The use of different intranasal splints Doyle splints versus Reuter bivalve splints versus no splints in primary septal surgeries: A randomised clinical trial looking at morbidity.

OBJECTIVE: The objective of this study is to compare the morbidity of different types of intranasal splints (Doyle splints and Reuter bivalve splints) with no intranasal splints in primary septal surgeries and concomitant submucosal reduction of the inferior turbinate. DESIGN: Randomised clinical trial SETTING: Single-Center trial at a tertiary care facility PARTICIPANTS: In this randomised clinical trial, 123 consecutive patients underwent primary septoplasty with bilateral submucosal reduction of the inferior turbinate, with no other concurrent procedure. Patients were randomised into three groups: Doyle splints, Reuter bivalve splints and patients with no splints placed. MAIN OUTCOME MEASURES: Following surgery, the patients were seen at three consecutive visits. During each visit, the Visual Analogue Scale score for headache, nasal obstruction, overall pain and bleeding and an endoscopic score for secretions, oedema and synechiae was filled. RESULTS: Patients were randomised into three groups, 42 received Doyle splints, 41 Reuter bivalve splints and 40 had no splints inserted. When comparing the three groups, the first two post-op visits were scheduled significantly earlier in patients with splints (p < .05). The scores from both groups with splints were statistically higher for headache, nasal obstruction and pain, for the first visit only (p < .05). There was no statistical difference between groups when looking at each subset of the endoscopic score, at each visit (p > .05). CONCLUSION: Increased post-operative pain, headaches and nasal obstruction scores were encountered in patients who had splints after surgery. However, endoscopic scores were statistically similar across the three groups with no difference in post-operative endoscopic scores at each visit. and no difference was seen in symptom scores and endoscopic scores between patients with different splints.

Prevalence of Laryngeal Muscle Tension in Patients With Obstructive Sleep Apnea.

OBJECTIVE/HYPOTHESIS: To determine the prevalence of laryngeal muscle tension in patients with obstructive sleep apnea (OSA). STUDY DESIGN: Retrospective case-control. METHODS: A total of 75 patients were included in this study. These were divided into a study group with a history of OSA (n = 45), and a control group with no history of OSA matched according to age and gender (n = 30). The risk of OSA was assessed using the STOP-BANG questionnaire. Demographic data included age, gender, body mass index, smoking, history of snoring, history of use of continuous positive airway pressure, and history of reflux disease. Symptoms such as hoarseness, throat clearing/cough, and globus sensation were also noted. The video recordings of the flexible nasopharyngoscopy of both groups were analyzed for the presence or absence of four laryngeal muscle tension patterns (MTPs). RESULTS: Twenty-five patients of the study group (55.6%) had signs of laryngeal muscle tension on laryngeal endoscopy compared to nine in the control patients (30%) (P = 0.029). The most common MTP observed in the study group was MTP III (n = 19), followed by MTP II (n = 17). Laryngeal muscle tension was more prevalent in patients of the intermediate and high-risk categories compared to those of the low-risk category (73.3% and 62.5% vs 28.6%, respectively) (P = 0.042). Patients with at least one MTP had more dysphonia and throat clearing than patients without any MTP. CONCLUSION: Patients with a history of OSA have a higher prevalence of laryngeal muscle tension in comparison to subjects with no history of OSA. Moreover, patients at high risk of OSA have a higher prevalence of laryngeal muscle tension than those at low risk of OSA.

Prevalence of Allergy in Patients with Primary Dysphonia.

Objective: The purpose of this investigation is to examine the prevalence of allergy in patients with primary dysphonia. Methods: The medical records of patients diagnosed with primary dysphonia and who underwent allergy testing during the period extending from June 2018-2020 were reviewed. Patients' demographics, laryngoscopic findings and allergy skin prick testing were analyzed. Results: A total of 22 patients were included. Eleven out of twenty-two patients (50%) tested positive to at least 2 allergens, and eight (36%) tested positive for at least 3 allergens. The most common allergens tested positive were D. Farinae for household inhalants, followed by Chenopodium, Russian thistle and weed mix for weeds. In patients with a positive allergy testing, the most common laryngeal findings included edema in 36%, followed by excess mucus and MTD in 18% of cases each. Conclusion: Allergy is common in patients presenting with primary dysphonia and non-specific laryngeal findings. Allergy testing should be part of the diagnostic work-up of affected patients.

Office-Based Blue Laser Therapy for Vocal Fold Leukoplakia: A Preliminary Report of 12 Cases.

