty-one studies were eligible for inclusion in the review. Eight different research designs were used, and three intervention types were identified: direct voice intervention (voice training), indirect treatment (vocal hygiene or counseling), and comparative studies that contrasted different treatment methods. The most commonly used treatment method was eclectic direct intervention, which focused on vocal exercises or voicing patterns. Postintervention improvement was reported in all studies. In general, findings suggested an advantage of direct over indirect intervention and of longer treatment duration over short-term approaches. Conclusions The findings suggest that behavioral voice therapy may be generally effective in treating children with vocal fold nodules. Several limitations emerged in the corpus of studies reviewed including heterogeneity of research methods, missing information about outcome measures, and inappropriate statistical analyses. Thus, a need exists for further well-designed controlled studies to enhance the body of knowledge about developmental factors affecting vocal treatment outcomes, in particular, vocal fold structure as well as cognitive and linguistic development.
Topics: Child; Humans; Laryngeal Diseases; Polyps; Treatment Outcome; Vocal Cords; Voice Training
PubMed: 33751899
DOI: 10.1044/2020_AJSLP-20-00304 -
Clinical Otolaryngology : Official... May 2022Locally aggressive thyroid cancer can result in airway obstruction secondary to tracheal compression or vocal cord palsy. A tracheal stent provides an alternative to... (Review)
Review
OBJECTIVE
Locally aggressive thyroid cancer can result in airway obstruction secondary to tracheal compression or vocal cord palsy. A tracheal stent provides an alternative to surgical resection, tracheostomy or conservative management in patients with compressive symptoms. This systematic review synthesises the current evidence associated with tracheal stenting in locally advanced thyroid cancer.
DESIGN, SETTING AND PARTICIPANTS
We conducted a systematic review of tracheal stenting in locally advanced thyroid cancers. We searched MEDLINE, Embase and Web of Science for studies until 22 September 2020. Inclusion criteria were studies involving patients who had received tracheal stents to treat laryngotracheal stenosis secondary to locally advanced thyroid cancer. Single case reports or single cases were not included.
MAIN OUTCOME MEASURES
We assessed studies for data on the performance of tracheal stenting; defined as symptomatic relief, spirometry data, complication rates and mortality. We also extracted data pertaining to the use of different types of stent.
RESULTS
We identified eight full-text articles from 325 titles found in our search. These were all single-centre retrospective studies that lacked homogeneity of thyroid cancer histotypes. The number of patients in each study ranged from 4 to 35 patients. Stenting improved performance status (two of two studies), symptoms (five of five studies) and spirometry (two of three studies). The most common complications were tracheal granulation, tumour overgrowth, stent migration and sputum retention.
CONCLUSION
There is a lack of evidence in the literature of tracheal stents in locally advanced thyroid cancer. However, the evidence available suggests tracheal stenting may be a useful treatment adjunct in advanced thyroid cancer-causing symptomatic airway obstruction.
Topics: Airway Obstruction; Humans; Retrospective Studies; Stents; Thyroid Neoplasms; Tracheal Stenosis; Treatment Outcome
PubMed: 35218682
DOI: 10.1111/coa.13923 -
Disability and Rehabilitation Jul 2020Oropharyngeal dysphagia and laryngeal dysfunction are known to impact on health outcomes of patients with critical illness. The incidence in patients after heart and/or...
Oropharyngeal dysphagia and laryngeal dysfunction are known to impact on health outcomes of patients with critical illness. The incidence in patients after heart and/or lung transplantation is unknown. This paper investigates the frequency, characteristics and risk factors for these complications following such transplantation. Eight databases were systematically searched. Inclusion criteria were (a) adults who underwent heart and/or lung transplantation as their primary surgery, (b) new onset of oropharyngeal dysphagia and/or laryngeal dysfunction and dysphonia identified in the acute hospital phase (c) original studies (d) in English. Two thousand six hundred and sixteen articles were identified. Five met the inclusion criteria. Studies were few and heterogeneous in design and sample size, therefore meta-analysis was not performed. All included studies were of relatively low quality. However, rates of oropharyngeal dysphagia up to 70.5% were reported, with 25% of these patients presenting with vocal cord palsy. Limited conclusions can be drawn from the available evidence regarding the frequency, characteristics and risk factors for the development of oropharyngeal dysphagia and/or laryngeal dysfunction after heart and/or lung transplantation due to limited evidence and low quality of the included studies. This highlights the need for high quality studies in this population.Implications for rehabilitationOropharyngeal dysphagia and dysphonia are known to impact on mortality and quality of lifeThere is a paucity of literature describing these complications after lung and/or heart transplantation, however the data available indicates high rates of swallowing and voice disorders in this immunosuppressed populationEarly identification and management of oropharyngeal dysphagia and dysphonia is vital to aid rehabilitation and improve mortality and quality of life in patients following lung and/or heart transplantation.
