Miki Nozawa1,2, Satoka Takahashi1,2, Takeharu Kanazawa1,2, Kazuya Kurakami2,3, Tomohiro Hasegawa2, Mayu Hirosaki2, Manami Kamitomai2, Daigo Komazawa2,4, Ujimoto Konomi2,5, Makoto Ito1, Yusuke Watanabe2. 1. Division of Laryngeal Surgery, Department of Otolaryngology-Head and Neck Surgery, School of Medicine Jichi Medical University Shimotsuke Japan. 2. Tokyo Voice Center International University of Health and Welfare Tokyo Japan. 3. Department of Otolaryngology-Head and Neck Surgery Yamagata University, Faculty of Medicine Yamagata Japan. 4. AKASAKA Voice Health Center Tokyo Japan. 5. Voice and Dizziness Clinic Futakotamagawa Otolaryngology Tokyo Japan.
Abstract
Objectives: Vocal fold scarring is caused by replacement of vocal fold mucosa with fibrous tissue due to repeated inflammation or trauma. It can lead to severe dysphonia. It is currently treated conservatively and with phonosurgery and intracordal injections. Intracordal injection of steroid or basic fibroblast growth factor (bFGF) has been recently found to be useful for treating vocal fold scarring that does not respond to voice therapy. Methods: This retrospective study involved the administration of steroid injection and bFGF injection bilaterally under local anesthesia in 16 patients each. Laboratory measurements of voice parameters were performed before and 3-6 months after injection. Results: In the steroid injection group, the Voice Handicap Index (VHI) score significantly improved from 57.1 to 40.5, total Grade, Roughness, Breathiness, Asthenia, Strain (tGRBAS) score significantly improved from 4.2 to 2.6, and mean speech fundamental frequency (SFF) increased from 192.5 to 211.4 dB, but there was no improvement in maximum phonation time (MPT) and mean airflow rate (MFR). In the bFGF injection group, significant improvements in the VHI score (from 53.3 to 35.7), MPT (from 16.9 to 21.8 s) and MFR (from 314.6 to 210.5 ml/s) were seen; however, the tGRBAS score did not improve. In addition, the SFF significantly decreased from 178.1 to 160.5 Hz. Conclusion: These results suggest that both steroid and bFGF injections are effective for treating vocal fold scarring, with steroids improving voice quality and bFGF improving glottic closure, thereby contributing to improvements in VHI scores. Level of Evidence: 4.
Objectives: Vocal fold scarring is caused by replacement of vocal fold mucosa with fibrous tissue due to repeated inflammation or trauma. It can lead to severe dysphonia. It is currently treated conservatively and with phonosurgery and intracordal injections. Intracordal injection of steroid or basic fibroblast growth factor (bFGF) has been recently found to be useful for treating vocal fold scarring that does not respond to voice therapy. Methods: This retrospective study involved the administration of steroid injection and bFGF injection bilaterally under local anesthesia in 16 patients each. Laboratory measurements of voice parameters were performed before and 3-6 months after injection. Results: In the steroid injection group, the Voice Handicap Index (VHI) score significantly improved from 57.1 to 40.5, total Grade, Roughness, Breathiness, Asthenia, Strain (tGRBAS) score significantly improved from 4.2 to 2.6, and mean speech fundamental frequency (SFF) increased from 192.5 to 211.4 dB, but there was no improvement in maximum phonation time (MPT) and mean airflow rate (MFR). In the bFGF injection group, significant improvements in the VHI score (from 53.3 to 35.7), MPT (from 16.9 to 21.8 s) and MFR (from 314.6 to 210.5 ml/s) were seen; however, the tGRBAS score did not improve. In addition, the SFF significantly decreased from 178.1 to 160.5 Hz. Conclusion: These results suggest that both steroid and bFGF injections are effective for treating vocal fold scarring, with steroids improving voice quality and bFGF improving glottic closure, thereby contributing to improvements in VHI scores. Level of Evidence: 4.
Authors: William G Young; Matthew R Hoffman; Ian J Koszewski; Chad W Whited; Brienne N Ruel; Seth H Dailey Journal: Otolaryngol Head Neck Surg Date: 2016-08-09 Impact factor: 3.497
Authors: Emke M J M van den Broek; Bas J Heijnen; Martine Hendriksma; Vivienne A H van de Kamp-Lam; Antonius P M Langeveld; Peter Paul G van Benthem; Elisabeth V Sjögren Journal: Eur Arch Otorhinolaryngol Date: 2019-05-27 Impact factor: 2.503