Objective: To report the efficacy of office-based blue laser therapy for vocal fold leukoplakia. Study Design: A retrospective case series. Setting: A tertiary care center. Methods: A retrospective chart review of patients with vocal fold leukoplakia who underwent office-based blue laser therapy between July 2019 and October 2022 was conducted. The video recordings of their laryngeal examination and their voice evaluation were analyzed before and after surgical intervention. Results: A total of 10 patients, eight with unilateral disease and 2 with bilateral disease, were included in this study. In total, 12 vocal folds with leukoplakia were treated. Nine had a single session and 3 had 2 sessions due to incomplete regression of the lesion after the first laser therapy session. Following treatment, 9 regressed completely (75%) and 3 regressed partially (25%). The mean Voice Handicap Index-10 (VHI-10) score decreased significantly from 15.4 ± 12.9 preoperatively to 3.8 ± 2.86 after surgery (p = .023). There was a statistically significant decrease in the means of grade, roughness, breathiness, asthenia, and strain (p < .05). There was also a statistically significant decrease in the jitter and shimmer percent (p = .008 and p = .048, respectively) and a significant increase in the maximum phonation time from 9.63 ± 3.83 to 13.54 ± 5.92 seconds (p = .039). Conclusion: This preliminary study indicates that office-based blue laser therapy is an effective treatment modality for vocal fold leukoplakia.

Hyaluronic Acid in Rhinology: Its Uses, Advantages and Drawbacks-A Review.

Hyaluronic acid has been increasingly involved in recent research due to its many chemical and physical properties. This is a review of the literature for studies involving the use of hyaluronic acid in rhinology. Hyaluronic acid washes and irrigation have been increasingly used in chronic sinusitis medical therapy and post-operatively with mixed results. It has also been shown to play a role in the treatment of nasal polyposis, allergic rhinitis, acute rhinosinusitis and empty nose syndrome. Its effect on biofilm in many disease entities has also been studied. HA is being recently used as ancillary treatment for several rhinologic conditions such as post-operative endoscopy care and chronic sinonasal infections. The properties of HA have intrigued researchers over the past years particularly in biofilm management, healing and inflammation.

Office-based blue laser therapy for dyspnea in patients with type 3 Reinke's edema.

PURPOSE: To investigate the effectiveness of in-office blue laser therapy on dyspnea in patients with type 3 Reinke's edema. METHODS: The medical records and video-recordings of patients with Reinke's edema type 3 who had undergone office-based blue laser therapy between March 2022 and January 2023 were reviewed. The primary outcome measures assessed before and after surgery were dyspnea severity, risk of obstructive sleep apnea (OSA), and disease regression. The severity of dyspnea was measured using the Dyspnea Severity Index (DSI), the risk of OSA was assessed using the STOP-BANG questionnaire, and disease regression was assessed by reviewing the laryngeal examination before and after surgery. The Voice Handicap Index-10 (VHI-10) was used as a secondary outcome measure. RESULT: A total of 10 patients were included. The mean age of the study population was 58.9 ± 4.2 years. The male-to-female ratio was 2:3. In total, 20 vocal fold lesions were treated among which 18 were reviewed. Eight lesions regressed completely and 10 partially. There was a statistically significant drop in the mean score of DSI after surgery (16.1 ± 10.2 pre-operatively vs 2.3 ± 2.3 post-operatively, p-value < 0.001). The mean STOP-BANG score decreased from 4.8 ± 1.47 to 3.1 ± 1.28 (p-value = 0.001). There was also a significant improvement in VHI-10 score (22.7 ± 7.0 vs 4.4 ± 5.6, p-value < 0.001). CONCLUSION: Office-based blue laser therapy offers a safe and effective treatment for shortness of breath in patients with type 3 Reinke's edema.

Incidence of pediatric tonsillitis, otitis and upper respiratory infectious entities in the pre and post COVID-19 quarantine eras.

