Efficacy and Safety of Adjunctive Steroid Injection After Microsurgical Removal of Benign Vocal Fold Lesions

Cho, Jung-Hae; Kim, Sang-Yeon; Joo, Young‐Hoon; Park, Young-Hak; Hwang, Woo-Seob; Sun, Dong‐Il

doi:10.1016/j.jvoice.2017.01.003

Cited by 23 publications

(21 citation statements)

References 18 publications

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“…They chose triamcinolone for its longer dwell time and depot effect and were able to detect white residue subepithelially in the VF at 1 to 2 months postsurgery in injected patients. Reduced likelihood of recurrent pathology and decrease in persistent dysphonia was noted in this group 12 …”

Section: Introductionmentioning

confidence: 56%

“…Two different concentrations are commonly available—10 or 40 mg/mL. Cho et al preferred use of triamcinolone in a study of steroid injection at the time of microsurgical removal of benign VF pathology 12 . They chose triamcinolone for its longer dwell time and depot effect and were able to detect white residue subepithelially in the VF at 1 to 2 months postsurgery in injected patients.…”

Section: Introductionmentioning

confidence: 99%

“…Cho et al preferred use of triamcinolone in a study of steroid injection at the time of microsurgical removal of benign VF pathology. 12 They chose triamcinolone for its longer dwell time and depot effect and were able to detect white residue subepithelially in the VF at 1 to 2 months postsurgery in injected patients. Reduced likelihood of recurrent pathology and decrease in persistent dysphonia was noted in this group.…”

Section: Introductionmentioning

confidence: 99%

“…Reduced likelihood of recurrent pathology and decrease in persistent dysphonia was noted in this group. 12 …”

Section: Introductionmentioning

confidence: 99%

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Effects of corticosteroids vs halofuginone on vocal fold wound healing in an ovine model

Allen

2021

Laryngoscope Investig Oto

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Objectives To evaluate antifibrotic effects of corticosteroids and halofuginone, a small molecule inhibitor of Smad3, in an ovine model of vocal fold (VF) injury. Methods Thirty sheep, using a paired study design, underwent controlled right VF injury by biopsy and then were treated with either no treatment, oral dexamethasone, intralesional triamcinolone, or oral halofuginone. Larynges were evaluated for histological evidence of fibrosis, immunohistochemical presence of Smad3, and vibratory parameters. Outcomes were compared across treatment groups. Results Following injury, VF collagen density decreased in both halofuginone‐treated and dexamethasone‐treated sheep but not in triamcinolone treated sheep. A significant difference was noted between halofuginone and triamcinolone treated sheep (27.8% vs 37%, P = .017). Elastin was preserved postinjury by halofuginone treatment in contrast with all steroid treated animals where significant loss of elastin was noted (P <.05). Smad3 staining was up‐regulated at all injury sites compared to normal left VFs however halofuginone and dexamethasone treatment reduced Smad3 activity significantly whereas triamcinolone treatment did not (P <.05). Ex‐vivo stroboscopic evaluation demonstrated mucosal wave in all excised larynges with a normalized glottal gap less than 3, suggesting adequate glottal closure. Conclusions VF injury in an ovine model results in a wound response able to be modified by Smad3 inhibitor, halofuginone, with benefit to vibratory function. Halofuginone treated sheep demonstrated reduced collagenization of lamina propria with greater elastin density after injury, than sheep treated with either steroid medication. These data support this pathway as a suitable target for manipulation to prevent or reverse fibrosis in the glottis and restore voice quality. Level of Evidence: NA.

