No abstract

Objective To demonstrate the safety profile of platelet‐rich plasma (PRP) as an injectable therapeutic for the treatment of vocal fold scarring and atrophy. Methods Preliminary report on a prospective clinical trial of patients with vocal fold scar or atrophy undergoing unilateral vocal fold subepithelial infusion with autologous PRP. Enrolled patients underwent four subepithelial injections spaced 1 month apart. Adverse events were assessed peri and post‐injection at each session. Patient‐reported outcomes were collected at every visit using the Voice Handicap Index‐10 (VHI‐10) and Vocal Fatigue Index (VFI) questionnaires. Results Twelve patients underwent unilateral vocal fold injection with autologous PRP prepared according to Eclipse PRP® system protocol. Forty‐three injections were performed using a peroral or percutaneous approach. An average of 1.57 ± 0.4 cc (range 0.6–2.0 cc) injectate was used. All patients tolerated the procedure without difficulty or peri‐procedural complications. The average duration of follow‐up was 3.6 ± 1.8 months. No significant inflammatory reactions or adverse events were seen to date. There was statistically significant improvement in patient‐reported outcomes at the 3 month follow up (n = 9) follow‐up (mean ΔVHI‐10 = 10.8, p < 0.001, mean ΔVFI = 18.9, p = 0.01, t test, paired two sample for means, two‐tail). All nine patients who completed the series of four injections subjectively (yes/no) reported they were satisfied with the results. Conclusion This prospective study cohort demonstrated a favorable safety profile, with no adverse events or peri‐procedural complications. Subjective improvements in vocal quality and reduction in vocal fatigue need to be clinically correlated with further study. Level of Evidence 4 Laryngoscope, 133:647–653, 2023

Objective To compare postoperative pain scores and opioid consumption in patients after transoral robotic surgery (TORS). Study Design Single institution retrospective cohort study. Setting TORS was performed at a single academic tertiary care center. Methods This study compared traditional opioid‐based and opioid‐sparing multimodal analgesia (MMA) regimens in patients with oropharyngeal and supraglottic malignancy after TORS. Data were obtained from the electronic health records from August 2016 to December 2021. The average postoperative pain scores and total opioid consumption in morphine milligram equivalents were calculated for postoperative days (PODs) 0 to 3. The secondary objectives were to quantify and characterize opioid prescriptions upon hospital discharge. Results A total of 114 patients were identified for this study, 58 patients in the non‐MMA cohort and 56 in the MMA cohort. Postoperative pain levels in the MMA cohort were statistically lower on POD 0 ( p = 0.001), POD 1 ( p = 0.001), and POD 3 ( p = 0.004). Postoperative opioid consumption decreased significantly in the MMA cohort from 37.7 to 10.8 mg on POD 0 ( p = 0.002), 65.9 to 19.9 mg on POD 1 ( p < 0.001), 36.0 to 19.3 mg on POD 2 ( p = 0.02), and 45.4 to 13.8 mg on POD 3 ( p = 0.02). The number of patients discharged from the hospital with a prescription for narcotics was significantly lower in the MMA cohort (71.4%) compared with the non‐MMA cohort (98.3%) ( p < 0.001). Conclusion Implementation of our MMA pain protocol reduced pain levels and narcotic consumption in the immediate postoperative period.