BACKGROUND: At this point of the COVID-19 pandemic, with the worldwide loosening of health restrictions, there has been an observed jump in infectious load especially of the upper airways.Aims/Objectives: To shed light on children's immunity and potential health risks after the COVID-19 pandemic. METHODS: A retrospective chart review from May 2019 to January 2022. Pediatric patients with a discharge diagnosis suggestive of an upper respiratory or ENT infection were included. The sample was divided into three groups according to the date of presentation. RESULTS: A total 4356 patients were diagnosed with ENT infectious aetiology. The mean age was 4.69 years. The three periods studied were: Period-1 (May 2019-January 2020), period-2 (February 2020-April 2021) and period-3 (May 2021-January 2022). The distribution of adenoiditis and MEE is the same across all periods (p > .05). The incidence of URTI, AOM and tonsillitis were significantly highest during period-3 followed by period-1, which in turn was significantly higher than during period-2 (p < .05). The incidence of sinusitis was the highest during period-3 (p < .001). CONCLUSION: There seems to be a heightened susceptibility to acute infection in children after the pandemic.Significance: It is important to keep in mind the changes in microbiota and implement measures to promote healthy gut flora, timely vaccination, and prompt medical interventions.Summary BoxWhat is already known: We already know that quarantine has significantly decreased infectious load especially in children.This study adds an objective assessment of this decrease with an assessment of the infectious load post-quarantine.This study is a model for future pandemics on the importance of vaccinations and the importance of microbiota changes after pandemics.

Office-Based Laser Therapy in Vocal Fold Polyps: A Systematic Review and Meta-Analysis.

OBJECTIVES: To analyze voice outcomes and lesion regression in patients with vocal fold polyps treated in-office using lasers. STUDY DESIGN: Systematic review and meta-analysis. METHODS: The search was performed in the Medline, Embase, and Cochrane databases using the preferred reporting items for systematic review and meta-analyses framework. There were no limitations to the year of publication and the search included studies looking at voice outcomes and lesion evolution of in-office laser treatment for vocal fold polyps measured through voice-handicap index, GRB, acoustic analysis or aerodynamics measures. Risk of bias was assessed using Cochrane's ROBINS-I tool for observational studies. Data analysis was performed SPSS software with a significance level of 5%. RESULTS: We identified 167 articles, 10 of which met the inclusion criteria and were analyzed. The total number of participants was 242. Meta-analysis showed significant improvement in voice handicap index-10 scores (95% CI, [0.86; 1.45]) and decrease in GRB score (95% CI, [1.09; 4.13]) after in-office laser therapy. It also showed significant improvement in percent shimmer (95% CI, [0.26; 1.01]), and significant increase in maximum phonation time (95% CI, [-0.92; -0.18]). CONCLUSIONS: Laser therapy an outpatient office setting is a reliable alternative to classical phono-microsurgery. Results show Office-based laser therapy of vocal fold polyps results in a significant improvement in subjective voice outcomes measures. This subjective improvement in voice quality is associated with partial or complete disease regression on laryngeal examination and an increase in maximum phonation time. Ovlaryngeal examination in patients with polyps treated with in-office laser.

The Added Value of Steroid Injection Following Office-based Blue Laser Therapy of Benign Lesions of the Vocal Folds; Short-Term Effect in a Cohort of 43 Patients.

OBJECTIVES: To investigate the added value of steroid injection following office-based blue laser therapy of benign lesions of the vocal folds. STUDY DESIGN: Retrospective cohort analysis. METHODS: The medical records and video-recordings of patients with benign lesions of the vocal folds who underwent office-based blue laser therapy in a tertiary referral center between February 2020 and October 2022 were reviewed. Patients were divided into two subgroups, those who underwent office-based blue laser therapy alone (n = 23) and those who underwent office-based blue laser therapy with steroid injection (n = 19). Disease regression and voice outcome measures included Voice Handicap Index-10 score, perceptual voice evaluation using the GRB grading, jitter, shimmer, noise to harmonic ratio, voice turbulence index, and maximum phonation time were reviewed. RESULTS: A total of 42 patients were included. The mean age was 54.7 ± 10.1 years. Lesions included polyps (n = 21), Reinke's edema (n = 19), and cysts (n = 2). There was partial or complete disease regression in all patients who presented for follow-up (n = 37). In patients who underwent blue laser therapy alone (n = 19), 42.1% had complete regression and 57.9% had partial regression. In those who underwent blue laser therapy followed by steroid injection (n = 18), 77.7% had complete disease regression and 22.3% had partial regression. The difference in disease regression between the two subgroups was statistically significant (P = 0.027). The decrease in the mean Voice Handicap Index-10 score was also statistically significant with a higher mean being noted in the subgroup who underwent blue laser therapy followed by steroid injection (-10.5 ± 6.9 vs. -17.3 ± 11.8, P = 0.031). There was no significant difference in the decrease in the perceptual evaluation scores nor in the decrease in jitter, shimmer, noise to harmonic ratio, and voice turbulence index between the two subgroups. There was also no significant increase in the maximum phonation time. CONCLUSION: Steroid injection after blue laser therapy improves disease regression and voice outcome of laser therapy.

