Office-Based Blue Laser Therapy vs Thulium Laser Therapy for Reinke's Edema.

OBJECTIVE: To compare the treatment outcomes of patients with Reinke's edema (RE) who were treated in-office using the blue laser vs those treated in-office using the thulium laser. STUDY DESIGN: Retrospective case-control study. METHODS: The medical records and video recordings of patients who underwent office-based thulium laser therapy for RE between November 2018 and July 2019, and office-based blue laser therapy for RE between November 2023 and March 2024 in a tertiary referral center were reviewed. The primary outcome measures used in this study were the Voice Handicap Index-10 (VHI-10) score and disease regression based on the laryngeal examination performed before and after therapy. RESULTS: Twenty-two patients were included in this study. They were divided into 2 subgroups, 12 patients with 22 lesions who underwent office-based thulium therapy and 10 patients with 17 lesions who underwent office-based blue laser therapy. There was no significant difference in the decrease in the mean VHI-10 score following surgery between those treated with the thulium laser vs those treated with the blue laser (10.5 ± 13.15 vs 8.2 ± 5.98, P = 0.657). Nine out of 22 lesions (40.9%) treated with thulium laser regressed completely compared to 9 out of 17 lesions (52.9%) treated with a blue laser. The difference in disease regression between the two subgroups was not statistically significant (P = 0.455). CONCLUSIONS: Blue laser and thulium laser can be used interchangeably in-office for the treatment of RE with no significant difference in patient self-perceived improvement in voice quality and disease regression. A larger study using objective measures is warranted.

Assessment of Tracheostomy Tube Placement and Late Change Practices in an Academic Tertiary Care Center.

Introduction The optimal time for tracheostomy changes is unknown. Most surgeons opt to wait until five to seven days postoperatively, while more recent studies suggest that changes occurring as early as two to three days postoperatively are also safe. Objective To evaluate the safety of changing the tracheostomy tube later than 14 days postoperatively. Methods The charts of patients who underwent tracheostomy placement and change at a tertiary care center from 2015 to 2019 were retrospectively reviewed, and the subjects were divided into 2 cohorts (late and very late), depending on the time of the first tracheostomy change. Results The study included 198 patients, 53 of whom aged between 0 and 18 years, and 145, aged > 18 years. The time until the first tracheostomy change was on average of 131.1 days. The most common indication for tracheostomy tube placement was prolonged intubation. Adverse events were observed in 30.8% of the cases (the most common being the formation of granulation tissue), a rate that does not differ much from the incidence reported in the literature (of 34% to 77%) when tracheostomy tubes are changed as early as 3 to 7 days postoperatively. There was no significant difference in the incidence of complications between patients undergoing late and very late changes ( p = 0.688), or between pediatric and adult subjects ( p = 0.36). There were no significant correlations regarding the time of the first or second change and the incidence of complications (r = -0.014; p = 0.84 for the first change; and r = -0.57; p = 0.64 for the second change). Conclusion The late first tracheostomy tube change was safe and could save resources and decrease the financial burden of frequent changes. It is always crucial to provide adequate information about home tracheostomy care for patients.

Office-Based Steroid Injection for Benign Lesions of the Vocal Folds: Case Series and Review of the Literature.

OBJECTIVES: To present the authors' experience on intralesional steroid injection (ILSI) for benign lesions of the vocal folds and a review of the literature. STUDY DESIGN: Retrospective chart review. METHODS: The medical records of patients with vocal folds nodules, polyps, Reinke's edema, laryngitis/localized edema, and vocal fold granuloma who underwent ILSI were reviewed. Disease regression was assessed by reviewing the video recordings of laryngeal endoscopy before and after surgery. Subjective and objective voice outcome measures were compared before and after office-based ILSI. RESULTS: Forty-seven patients with 81 lesions were included. The most common lesion treated was Reinke's edema followed by vocal fold nodules. All patients who presented for follow-up (n = 37) had partial or complete regression of their disease. When stratified by disease type, vocal fold polyps showed the highest percentage of complete regression (66.7%) followed by vocal fold nodules (65%). The mean voice handicap index-10 (VHI-10) score of the study group dropped from 16.63 ± 6.95 to 6.21 ± 6.09 points (P < 0.001). Patients with vocal fold polyps had the highest drop in the mean VHI-10 score by 16.66 ± 4.73 (P = 0.026). There was no significant difference in the mean acoustic and aerodynamic parameters before and after office-based steroid injection. CONCLUSIONS: ILSI is an effective treatment modality for benign lesions of the vocal folds leading to partial or complete disease regression and self-reported improvement in voice quality.