Laryngeal schwannoma masquerading as malignancy.

Laryngeal schwannoma is a rare type of neurogenous tumour with a non-specific presentation. We present a case of a middle-aged man with issues of hoarseness, globus sensation and intermittent episodes of throat pain. The Hopkins examination showed right vocal fold irregularity with fullness in the right ventricle. The contrast-enhanced CT neck revealed an ill-defined lesion with contrast uptake extending into the paraglottic region with no neck node involvement. Considering the clinical presentation of hoarseness, throat pain and globus with imaging revealing contrast enhancement of lesion, direct laryngoscopy and biopsy were planned to rule out malignancy. Intraoperatively, a well-defined submucosal capsulated swelling became apparent after incision and dissection of the mucosa over the right vocal fold. A complete excision of the swelling was done with microlaryngeal instruments without tracheostomy. The histopathological report was suggestive of schwannoma. The literature review discusses clinical presentation, location, imaging features and management strategy.

A large, locally aggressive giant cell tumour arising from the laryngeal cartilage: A Rare Case Report.

Giant cell tumour is a growth predominantly found in long bones of the body. Giant cell tumour has a rare occurrence in the head and neck. A case of a 31 year old male with no known comorbidities at the ENT Department, Shifa International Hospital, Islamabad presented with anterior neck swelling and hoarseness of voice. Patient was diagnosed as having Giant Cell Tumour of Larynx (GTCL) proven on FNA cytology and post-operative biopsy. GCTL is an uncommon entity with only 45 reported cases in the world.

Intrathyroidal thymic carcinoma.

A young woman in her early 30s presented with a right thyroid mass and progressive hoarseness due to a right vocal cord palsy. The preoperative fine-needle aspiration cytology was classified as Bethesda V and she underwent a total thyroidectomy and neck dissection. Intraoperatively, the thyroid mass was adherent to the oesophagus, trachea and encasing the right recurrent laryngeal nerve which was sacrificed. Final histopathology diagnosed a rare subtype of thyroid cancer known as intrathyroidal thymic carcinoma (ITC). She was then sent for adjuvant radiotherapy after a multidisciplinary tumour board discussion. This case report highlights the difficulty in preoperative diagnosis of ITC and the importance of immunohistochemical staining in clinching the diagnosis. In view of its rarity, there have been no published consensus on the treatment of ITC, hence we would like to share some learning points through a comprehensive literature review.

Subglottic Mass With Hoarseness and Difficulty Breathing.

A man in his 70s was referred for a 5-cm submandibular mass, hoarseness, and difficulty breathing with no cough, blood in sputum, or dysphagia. What is your diagnosis?

Effects of preoperative inhaled budesonide combined with intravenous dexamethasone on postoperative sore throat in patients who underwent thyroidectomy: A randomized controlled trial.

BACKGROUND: This randomized controlled trial aimed to evaluate the efficacy of preoperative inhaled budesonide combined with intravenous dexamethasone on postoperative sore throat (POST) after general anesthesia in patients who underwent thyroidectomy. METHODS: Patients who underwent elective thyroidectomy were randomly divided into the intravenous dexamethasone group (group A) and budesonide inhalation combined with intravenous dexamethasone group (group B). All patients underwent general anesthesia. The incidence and severity of POST, hoarseness, and cough at 1, 6, 12, and 24 hours after surgery were evaluated and compared between the 2 groups. RESULTS: There were 48 and 49 patients in groups A and B, respectively. The incidence of POST was significantly lower at 6, 12, and 24 hours in group B than that in group A (P < .05). In addition, group B had a significantly lower incidence of coughing at 24 hours (P = .047). Compared with group A, the severity of POST was significantly lower at 6 (P = .027), 12 (P = .004), and 24 (P = .005) hours at rest, and at 6 (P = .002), 12 (P = .038), and 24 (P = .015) hours during swallowing in group B. The incidence and severity of hoarseness were comparable at each time-point between the 2 groups (P > .05). CONCLUSION: Preoperative inhaled budesonide combined with intravenous dexamethasone reduced the incidence and severity of POST at 6, 12, and 24 hours after extubation compared with intravenous dexamethasone alone in patients who underwent thyroidectomy. Additionally, this combination decreased the incidence of postoperative coughing at 24 hours.

A lecturer's voice quality and its effect on memory, listening effort, and perception in a VR environment.