Topics: Adult; Deglutition; Deglutition Disorders; Heart Transplantation; Humans; Lung; Quality of Life
PubMed: 30694075
DOI: 10.1080/09638288.2018.1552326 -
European Archives of... Oct 2019The objectives of this meta-analysis were to summarize the key surgical procedures for UVCP and to evaluate which of these is associated with better results in terms of... (Meta-Analysis)
Meta-Analysis
PURPOSE
The objectives of this meta-analysis were to summarize the key surgical procedures for UVCP and to evaluate which of these is associated with better results in terms of vocal improvement.
METHODS
A systematic review of the literature was conducted in search of articles focused on the comparison of voice outcome between different techniques for the UVCP treatment. Then, a quantitative analysis was carried out for papers published from 2013 onwards, reporting only adult patients with unilateral paralysis for each study, and each surgical technique was evaluated for its capability of achieving good functional outcomes in terms of GRBAS-I scale and maximum phonation time in seconds (MPT).
RESULTS
The search identified 1853 publications. A total of 159 articles were stratified and included according to our selection criteria. 21 out of 159 articles were selected for quantitative synthesis. For trans-oral techniques: the mean GRBAS-I scale were 2.33 before injection and 0.41 after injection. The mean MPT before injection were 4.78 and 12.50 after injection. For open techniques the mean GRBAS-I scale were 2.43 before surgery and 0.68 after surgery. For open technique, the mean MPT were 3.50 before surgery and 12.40 after surgery.
CONCLUSIONS
The two types of techniques lead to an improvement in terms of vocal outcomes emphasizing that from the examined literature an indication emerges to perform an early injection because this could reduce the possible need for a more invasive intervention of permanent medialization in the future.
Topics: Comparative Effectiveness Research; Humans; Laryngoplasty; Postoperative Complications; Plastic Surgery Procedures; Vocal Cord Paralysis; Voice Quality
PubMed: 31375895
DOI: 10.1007/s00405-019-05587-2 -
Archives of Otolaryngology--head & Neck... Mar 2012To conduct a systematic review to determine the occurrence and type of vocal cord injury, as well as the occurrence of hoarseness, in adults using an endotracheal tube... (Review)
Review
OBJECTIVE
To conduct a systematic review to determine the occurrence and type of vocal cord injury, as well as the occurrence of hoarseness, in adults using an endotracheal tube or laryngeal mask during routine anesthetic care.
DATA SOURCES
Two reviewers independently performed a literature search using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. The search was limited to articles published in English, German, French, or Dutch. In addition, reference lists of the included articles were searched manually.
DATA EXTRACTION
Studies describing vocal cord injury and/or hoarseness following short-term general anesthesia (<5 hours) using an endotracheal tube or any type of laryngeal mask were included. To obtain a reliable outcome regarding the occurrence of anesthesia-related laryngeal morbidity, only studies reporting both preoperative and postoperative measurements of vocal cord function were included.
DATA SYNTHESIS
A total of 4119 articles were identified; of these, 13 studies met the inclusion criteria. The studies were found to be heterogeneous and hardly comparable. Hoarseness and vocal cord injuries were common findings in most investigations.
CONCLUSIONS
Hoarseness and vocal cord injuries are clinically relevant complications related to short-term general anesthesia using an endotracheal tube or laryngeal mask. However, more well-designed prospective studies are necessary to generate reliable data as well as to investigate techniques to reduce adverse laryngeal effects. For future research, a proposal to categorize the vocal cord lesions due to general anesthesia is presented. Furthermore, use of a preoperative and postoperative standardized measurement protocol using acoustic analysis and the Voice Handicap Index is advised.
Topics: Adult; Anesthesia, General; Humans; Intubation, Intratracheal; Laryngeal Masks; Larynx; Vocal Cords
PubMed: 22431870
DOI: 10.1001/archoto.2011.1427 -
Clinical Otolaryngology : Official... Jul 2024Laryngeal leukoplakia (LL) is a white lesion with high potential of recurrence and malignant transformation. Currently, CO laser has become the primary surgical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Laryngeal leukoplakia (LL) is a white lesion with high potential of recurrence and malignant transformation. Currently, CO laser has become the primary surgical treatment for LL, and the recurrence and malignant transformation rates after treatment vary widely.
OBJECTIVE
We performed a systematic review and meta-analysis dedicated to evaluating the rates of recurrence and malignant transformation of LL lesions treated with CO laser and exploring relevant risk factors for recurrence or malignant transformation.
METHODS
Literature searches were conducted on ProQuest, PubMed, Web of Science, Ovid Medline, Embase, and Cochrane databases. Some articles identified through hand searching were included.
