Unsedated Office-Based Thulium Laser Therapy in Patients With Reinke's Edema.

OBJECTIVE: To report the outcome of unsedated office based Thulium laser therapy for Reinke's edema. MATERIALS AND METHODS: A retrospective chart review of patients operated between March 2017 and November 2018 was conducted. Twelve patients were included, two of whom had two procedures performed. Demographic data included age, gender, smoking status, and grade of Reinke's edema. Outcome measures included Voice Handicap Index-10 (VHI), perceptual evaluation, extent of disease regression, acoustic analysis, and maximal phonation time. RESULTS: Twelve patients were enrolled in this study, one of whom was lost for follow-up. There were eight females and three males. The mean age was 51.27 ± 9.12 years. Endoscopic evaluation 6-12 weeks after surgery revealed complete and partial regression of disease in three and eight patients, respectively. There was a significant improvement in the mean score of VHI-10 (15.00 ± 9.45 vs 3.07 ± 3.81) and the mean score of GRABS parameters following surgery (P < 0.05). The mean habitual pitch increased from 125.11 ± 28.48 Hz to 155.86 ± 55.14 Hz (P = 0.070). There was improvement in the mean jitter and shimmer but none reached a statistical significance. There was no significant change in the mean Maximum phonation time (MPT) scores before and after surgery. CONCLUSION: Unsedated office-based Thulium laser therapy can be considered as an alternative therapy to patients with Reinke's edema who are not willing to undergo conventional microlaryngeal surgery.

The Prevalence of Dysphonia and Dysphagia Symptoms in Patients on Statin Therapy.

OBJECTIVE: To investigate the effect of statin therapy on swallowing and phonation. METHODS: A group of patients on statin therapy and another group not on statins (controls) presenting to the endocrinology clinic between January 2018 and April 2018 were asked to participate. All patients filled Voice Handicap Index (VHI-10), Eating Assessment Tool (EAT-10), and Likert scales for vocal fatigue and hoarseness. Demographic data included age, gender, allergy, and history of smoking. RESULTS: A total of 160 patients were recruited, 75 patients on statin therapy and 85 not on statin therapy. The mean age of the study group was 55.00 years, whereas that of the control group was 45.70 years. The mean duration of statin treatment was 74.92 months. The mean VHI-10 and EAT-10 scores were significantly higher in the statin group compared to the control group (P < 0.05). Although there was no significant difference in the mean Likert scale for vocal fatigue, the mean Likert scale for hoarseness was significantly higher in the statin group compared to the control group (P < 0.05). CONCLUSION: This investigation revealed a significantly higher prevalence of laryngopharyngeal symptoms in patients on statin therapy versus a control group.

Laser Partial Arytenoidectomy as an Office Procedure.

Bilateral vocal fold paralysis is a disabling condition that results in airway symptoms, dysphonia, and sometimes difficulty swallowing. Various types of glottal widening procedures have been described in the literature, all of which are performed in the operating room under general anesthesia. The aim is to report laser partial arytenoidectomy as an office-based treatment modality in a patient with bilateral vocal fold paralysis. Using Thulium laser fiber introduced through the working channel of fiberoptic nasopharyngoscope, a posterior cordectomy followed by resection of the vocal process of the right arytenoid was performed. The laser was used in a pulsed mode, power range 3.5 to 4.5 W, duration 70 to 300 milliseconds, repetition 2 to 4 Hz, and aiming beam 65%. The procedure was well tolerated and the patient was successfully decannulated 3 weeks later. Unsedated office-based laser arytenoidectomy might be considered a safe alternative to the commonly practiced glottal widening procedures in patients with a preexisting tracheotomy.