Office-based Blue Laser Therapy of Vocal Fold Polyps: A Cohort of 18 Patients: Blue Laser Therapy of Vocal Fold Polyps.

OBJECTIVE: To investigate the effect of office-based blue laser therapy of vocal fold polyps on voice. METHODS: The medical records and video recordings of patients who underwent office-based laser therapy in a tertiary referral center between February 2020 and May 2020, and May 2021 and October 2022 was conducted. Only patients with vocal fold polyps who had undergone office-based blue laser therapy were included. The voice was evaluated before and after surgery using the Voice Handicap Index-10 (VHI-10), GRB perceptual evaluation, acoustic analysis, and maximum phonation time. RESULTS: A total of 18 patients were included. The mean age of the study group was 52.5 ± 11.94 years. The male-to-female ratio was 2:1. Ten patients of the total group (53.6%) had hemorrhagic polyps and the most common site was the mid-third of the vocal fold. All patients who presented for follow-up (n = 15) had partial or complete regression of the lesion (4 and 11, respectively). There was a significant decrease in the mean score of VHI-10 (17.6 ± 9.97 vs. 4.27 ± 5.76, p < 0.001) and in the means of grade of dysphonia (2.0 ± 0.73 to 0.5 ± 0.63, p < 0.001), roughness (1.88 ± 0.81 to 0.44 ± 0.51, p < 0.001) and breathiness (0.81 ± 0.75 to 0.13 ± 0.34 p < 0.001). There was also a marked decrease in the perturbation parameters (jitter and shimmer) and a significant increase in the MPT from 10.66 ± 4.22 s to 14.26 ± 6.26 s (p = 0.028). CONCLUSION: Office-based blue laser therapy is an effective treatment modality in patients with vocal fold polyps. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:2712-2718, 2023.

Prevalence of Self-Reported Dysphonia and Dysphagia in Patients with Allergy.

OBJECTIVE: To investigate the prevalence of self-reported dysphonia and dysphagia in patients with positive allergy test in comparison to patients with negative allergy tests. SUBJECTS AND METHODS: A total of 52 patients who presented to the allergy clinic of a tertiary medical referral center for skin testing between June 2019 and December 2019 were were recruited for this study. Demographic data included age, gender, history of smoking, family history for eczema, atopy, asthma, food and drug allergy. A control group of 20 subjects was matched according to age and gender. All subjects were asked to fill the voice handicap index -10 and the eating assessment tool (EAT-10) questionnaires. RESULTS: Thirty-six of 52 patients were positive for at least one allergen, and 23 tested positive for at least three allergens. On the other hand, there was no significant difference in the mean score of VHI-10 in patients with allergy to at least one allergen, in comparison to patients with no allergy (3.667 vs 3.066, respectively, P value 0.307). Similarly, there was no significant difference in the mean score of EAT-10 between the two groups (0.305 vs 0.00, respectively, P value 0.270). There was also no significant difference in the mean score of VHI-10 in patients with allergy to at least three allergens in comparison to patients with no allergy (3.304 vs 3.066, respectively, P-value 0.603). Similarly, there was no significant difference in the mean score of EAT-10 between the two groups (0.435 vs 0.00, respectively, P-value 0.667). There was a significant difference in mean VHI-10 scores between patients testing positive for at least one allergen and the control group (P = 0.0002). CONCLUSION: The results of this investigation did not show any significance in the prevalence of self-reported dysphonia and dysphagia in patients with positive allergy skin testing in comparison to those with negative allergy skin-testing. More clinical studies on the prevalence of self-reported phonatory complaints in patients with allergy are warranted.

Prevalence of Laryngopharyngeal Symptoms in Patients With Gastroesophageal Reflux Disease Refractory to Medical Therapy Undergoing Esophagogastroduodenoscopy.