Many lecturers develop voice problems, such as hoarseness. Nevertheless, research on how voice quality influences listeners' perception, comprehension, and retention of spoken language is limited to a small number of audio-only experiments. We aimed to address this gap by using audio-visual virtual reality (VR) to investigate the impact of a lecturer's hoarseness on university students' heard text recall, listening effort, and listening impression. Fifty participants were immersed in a virtual seminar room, where they engaged in a Dual-Task Paradigm. They listened to narratives presented by a virtual female professor, who spoke in either a typical or hoarse voice. Simultaneously, participants performed a secondary task. Results revealed significantly prolonged secondary-task response times with the hoarse voice compared to the typical voice, indicating increased listening effort. Subjectively, participants rated the hoarse voice as more annoying, effortful to listen to, and impeding for their cognitive performance. No effect of voice quality was found on heard text recall, suggesting that, while hoarseness may compromise certain aspects of spoken language processing, this might not necessarily result in reduced information retention. In summary, our findings underscore the importance of promoting vocal health among lecturers, which may contribute to enhanced listening conditions in learning spaces.

A Plasmacytoma of the Lateral Pharyngeal Wall: A Diagnostic Enigma.

Plasmacytoma is a rare plasma cell dyscrasia that grows in bones or soft tissues such as the pharynx. Soft tissue plasmacytomas are rare, and a higher burden has been reported in the upper aero-digestive tract, often manifesting as hoarseness, dysphagia, or odynophagia. Due to their rarity, extramedullary plasmacytomas (EMPs) have unknown prognostic factors, and guidelines for optimal management are still lacking. However, radiation therapy and surgery have been used with positive outcomes. Herein, we describe a unique case of plasmacytoma of the pharyngeal tissue in a male patient with a history of HIV disease. The patient completed 28 sessions of radiation therapy, resulting in an improvement in his throat pain and hoarseness. Given the patient's age and lack of traditional risk factors for head and neck cancers, his hoarseness and odynophagia proved to be a diagnostic conundrum. Although infrequent, soft tissue plasmacytomas should be considered in the differential diagnosis of head and neck tumors.

[Thyroid cartilage fracture following sneezing as a cause of spontaneous pneumomediastinum]. / Perelom shchitovidnogo khryashcha vsledstvie chikhan'ya kak prichina spontannogo pnevmomediastinuma.

OBJECTIVE: To evaluate the possible etiological factors of spontaneous pneumomediastinum and to describe a case that was unusual in its etiology: a thyroid cartilage fracture as a result of sneezing. MATERIAL AND METHODS: Six patients (four male, two female, aged 16-82 years) were hospitalized with spontaneous pneumomediastinum diagnosed with a chest X-ray in five patients and 100% with computed tomography. Treatment was symptomatic. RESULTS: The commonest symptoms (cough, shortness of breath, hoarseness) were in four patients. Spontaneous pneumomediastinum developed in three cases as a result of bronchospasm during an attack of bronchial asthma, in one patient after exercise, in one after fibrogastroscopy, in one after sneezing. We report a 30-year-old man who presenting subcutaneous emphysema on the neck, hoarseness, pain when swallowing, hemoptysis developed after sneezing. His computed tomography revealed a pneumomediastinum due to fistula of the fracture of the thyroid cartilage following sneezing while simultaneously obstructing both nostrils. At laryngoscopy, there was a linear hematoma in the resolution stage on the anterior wall of the larynx. He was treated conservatively and recovered rapidly. There are no previous published reports of spontaneous pneumomediastinum following fracture of the thyroid cartilage. CONCLUSION: Fracture of the thyroid cartilage as a result of a sharp rapid increase in airway pressure during a sneeze with blocked nasal passages can be one of the rare causes of spontaneous pneumomediastinum. Avoid closing both nostrils at the same time when sneezing.

Effect of intravenous and topical laryngeal lidocaine on sore throat after extubation: a prospective randomized controlled study.

OBJECTIVE: The present study aimed to compare the effect of topical laryngeal lidocaine with intravenous lidocaine before endotracheal intubation on the incidence and severity of postoperative sore throat, hoarseness, and cough. PATIENTS AND METHODS: This prospective randomized controlled study enrolled 144 patients undergoing laparoscopic cholecystectomy with endotracheal intubation. The patients were randomized to three groups and received 2% lidocaine by topical laryngeal spray (group T), intravenous 2% lidocaine (group I), and the equivalent volume of intravenous saline (group C) before intubation. The incidence and severity of sore throat, hoarseness, and cough reaction at 0.5, 1, 6, and 24 h after extubation were collected. RESULTS: The incidence of sore throat was significantly lower in group T than in groups I and C (6.4% vs. 37.2% and 86.7%, p < 0.001), respectively at 0.5 h after extubation, and it was significantly lower in group I than that in group C (37.2% vs. 86.7%, p < 0.001). Both the incidence of hoarseness and cough were significantly lower in group T than in group I and in group C (14.9% vs. 97.7% and 97.8%, p < 0.001, and 19.1% vs. 72.0% and 93.3%, p < 0.001), respectively. The severity of sore throat, hoarseness and cough in group T was significantly lower than that in group I and that in group C (p < 0.05), and it was significantly lower in group I than in group C (p < 0.05). CONCLUSIONS: Both topical laryngeal lidocaine and intravenous lidocaine before intubation have positive effects on preventing sore throat. Topical laryngeal route was superior to intravenous route. Chictr.org.cn ID: ChiCTR2100042442.