RESULTS
A total of 14 articles and 1462 patients were included in this review. Pooled results showed that the overall recurrence rate was 15%, and the malignant transformation rate was 3%. Subgroup analysis showed that the dysplasia grade was not a significant risk factor for the recurrence and malignant transformation of LL (Pā>ā.05).
CONCLUSIONS
The results of this systematic review and meta-analysis suggest that the CO laser is a safe and effective surgical instrument for the excision of LL, which yields low rates of recurrence and malignant transformation. The risk factors relevant to recurrence or malignant transformation remain unclear and require further investigation.
Topics: Humans; Lasers, Gas; Cell Transformation, Neoplastic; Neoplasm Recurrence, Local; Laryngeal Neoplasms; Leukoplakia; Laser Therapy; Risk Factors
PubMed: 38558499
DOI: 10.1111/coa.14151 -
The Cochrane Database of Systematic... Jan 2014Amnioinfusion is thought to dilute meconium present in the amniotic fluid and so reduce the risk of meconium aspiration. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Amnioinfusion is thought to dilute meconium present in the amniotic fluid and so reduce the risk of meconium aspiration.
OBJECTIVES
To assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013).
SELECTION CRITERIA
Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium staining of the amniotic fluid.
DATA COLLECTION AND ANALYSIS
Three review authors independently assessed eligibility and trial quality, and extracted data.
MAIN RESULTS
Fourteen studies of variable quality (4435 women) are included.Subgroup analysis was performed for studies from settings with limited facilities to monitor the baby's condition during labour and intervene effectively, and settings with standard peripartum surveillance.Settings with standard peripartum surveillance: there was considerable heterogeneity for several outcomes. There was no significant reduction in the primary outcomes meconium aspiration syndrome, perinatal death or severe morbidity, and maternal death or severe morbidity. There was a reduction in caesarean sections (CSs) for fetal distress but not overall. Meconium below the vocal cords diagnosed by laryngoscopy was reduced, as was neonatal ventilation or neonatal intensive care unit admission, but there was no significant reduction in perinatal deaths or other morbidity. Planned sensitivity analysis excluding trials with greater risk of bias resulted in an absence of benefits for any of the outcomes studied.Settings with limited peripartum surveillance: three studies were included. In the amnioinfusion group there was a reduction in CS for fetal distress and overall; meconium aspiration syndrome (three studies, 1144 women; risk ratio (RR) 0.17, 95% confidence interval (CI) 0.05 to 0.52); perinatal mortality (three studies, 1151 women; RR 0.24, 95% CI 0.11 to 0.53) and neonatal ventilation or neonatal intensive care unit admission. In one of the studies, meconium below the vocal cords was reduced and, in the other, neonatal encephalopathy was reduced.
AUTHORS' CONCLUSIONS
Amnioinfusion is associated with substantive improvements in perinatal outcome only in settings where facilities for perinatal surveillance are limited. It is not clear whether the benefits are due to dilution of meconium or relief of oligohydramnios.In settings with standard peripartum surveillance, some non-substantive outcomes were improved in the initial analysis, but sensitivity analysis excluding trials with greater risk of bias eliminated these differences. Amnioinfusion is either ineffective in this setting, or its effects are masked by other strategies to optimise neonatal outcome.The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.
Topics: Amnion; Cesarean Section; Female; Humans; Infant, Newborn; Injections; Meconium; Meconium Aspiration Syndrome; Obstetric Labor Complications; Perinatal Mortality; Pregnancy; Randomized Controlled Trials as Topic; Sodium Chloride
PubMed: 24453049
DOI: 10.1002/14651858.CD000014.pub4 -
Journal of Clinical Medicine Feb 2023Recurrent laryngeal nerve (RLN) injury is a well and long-known complication of thyroid and parathyroid surgery that significantly affects the quality of life of... (Review)
Review
Recurrent laryngeal nerve (RLN) injury is a well and long-known complication of thyroid and parathyroid surgery that significantly affects the quality of life of patients. Despite the advances in surgical techniques and technology, it still occurs in clinical practice either as temporary paresis or as permanent paralysis of the corresponding vocal cord. The purpose of the current systematic review is to examine the value of intraoperative repair of the RLN in voice restoration. A systematic review of the existing literature was conducted using PubMed, Scopus, Cochrane Library, and Google Scholar databases according to the PRISMA guidelines. The systematic review resulted in 18 studies, which met the inclusion criteria. An improvement in phonatory function and voice quality was observed in all these studies after immediate RLN reconstruction (not always statistically significant). This improvement appears to be comparable to or even higher than that achieved with other methods of repair, and in some cases, the improvement approaches levels found in normal subjects. Intraoperative RLN reconstruction is not widely used in clinical practice, but the evidence so far makes it a viable and safe alternative to traditional techniques with better long-term results, as it prevents the occurrence of atrophy of the vocal cord and should be considered in the operating room if possible.
PubMed: 36769864
DOI: 10.3390/jcm12031212