OBJECTIVE: Casting more information on the link between GERD and LPR by investigating the prevalence of laryngopharyngeal symptoms in patients with severe GERD refractory to medical treatment. DESIGN: Prospective Study METHODS: Fifty patients with typical GERD symptoms presenting for EGD were recruited. All patients filled the GERD-Health-Related Quality of Life (HRQL) questionnaire and were screened for LPR using the Reflux Symptom Score questionnaire. All patients were also evaluated for the presence of hiatal hernia, esophagitis, inlet patch, gastritis (erosive vs. non erosive), polyps, intestinal metaplasia and or Helicobacter pylori infection. Laryngeal images were taken during EGD and evaluated using the Reflux Sign Assessment (RSA). RESULTS: A total of 50 patients were recruited for this study. The prevalence of heartburn was the highest (90%). The mean score of GERD-HRQL was 30.76±15.09. The mean RSS score was 70.96±46.08. Laryngeal examination was documented in 49 patients. the most common finding was edema (34.7%) followed by redness (28.6%). The mean RSA score for the total group was 21.15±8.04. There was a strong correlation between RSS score and GERD-HQRL score. There was no significant correlation between the RSS and any of the EGD findings (P > 0.05). There was no significant correlation between RSA and GERD-HRQL scores or any of the EGD findings (P > 0.05). However, there was a significant correlation between total RSA and RSS scores (rho=0.287, P = 0.04). CONCLUSION: The suggested high prevalence of LPRD should alarm the treating physician to the need for a thorough otolaryngologic examination in patients presenting with severe GERD, particularly those in whom the LPR symptoms may be masked by the typical symptoms of GERD.

Prevalence of Laryngopharyngeal Reflux Related Symptoms in Patients With Allergy.

OBJECTIVE: To describe the prevalence of laryngopharyngeal reflux (LPR)-related symptoms in allergy patient using the Reflux Symptom Index (RSI) by Belafsky et al and the Reflux Symptom Score (RSS) by Lechien et al. SUBJECTS AND METHODS: A total of 84 patients were enrolled in this study. Fifty-two consecutive patients were asked to fill RSI. Similarly, 32 patients were asked to fill RSS. Demographic data included age, gender, history of smoking, family history for eczema, atopy, asthma, food and drug allergy. RESULTS: Fifty-seven of the 84 patients were positive for at least one allergen and hence were diagnosed with allergy. Of the 52 patients who received the RSI, 36 patients were allergic to at least one allergen (36/52). Of the 32 patients who filled the RSS, 21 tested positive for at least one allergen (21/32). There was no significant difference in the number of positive RSI scores (>13) between patients with allergy to at least one allergen in comparison to patients with no allergy (P = 0.329). There was a significant difference in the number of positive RSS scores (>13) between patients with allergy to at least one allergen in comparison to patients with no allergy (P-value 0.0345). The odds of having RSS >13 in an allergic patient was significant (OR = 5.6, CI 95% = 1.15-27.37). CONCLUSION: The results of this study provide evidence that patients with allergy have increased incidence of LPR related symptoms using the RSS. The cross-cutting in the clinical picture of patients with allergy and LPR stresses the need for objective testing such as double probe Ph-metry and impedance to diagnose this latter. Future studies are needed to explore further the cause-effect relationship between allergy and LPR.

Hyaluronic acid in otology: Its uses, advantages and drawbacks - A review.

OBJECTIVES: Review of the literature for studies involving the use of hyaluronic acid (HA) in otology. METHODS: Pubmed and OvidMedline were searched using a combination of the following words in different variations: hyaluronic acid, hyaluronate, otolaryngology, otology, ear, tympanic membrane, perforation, tympanostomy, tympanoplasty, myringoplasty, packing, middle ear, cochlea, gene delivery, gene therapy, cochlear implant, hearing loss, meniere, vertigo, otitis and cholesteatoma. RESULTS: The papers relevant for this review were triaged based on abstracts and titles and were then categorized based on topic/disease entity/procedure. The papers were read and summarized in order to use their findings in this review. CONCLUSIONS: HA is being recently used as adjuvant therapy for multiple inflammatory conditions and in tissue repair. These immunomodulatory properties and biocompatibility have interested researchers specially in the field of otology for repair, gene delivery, immunomodulation etc. Recent data in the field show optimistic results for the use of HA in several conditions especially tympanic membrane perforations and gene delivery. It also establishes the role of HA as ancillary treatment in many other otologic pathologies. This review presents the most recent findings on the use of HA in otology. The results could be used to guide clinical practice and incite further research based on the presented results of the literature.

A Venous Malformation of the Inferior Turbinate: A Case Report with Review of the Literature.

Arteriovenous Malformations of the head and neck are rare vascular anomalies that can be aggressive and lethal. It is crucial to have a high clinical suspicion to avoid the consequent mortality and morbidity that may result from bleeding. We present the case of a rare inferior turbinate venous malformation in a 17 year old female that presented with epistaxis and was treated with surgery. Treatment varies and depends on the stage; however complete resection should be the goal to prevent recurrence. The endoscopic endonasal approach is minimally invasive, safe and effective in selected patients.