scholarly journals The Effect of Vocal Fold Steroid Injection via Cricothyroid Membrane in Patients with Vocal Polyp

2020 ◽  
Vol 63 (11) ◽  
pp. 511-516
Author(s):  
Woojoo Nam ◽  
Seung Ho Noh ◽  
Jin Lee ◽  
Sun Woo Kim ◽  
Sung Min Jin ◽  
...  
Keyword(s):  
Program Analysis ◽  
Vocal Fold ◽  
Acoustic Analysis ◽  
Steroid Injection ◽  
Post Treatment ◽  
Symptom Improvement ◽  
Cricothyroid Membrane ◽  
Mean Values ◽  
Vocal Polyp ◽  
Alternative Treatment Option

Background and Objectives Vocal polyps are generally caused by phonotrauma such as vocal overuse, and the first line treatment is known as laryngeal microsurgery. The aim of the study is to evaluate the applicability and effectiveness of percutaneous steroid injection via cricothyroid membrane in patients with vocal polyp and to evaluate its advantages and limitations of the technique.Subjects and Method We included in this study 70 patients with vocal polyp managed by vocal fold steroid injection via the cricothyroid membrane from Jan 2008 to July 2018. We compared their medical records of laryngoscopy, stroboscopy, and multi-dimensional voice program analysis at pre and post treatment. Subjective voice improvement was evaluated using Voice Handicap Index-30 (VHI-30).Results Of the patients, 54.3 percent showed morphological improvement. In acoustic analysis, the pre-treatment mean values of jitter, shimmer, and NHR were 2.20±2.23, 5.09±3.24, 0.15±0.04, respectively. The post-treatment values were 1.54±1.28, 5.00±4.40, 0.13±0.04, respectively, and only jitter was statistically significant. For subjective symptom improvement, 32 (45.8%) patients showed better score on the post-treatment of VHI-30 compared to pretreatment. Ten patients experienced mild complications such as vocal fold atrophy and scar; however, no critical complications such as internal bleeding or dyspnea were reported.Conclusion According to our study, steroid injection is a safe and effective procedure for patients with vocal polyp. A vocal fold steroid injection via the cricothyroid membrane can be an alternative treatment option for those who are not able to undergo conventional laryngeal microscopic surgery.

scholarly journals 663 Improved Sleep After a Brief Intervention for Insomnia Mediates Improvements in Depression Symptoms During the COVID-19 Pandemic

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A259-A259
Author(s):  
Kathleen O’Hora ◽  
Mateo Lopez ◽  
Allison Morehouse ◽  
Andrea Cordero ◽  
Raquel Osorno ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Outcome Measures ◽  
Symptom Severity ◽  
Post Treatment ◽  
Symptom Improvement ◽  
Depression Symptoms ◽  
Insomnia Symptom ◽  
The Impact ◽  
Insomnia Symptoms ◽  
Rate Of Improvement

Abstract Introduction The COVID-19 Pandemic and mitigation efforts have led to drastic increases in acute insomnia symptoms, which left untreated may contribute to increased risk for other negative mental health outcomes, including depression. However, the impact of treating acute insomnia symptoms on future depression outcomes remains unknown. Moreover, whether sleep improvements as a result of an insomnia treatment mediate subsequent reduction of depression symptoms similarly remains unknown. Methods At this writing, 44 individuals experiencing insomnia symptoms (Insomnia Severity Index; ISI ≥ 10) that began during the COVID-19 pandemic have been randomized to receive a brief, telehealth Cognitive Behavioral Therapy for Insomnia (CBTI) waitlist control. Treatment was delivered in 4 sessions over a 5-week period. CBTI is the gold-standard behavioral intervention for chronic insomnia and has been applied successfully via telemedicine. Outcome measures were depressive symptoms as measured by the Patient Health Questionnare-9 (PHQ-9) minus the sleep item and insomnia symptom severity as measured by the ISI. Both outcome measures were collected at baseline (week 0), throughout treatment phase (weeks 2–6), and at the post-treatment (week 7). Linear mixed models determined the impact of treatment on depression and insomnia symptom severity. Mediation was tested using the MacArthur framework. Results There was a significant Group x Time interaction, with CBTI leading to a greater rate of improvement in ISI (b = -1.14, p < 0.001) and PHQ-9 (b = -0.61, p = 0.002) than the control. Critically, the rate of improvement in insomnia symptoms to the last session of treatment, was associated with the subsequent improvement in depressive symptoms post-treatment (b = 2.06, p = 0.017). In contrast, depressive symptom improvement was not associated with insomnia symptom improvement (b = 4.28, p = 0.102). Conclusion This preliminary data suggests that brief CBTI can reduce pandemic onset insomnia and other depressive symptoms. The preliminary mediation results further suggest that sleep may be an important treatment target for reducing situational depressive symptoms and supports the need to examine the physiological mechanisms of sleep using high-density EEG in a larger sample. Support (if any):

scholarly journals Expectancies as predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease

