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Clinical Otolaryngology : Official... Sep 2023This systematic review and meta-analysis examines if intralaryngeal injection of basic fibroblast growth factor 2 (FGF2) can improve voice outcomes in those with vocal... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This systematic review and meta-analysis examines if intralaryngeal injection of basic fibroblast growth factor 2 (FGF2) can improve voice outcomes in those with vocal disability.
DESIGN
A Systematic review of original human studies reporting voice outcomes following intra-laryngeal injection of basic fibroblast growth factor 2 in those with vocal dysfunction. Databases searched were Medline (1946-July 2022), Embase (1947-July 2022), Cochrane database and Google Scholar.
SETTING
Secondary or tertiary care centres that undertook the management of voice pathology Hospital.
PARTICIPANTS
Inclusion criteria were original human studies reporting voice outcome measurements following intralaryngeal injection of FGF2 to treat vocal fold atrophy, vocal fold scarring, vocal fold sulcus or vocal fold palsy. Articles not written in English, studies that did not include human subjects and studies where voice outcome measures were not recorded before and after FGF2 injection were excluded from the review.
MAIN OUTCOME MEASURES
The primary outcome measure was maximum phonation time. Secondary outcome measures included acoustic analysis, glottic closure, mucosal wave formation, voice handicap index and GRBAS scale.
RESULTS
Fourteen articles were included out of a search of 1023 and one article was included from scanning reference lists. All studies had a single arm design without control groups. Conditions treated were vocal fold atrophy (n = 186), vocal cord paralysis (n = 74), vocal fold fibrosis (n = 74) and vocal fold sulcus (n = 56). A meta-analysis of six articles reporting on the use of FGF2 in patients with vocal fold atrophy showed a significant increase of mean maximum phonation time of 5.2 s (95% CI: 3.4-7.0) at 3-6 months following injection. A significant improvement in maximum phonation time, voice handicap index and glottic closure was found following injection in most studies assessed. No major adverse events were reported following injection.
CONCLUSIONS
To date, intralaryngeal injection of basic FGF2 appears to be safe and it may be able to improve voice outcomes in those with vocal dysfunction, especially vocal fold atrophy. Randomised controlled trials are needed to further evaluate efficacy and support the wider use of this therapy.
Topics: Humans; Fibroblast Growth Factor 2; Plastic Surgery Procedures; Vocal Cord Paralysis; Laryngeal Diseases; Atrophy
PubMed: 37246756
DOI: 10.1111/coa.14073 -
The Journal of Laryngology and Otology Nov 2023To evaluate the outcomes of reinnervation techniques for the treatment of adult unilateral vocal fold paralysis and bilateral vocal fold paralysis.
OBJECTIVE
To evaluate the outcomes of reinnervation techniques for the treatment of adult unilateral vocal fold paralysis and bilateral vocal fold paralysis.
METHODS
A literature review was conducted in the Embase and Medline databases in English, with no limitations on the publication date. The outcome parameters of interest included visual, subjective perceptual, acoustic, aerodynamic analysis and electromyography. A meta-analysis with a random-effects model and inverse variance was calculated.
RESULTS
The systematic Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach resulted in 27 studies, totalling 803 patients (747 unilateral cases and 56 bilateral cases). Thyroid cancer and/or surgery had caused unilateral vocal fold paralysis in 74.8 per cent of cases and bilateral vocal fold paralysis in 69.6 per cent of cases. Statistically significant improvements in patients were observed for voice, deglutition and decannulation (bilateral vocal fold paralysis). Meta-analysis of 10 reinnervation techniques was calculated for the maximum phonation time of 184 patients.
CONCLUSION
Reinnervation was shown to improve voice, swallowing and decannulation, but studies lacked control groups, limiting generalisability. Larger studies with controls are needed.
PubMed: 37982255
DOI: 10.1017/S0022215123001950 -
European Archives of... Nov 2022Glottal insufficiency, mostly caused by unilateral vocal fold paralysis (UVFP) or vocal fold atrophy can be treated by injection laryngoplasty (IL). Materials such as... (Review)
Review
BACKGROUND
Glottal insufficiency, mostly caused by unilateral vocal fold paralysis (UVFP) or vocal fold atrophy can be treated by injection laryngoplasty (IL). Materials such as hyaluronic acid (HA) gels are now widely available and used to improve voice quality. Various durability and effects of HA injection laryngoplasties have been reported. The aim of this study is to provide a systematic review of the literature for the use of HA in injection laryngoplasties.