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Section: Introductionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Reduced likelihood of recurrent pathology and decrease in persistent dysphonia was noted in this group. 12 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of corticosteroids vs halofuginone on vocal fold wound healing in an ovine model

Allen

2021

Laryngoscope Investig Oto

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“…Adjunctive steroid injections after laryngeal microsurgery have recently been reported to be safe and associated with improved voice quality in patients with benign vocal fold lesions [ 10 ]. In that study, adjunctive steroid injections were associated with a 0.3-fold lower risk of persistent dysphonia after surgery; however, patients with RE were not enrolled as the study subjects [ 10 ]. Since excessive fibrosis and scarring of the vocal folds after surgery may hamper mucosal vibration, the use of steroid injections is reasonable to reduce fibrosis of the vocal folds.…”

mentioning

confidence: 99%

Voice Outcomes After Laryngeal Microsurgery With Adjunctive Steroid Injection for Reinke Edema

Jang

Kim

Lee

et al. 2021

Clin Exp Otorhinolaryngol

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Assessment of Patient Outcomes After Adjuvant Vocal Fold Steroid Injection for Fibrosis After Microlaryngeal Surgery

Hsu

Liao

Huang

et al. 2019

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Microlaryngeal surgery (MLS) is one of the most common procedures in laryngology; however, in cases of postoperative fibrosis, few remedial options are available.OBJECTIVE To investigate the outcomes of vocal fold steroid injection (VFSI) as an adjuvant treatment for fibrosis after MLS. DESIGN, SETTING, AND PARTICIPANTS Case series of 228 consecutive patients who underwent MLS for benign vocal lesions between January 2014 and December 2016 at a tertiary medical center. Adjuvant VFSI was performed in 25 patients (11%) with postoperative fibrosis, defined as severely decreased or absent mucosal wave on videolaryngostroboscopy (VLS) lasting for longer than 1 month postoperatively. Data were analyzed from July 1, 2018 to April 30, 2019.INTERVENTION All adjuvant VFSIs were performed in the office under local anesthesia and were repeated monthly if the status of the mucosal wave did not return to normal or mildly decreased on the follow-up VLS. MAIN OUTCOMES AND MEASURESThe outcome parameters, namely, the 10-item Voice Handicap Index (VHI-10), smoothed cepstral peak prominence (CPP) of recorded voice samples, and mucosal wave status on VLS, were measured before and after MLS and after adjuvant VFSI. RESULTSIn this case series of 228 patients (72 men and 156 women; mean [SD] age, 42.8 [12.3] years), 25 had a decreased or absent mucosal wave after MLS, indicating postoperative fibrosis. Of these patients, 22 presented with deep-seated lesions that were removed using a microflap approach. After 1 course of adjuvant VFSI in 17 patients and 2 serial monthly injections in 8 patients, VFSI was associated with improved VHI-10 scores (mean, 24.4 points preoperatively, 22.1 points postoperatively, and 12.9 points after VFSI) that were comparable to the scores of the other 203 patients without vocal fold fibrosis after MLS (mean, 24.8 points preoperatively, 11.7 points postoperatively). Adjuvant VFSI was also associated with improved CPP (mean, 4.04 preoperatively, 4.23 postoperatively, and 5.11 after VFSI) that was comparable to the CPP of the other patients without postoperative fibrosis (mean, 4.33 preoperatively and 5.15 postoperatively). Overall, 19 (76%) of 25 patients with vocal fold fibrosis after MLS had normal (n = 11) or mildly decreased (n = 8) mucosal wave after adjuvant VFSI.CONCLUSIONS AND RELEVANCE Adjuvant VFSI appeared to be associated with improvements in mucosal wave, voice quality, and subjective perception of dysphonia in patients with fibrosis after MLS, with outcomes comparable to those of the other patients without fibrosis. Adjuvant VFSI may be considered a rescue technique, reducing the rate of fibrosis after MLS from 11% to 3%.

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Efficacy and Safety of Adjunctive Steroid Injection After Microsurgical Removal of Benign Vocal Fold Lesions

Cited by 23 publications

References 18 publications

Effects of corticosteroids vs halofuginone on vocal fold wound healing in an ovine model

Effects of corticosteroids vs halofuginone on vocal fold wound healing in an ovine model

Voice Outcomes After Laryngeal Microsurgery With Adjunctive Steroid Injection for Reinke Edema

Assessment of Patient Outcomes After Adjuvant Vocal Fold Steroid Injection for Fibrosis After Microlaryngeal Surgery

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