2021 ◽  
Author(s):  
Henriët van Middendorp ◽  
Anneleen Berende ◽  
Fidel J. Vos ◽  
Hadewych H. M. ter Hofstede ◽  
Bart Jan Kullberg ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Treatment Success ◽  
Symptomatic Improvement ◽  
Post Treatment ◽  
Symptom Improvement ◽  
Persistent Symptoms ◽  
Treatment Expectancies ◽  
End Of Treatment ◽  
Pre Treatment

Abstract Introduction/Objective Expectancies about symptom improvement or deterioration are reliable predictors of symptom progression and treatment outcomes (symptom resolution or symptomatic improvement) in many (non-)pharmacological studies and treatments. This study examined predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease, hypothesizing particularly pre-treatment expectancies regarding symptom improvement to be predictive. Methods A predictive study was performed on pre-treatment and post-treatment individual characteristics, including expectancies, and physical and mental health–related quality of life (HRQoL) from the PLEASE-trial comparing randomized 12-weeks of doxycycline, clarithromycin-hydroxychloroquine, or placebo following 2 weeks of intravenous ceftriaxone. At end-of-treatment (14 weeks after trial start) and follow-up (52 weeks), complete data of 231 and 170 (of initial 280) patients with persistent symptoms temporally related to a history of erythema migrans or otherwise confirmed symptomatic Lyme disease, or accompanied by B. burgdorferi IgG or IgM antibodies, were examined through hierarchical regression analyses. Results In addition to pre-treatment HRQoL, pre-treatment expectancies regarding symptom improvement were consistently associated with stronger physical and mental HRQoL improvements at both end-of-treatment and follow-up (95% CI range: .09;.54, p < .01 to .27;.92, p < .001). Post-treatment expectancies regarding having received antibiotics vs. placebo was associated with more HRQoL improvement at end-of-treatment, but not at follow-up (95% CI-range 1.00;4.75, p = .003 to −7.34; −2.22, p < .001). Conclusions The present study shows that, next to pre-treatment functioning, patients’ pre-treatment and post-treatment expectancies regarding improvement of persistent symptoms attributed to Lyme disease relate to a more beneficial symptom course. Expectancies of patients may be relevant to explain and potentially improve patient outcomes (e.g., by optimized communication about treatment success). Trial registration ClinicalTrials.gov, NCT01207739 (Registration date: 23–09-2010) Key Points• As there is currently no sufficient symptom resolution or symptomatic improvement for many patients with persistent symptoms attributed to Lyme disease, it is relevant to know which factors determine symptom progression and predict heterogeneity in treatment response.• Next to pre-treatment functioning, expectancies regarding symptom improvement and having received antimicrobial study medication are associated with a more beneficial symptom course after both shorter-term and longer-term antimicrobial treatment.• Expectancies are relevant to consider in treatment studies and may be useful in clinical settings to improve symptom course and treatment outcome (e.g., by optimized communication about treatment success).

1287 A Comparison of Surgical Decompression and Steroid Injections to Treat Carpal Tunnel Syndrome: A Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
F La Costa
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Muscular Atrophy ◽  
Meta Analysis ◽  
Surgical Decompression ◽  
Optimal Treatment ◽  
Post Treatment ◽  
Entrapment Neuropathies ◽  
Tunnel Syndrome

Abstract Introduction Carpal tunnel syndrome (CTS) is caused by compression of the median nerve at the wrist. It accounts for 90% of all entrapment neuropathies, with a 7-16% in the UK. It has a significant impact on patients’ daily lives. Clinically, CTS results in paraesthesia, while extreme cases may involve muscular atrophy and weakness. There is currently a disparity between optimal treatments for CTS. Therefore, this paper aims to identify the optimal treatment for CTS with post-treatment BCTQ (Boston Carpal Tunnel Questionnaire) scores (including both functional and symptomatic severity) at 1, 3 and 6 months. Method The BCTQ scores for were sited from PubMed, Google Scholar and the University of Dundee Library search engine by entering key words such as “carpal tunnel syndrome”, “surgical decompression”, “surgical release” and “steroid injection”. Means and standard deviations for pre- and post-treatment after 1, 3 and 6 months were obtained. From this, forest plots were constructed using a software where steroid injection and surgical decompression were inputted separately, and effect sizes were then compared for 1, 3 and 6 months. Results The meta-analysis included reviewing 133 articles. The effect size was determined using the random effects model. Steroid injection was more effective than surgical decompression after 1 and 3 months. However, after 6 months, surgical decompression was more effective. Conclusions Identification of long-term relief of CTS through surgical decompression allows the reduction of symptom recurrence and thus costly follow-up appointments. This study provides robust clinical findings for the optimal treatment of CTS.