METHODS
A systematic literature search was conducted in PubMed and Cochrane Libraries. Three reviewers assessed original research studies concerning vocal fold augmentation with HA for eligibility. English written full-text human studies from 2000 to 2020 with EBM level 1b-2 were included. In vitro studies, animal studies, case reports, case-control studies, correspondence and review articles, and articles with other injection materials were excluded. Demographical data, indication, type of HA, evaluation methods, follow-up, durability of implanted material and complications were assessed.
RESULTS
A total number of 311 articles were found in PubMed and Cochrane Library, 13 studies were eligible for final analysis with 1063 patients, mean age of patients was 58.7 years. Main indication for HA IL was unilateral vocal fold paralysis, evaluation methods were subjective-VHI (Voice Handicap Index) questionnaire and objective-acoustic and aerodynamic measurements, mean time of follow-up was 5.9 months. Large-particle HA gels were more favorable for longer durability than small-particle HA, reported time of resorption of HA gels ranges between 6 and 12 months, and complication rate was low.
CONCLUSION
Hyaluronic acid injection laryngoplasty increases voice quality, improves results of voice therapy, and can be recommended as overlap treatment before permanent medialization surgery. Compared to other injected materials, HA seems to have more favorable effect on vibratory functions of the vocal folds and thus on the voice quality parameters.
Topics: Animals; Glottis; Humans; Hyaluronic Acid; Laryngoplasty; Middle Aged; Retrospective Studies; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords
PubMed: 35767054
DOI: 10.1007/s00405-022-07437-0 -
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 -
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 -
Journal of the Neurological Sciences May 2011Patients with medically intractable seizures who are not candidates for epilepsy surgery are left with few options. Vagal nerve stimulation therapy is often a viable... (Review)
Review
Patients with medically intractable seizures who are not candidates for epilepsy surgery are left with few options. Vagal nerve stimulation therapy is often a viable alternative for these patients and can have a positive impact on quality of life. Rarely complications may occur. We report a case of mild blunt neck trauma resulting in VNS malfunction and delayed vocal cord paralysis. A systematic review of the literature on VNS malfunction, self-inflicted injuries, vagal nerve injury, and common side effects including voice changes was performed. Only a handful of relevant publications were found. Symptoms following VNS dysfunction include pain, dyspnea, and dysphonia. These symptoms are usually nonspecific, and in many cases, do not help differentiate from vagal nerve traction, lead breakage, or pulse generator malfunction. In our case, lead fracture and visible traction injury to the left vagus nerve were seen during surgical exploration. The vocal cord function completely recovered after revision of the leads. Prompt medical attention including appropriate diagnostic studies and early surgical exploration is necessary in cases of delayed vocal cord dysfunction and can help prevent long-term complications such as neuroma formation. The authors present a unique case of reversible vocal cord injury from blunt neck trauma leading to left vagus nerve damage.
Topics: Equipment Failure; Female; Humans; Neck Injuries; Vagus Nerve Stimulation; Vocal Cord Paralysis; Wounds, Nonpenetrating; Young Adult
PubMed: 21397256
DOI: 10.1016/j.jns.2011.02.022 -
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 -
Voice Outcome Measures for Adult Patients With Unilateral Vocal Fold Paralysis: A Systematic Review.The Laryngoscope Jan 2019Unilateral vocal fold paralysis (UVFP) typically results in marked changes in voice quality and performance and has a significant impact on quality of life. Treatment...
OBJECTIVES
Unilateral vocal fold paralysis (UVFP) typically results in marked changes in voice quality and performance and has a significant impact on quality of life. Treatment approaches generally aim to restore glottal closure for phonation and improve vocal function. There are a wide range of voice outcome measures that are available to measure the treatment effect. Careful selection of voice outcome measures is required to ensure that they are adequate for purpose and are psychometrically sound to detect the treatment effect. This article aims to critically evaluate the literature for voice outcome measures that are used for patients with UVFP.
STUDY DESIGN
Systematic review.
METHODS
Nine databases were searched for UVFP treatment studies published since 2003 (n = 2,484 articles). These articles and their references were screened using inclusion/exclusion criteria, including population characteristics, treatment, voice outcomes, and study findings. Data from the included articles was extracted and appraised with respect to multidimensionality, timing, selection rationale, validity, reliability, and responsiveness to change of the voice outcome measures.