RADT-30. MULTISESSION RADIOSURGERY ALONE FOR TREATMENT OF PRESUMED MENINGIOMAS: AN INTERIM REPORT FROM A SINGLE INSTITUTION PROTOCOL

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi47-vi48
Author(s):  
Michael Carrasquilla ◽  
Alexander Tai ◽  
Matthew Forsthoefel ◽  
Edina Wang ◽  
Siyuan Lei ◽  
...  
Keyword(s):  
Local Control ◽  
Tumor Resection ◽  
Symptom Improvement ◽  
Tumor Control ◽  
Single Institution ◽  
Robotic Radiosurgery ◽  
Early Results ◽  
Alternative Treatment Option

Abstract PURPOSE Meningiomas are the most commonly diagnosed primary intracranial tumor. Resection and single-fraction radiosurgery are treatment options with well-established long-term outcomes data. Multisession radiosurgery is an alternative treatment option with promising early results. However, mature outcomes literature does not yet exist. In this study, we report our institution’s interim results on the efficacy and safety of 5-fraction radiosurgery alone for radiographically diagnosed meningiomas. MATERIALS AND METHODS Between 2005-2015 all patients who completed treatment on a single institution protocol utilizing 5-fraction robotic radiosurgery alone for the treatment of progressing radiographically diagnosed meningiomas were eligible for inclusion. Local control was calculated using the Kaplan-Meier Method. RESULTS Forty-four consecutive predominately female patients (84%) ranging in age from 33-85 (median: 59) were included in the present study. Median tumor volume was 4.05mm3 (range: 0.94-15.4mm3) and the majority of tumors were located at the base of skull (66%). A median dose of 25Gy (range: 25Gy-35Gy), was delivered to a median isodose line of 82%, (range: 70%-90%) over a median of 7 days (range: 5-11 days). Acute toxicity was minimal with 7 patients (15%) requiring a short course of steroids for symptomatic edema during treatment. Of 16 patients who presented with a cranial nerve deficit, symptom improvement was noted in 11 patients (69%). No permanent treatment related toxicity was noted in our cohort. The median radiographic follow-up was 6.9 years (range: 0.5-14.8 years). The 5 and 8-year local control rates were 100% and 95%. The median time to local failure (n=2) in our cohort was 8.2 years. CONCLUSIONS The treatment of radiographically diagnosed meningiomas with 5-fraction robotic radiosurgery provides excellent local control to date, with low rates of acute and late toxicity. However, with late failures noted in our series, continued follow-up is needed to determine the optimal dose required for long-term tumor control.

scholarly journals Multidimensional acoustic analysis of pathological voice

2009 ◽  
Vol 137 (5-6) ◽  
pp. 234-238
Author(s):  
Mirjana Petrovic-Lazic ◽  
Snezana Babac ◽  
Zoran Ivankovic ◽  
Rade Kosanovic
Keyword(s):  
Vocal Fold ◽  
Acoustic Analysis ◽  
Control Group ◽  
Acoustic Parameters ◽  
Vocal Rehabilitation ◽  
Voice Treatment ◽  
Before And After ◽  
The Voice ◽  
Vocal Fold Nodules ◽  
Pathological Voice

Introduction. There are subjective and objective ways to examine the effects of vocal therapy in voice disorders. The most precise and objective check-up is the use of computer voice analysis. Objective. The aim of the research was to perform a detailed analysis of acoustic structure of the vowel A before and after voice treatment in patients with vocal fold nodules in order to obtain objective verification of the vocal rehabilitation success. Methods. We examined 30 female patients, aged 34.6?6.69 years, with vocal fold nodules. Acoustic parameters of voice were compared with the control group consisting of 21 subjects without voice pathology. In all persons the vowel A was recorded and analyzed before and after a month of vocal therapy. The success of the vocal therapy was tracked using computer analysis of vocal structure. Signal, noise and tremor parameters were processed. Results. Of the analyzed vowel A parameters: STD, PER, JITA, JITT, RAP, vFO, ShdB, SHIM, APQ, VTI, SPI, F0, NHR, FTRI, eleven improved (p<0.05 and p<0.01). Three parameters (F0, NHR, FTRI) changed showing improvement, but the obtained differences were not statistically significant (p>0.05). Conclusion. Based on the obtained results it was concluded that vocal therapy gave satisfactory results, but that it should be continually applied until full stabilization of the voice.

scholarly journals Using Innovative Acoustic Analysis to Predict the Postoperative Outcomes of Unilateral Vocal Fold Paralysis

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Yung-An Tsou ◽  
Yi-Wen Liu ◽  
Wen-Dien Chang ◽  
Wei-Chen Chen ◽  
Hsiang-Chun Ke ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Linear Prediction ◽  
Acoustic Analysis ◽  
Characteristic Curve ◽  
Voice Quality ◽  
Treatment Strategies ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Outcome Predictor ◽  
Laryngeal Framework Surgery