RESULTS
A total of 29 studies met the inclusion criteria for the systematic review. These studies showed considerable variability in the rationale, selection, and application of voice outcome measures for reporting the treatment effect for patients with UVFP.
CONCLUSION
There is currently a significant disparity in the selection and use of voice outcome measures for patients with UVFP. A set of principles around selection rationale, validity, reliability, and responsiveness to change is proposed to enhance the judicious selection of voice outcome measures for this patient group. Laryngoscope, 129:187-197, 2019.
Topics: Adult; Dysphonia; Humans; Outcome Assessment, Health Care; Quality of Life; Reproducibility of Results; Speech Therapy; Vocal Cord Paralysis; Voice Quality; Voice Training
PubMed: 30229922
DOI: 10.1002/lary.27434 -
Endocrinologia, Diabetes Y Nutricion 2020There is controversy regarding the performance of preoperative laryngoscopy (LP) in thyroid surgery, with different recommendations being made, based on observational... (Meta-Analysis)
Meta-Analysis
There is controversy regarding the performance of preoperative laryngoscopy (LP) in thyroid surgery, with different recommendations being made, based on observational studies, in various publications. The aim of the study was to know the prevalence of laryngeal paralysis found in the LPs of patients who underwent thyroidectomy in benign and malignant pathology. A systematic review was carried out with 29 articles included for the qualitative study and a meta-analysis of 13 articles in which the data could be obtained to evaluate the same effect (in all patients in which an LP was carried out, those with preoperative laryngeal paralysis were included, and assigned to malignant or benign postoperative histology groups). The pooled prevalence of preoperative paralysis in benign pathology was 1.1% (95% CI 0.7 to 1.7%, 71% I) and in 6.3% malignant pathology (95% CI 3.8 to 9.4%; I 85%). The prevalence was significantly higher among patients with malignant pathology with an estimated effect RR 5.66, 95% CI, 2.48, 12.88. The studies analyzed present biases that will need to be corrected in future research, eliminating blinding biases in the selection and allocation of patients or in the laryngoscopy technique used. The LP in thyroid surgery evaluates possible disorders of laryngeal motility. The prevalence of laryngeal paralysis in thyroid pathology found in LPs in patients with a postoperative diagnosis of malignant pathology was higher than in the benign pathology group. This information is necessary for interpreting the intraoperative neuromonitoring signal and for making informed decisions.
Topics: Humans; Laryngoscopy; Prevalence; Thyroid Diseases; Thyroid Neoplasms; Thyroidectomy; Vocal Cord Paralysis
PubMed: 31879254
DOI: 10.1016/j.endinu.2019.09.014 -
The Cochrane Database of Systematic... Oct 2012Patients with unilateral vocal fold paralysis (UVFP) usually present with dysphonia, but can also be breathless and have problems with their swallowing. Speech and... (Review)
Review
BACKGROUND
Patients with unilateral vocal fold paralysis (UVFP) usually present with dysphonia, but can also be breathless and have problems with their swallowing. Speech and language therapy forms the initial mainstay of management in cases of UVFP, since up to 60% of cases will resolve spontaneously. If vocal fold paralysis persists surgery, in the form of injection medialisation, has been shown to be an effective intervention. What is currently unclear is which is the most effective material available for injection.
OBJECTIVES
To assess the effectiveness of alternative injection materials in the treatment of UVFP.
SEARCH METHODS
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 23 March 2012.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of injectable materials in patients with UVFP. The outcomes of interest were patient and clinician-reported improvement, and adverse events.
DATA COLLECTION AND ANALYSIS
Two authors independently selected studies from the search results and extracted data. We used the Cochrane 'Risk of bias' tool to assess study quality.
MAIN RESULTS
We identified no RCTs which met the inclusion criteria for this review. We excluded 18 studies on methodological grounds: 16 non-randomised studies; one RCT due to inadequate randomisation and inclusion of non-UVFP patients; and one RCT which compared two different particle sizes of the same injectable material.
AUTHORS' CONCLUSIONS
There is currently insufficient high-quality evidence for, or against, specific injectable materials for patients with UVFP. Future RCTs should aim to provide a direct comparison of the alternative materials currently available for injection medialisation.
Topics: Biocompatible Materials; Humans; Injections; Vocal Cord Paralysis; Vocal Cords
PubMed: 23076955
DOI: 10.1002/14651858.CD009239.pub2