Objective.Autologous fat injection laryngoplasty is ineffective for some patients with iatrogenic vocal fold paralysis, and additional laryngeal framework surgery is often required. An acoustically measurable outcome predictor for lipoinjection laryngoplasty would assist phonosurgeons in formulating treatment strategies.Methods.Seventeen thyroid surgery patients with unilateral vocal fold paralysis participated in this study. All subjects underwent lipoinjection laryngoplasty to treat postsurgery vocal hoarseness. After treatment, patients were assigned to success and failure groups on the basis of voice improvement. Linear prediction analysis was used to construct a new voice quality indicator, the number of irregular peaks (NIrrP). It compared with the measures used in the Multi-Dimensional Voice Program (MDVP), such as jitter (frequency perturbation) and shimmer (perturbation of amplitude).Results.By comparing the [i] vowel produced by patients before the lipoinjection laryngoplasty (AUC = 0.98, 95% CI = 0.78–0.99), NIrrP was shown to be a more accurate predictor of long-term surgical outcomes than jitter (AUC = 0.73, 95% CI = 0.47–0.91) and shimmer (AUC = 0.63, 95% CI = 0.37–0.85), as identified by the receiver operating characteristic curve.Conclusions.NIrrP measured using the LP model could be a more accurate outcome predictor than the parameters used in the MDVP.

scholarly journals Meta-analysis of Vocal Fold Steroid Injection

2012 ◽  
Vol 147 (2_suppl) ◽  
pp. P193-P194
Author(s):  
Chi-Te Wang ◽  
Mei Shu Lai ◽  
Po Wen Cheng ◽  
Li-Jen Liao
Keyword(s):  
Vocal Fold ◽  
Steroid Injection ◽  
Meta Analysis

Urinary Steroids in Depressive Illness

1971 ◽  
Vol 16 (4) ◽  
pp. 224-227 ◽  
Author(s):  
A. Balfour Sclare ◽  
J. K. Grant
Keyword(s):  
Depressive Illness ◽  
Post Treatment ◽  
Normal Range ◽  
Mean Values ◽  
Female Patients ◽  
Significant Difference ◽  
The Mean ◽  
Pre Treatment ◽  
Depressive Patients ◽  
Source Of Information

A longitudinal study of urinary 17-OHCS in 16 depressive patients showed mean values within the accepted normal range. There were no significant differences between pre-treatment and post-treatment values; only the female patients showed a tendency to have somewhat lower post-treatment levels. 17-KS output was measured in 18 depressive patients. The mean values were within the normal range. There was no significant difference between pre-treatment and post-treatment values although the female patients displayed a tendency towards somewhat lower levels following treatment. DHA and EA excretion were measured in 9 depressive patients. There was a very wide variance in the findings. There was no significant difference between pre-treatment and post-treatment levels. The significance of the above findings is discussed. It is considered that measurements of urinary excretion of corticosteroids in affective disorders constitute a limited source of information.

Expression of a disintegrin and metalloproteinase-33 protein in vocal fold polyps

2015 ◽  
Vol 129 (7) ◽  
pp. 688-692 ◽  
Author(s):  
M V Akdogan ◽  
H Erinanc ◽  
O Topal ◽  
S S Erbek
Keyword(s):  
Immunohistochemical Staining ◽  
Vocal Fold ◽  
Clinical Characteristics ◽  
Laryngeal Squamous Cell Carcinoma ◽  
Symptom Duration ◽  
Over Expression ◽  
Vocal Polyp ◽  
Polyp Tissue ◽  
A Disintegrin And Metalloproteinase ◽  
Sinonasal Symptoms

AbstractBackground:This study aimed to evaluate the association of a disintegrin and metalloproteinase-33 protein (‘ADAM-33’) expression in vocal polyp formation and to determine its correlation with clinical characteristics.Methods:Medical charts and histological sections of 32 patients diagnosed with vocal polyps who underwent surgery were analysed. Controls were histopathologically normal vocal fold tissues obtained from 36 patients who underwent surgery for laryngeal squamous cell carcinoma. Immunohistochemical staining was performed to detect ADAM-33 expression in epithelial cells, stroma and vessels.Results:All epithelial, stromal and vascular staining scores were significantly greater in polyp tissue than in controls (p < 0.001). Stromal ADAM-33 staining scores were higher in vocal polyp patients with a symptom duration of less than six months (p < 0.05). Vocal overuse or the presence of reflux symptoms, sinonasal symptoms or allergy did not affect ADAM-33 immunostaining scores (p = 0.05).Conclusion:In this study, ADAM-33 immunostaining was significantly increased in vocal polyps. Therefore, over-expression of this protein may be associated with vocal polyp pathogenesis.

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