Flurbiprofen in the subglottic space to prevent postoperative sore throat after cardiac surgery: A randomized double-blind study.

STUDY OBJECTIVE: Postoperative sore throat (POST) and hoarseness are common complications of tracheal intubation. This study aims to evaluate the efficacy of flurbiprofen administered through the subglottic port of tracheal tubes to prevent POST after cardiac surgery. DESIGN: Single-center, prospective, randomized, double-blind, placebo-controlled trial. SETTING: Tertiary Care Referral University Hospital (Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome). PATIENTS: Included 71 patients undergoing for elective cardiac surgery. Inclusion criteria were (a) age between 50 and 75 years, (b) NYHA class I or II, (c) surgery for myocardial revascularization or valve repair or replacement under cardiopulmonary bypass. INTERVENTION: Patients were double blind randomized to receive flurbiprofen or saline in the subglottic port of the endotracheal tube (groups F and P). The solution was injected ten minutes after tracheal tube placement, ten minutes after ICU admission and ten minutes before tracheal tube removal. MEASUREMENTS: The primary outcome was to assess the effect of topical flurbiprofen administered through the subglottic port of the tracheal tube to prevent post-operative sore throat (POST). The secondary outcomes were the presence of hoarseness safety and patient's subjective satisfaction with their recovery. We did not report any exploratory outcomes. MAIN RESULTS: We analyzed 68 patients, 34 patients in each group. In group F, two patients complained of POST and hoarseness (5.9%), while all controls did. The two groups significantly differed in the severity scores (VAS and TPS for sore throat and HOAR for hoarseness) at all time points. In group P, patients reported mild to moderate symptoms that significantly improved or disappeared 36 h after tracheal tube removal. According to the multivariable model, hoarseness affected women less than men, in the control group (p = 0.002). None of the patients in either group reported any adverse effects. CONCLUSIONS: Repeated administration of flurbiprofen through the subglottic port of tracheal tubes reduced the incidence of sore throat and hoarseness after cardiac surgery without evidence of complications.

The effect of different endotracheal tube cuff pressure monitoring systems on postoperative sore throat in patients undergoing tracheal intubation: a randomized clinical trial.

BACKGROUND: Postoperative sore throat (POST) is an unpleasant outcome that can occur as a result of tracheal intubation in adults. Increased pressure from the endotracheal tube (ETT) cuff often leads to local mucosal injury, resulting in sore throat. The purpose of this study was to compare the effect of two different ETT cuff pressure monitoring systems vs. no cuff pressure monitoring on the incidence and severity of POST in adults. METHODS: One hundred and fourteen ASA I-III patients of either gender, aged 18-65 years, and undergoing surgery requiring endotracheal intubation were included in this study. Patients were randomized into three groups: control (C), cuff pressure gauge (G), and automated cuff controller (A). The ETT cuff pressure was not monitored intraoperatively in group C but was monitored using a cuff pressure gauge and an automated cuff controller in groups G and A, respectively. Postoperatively, patients were assessed at 2, 24, and 48 h for the presence and severity of POST, hoarseness and cough. RESULTS: One hundred and eleven patients completed the study. POST occurred in 40.5% of the patients in group G (n = 37) (p = 0.013) and 23.7% of the patients in group A (n = 38) (p < 0.001) within 48 h after surgery, compared to 69.4% in group C (n = 36). There were no significant differences in hoarseness, coughing, and dysphagia across the groups at any time. When comparing groups A and C, individuals in group A exhibited a lower occurrence of significant (grade ≥ 2) POST and hoarseness (10.5% vs. 41.7%, p = 0.002; 26.3% vs. 58.3%, p = 0.005). The incidence of significant cough and dysphagia did not differ substantially across the patient groups within 48 h after surgery. POST scores in group A at 2, 24 h postoperatively were both 0 (0-0), which was significantly lower than those in group C (1 (0-2) at 2 h, p < 0.001 ; 1 (0-1) at 24 h, p = 0.001). POST in group G at 2 h postoperatively was graded as 0 (0-1.5) which was milder than group C (P = 0.024). The severity of hoarseness in group A with scores of 0 (0-2) was superior to that in group C (2 (0-2), p = 0.006) at 2 h postoperatively. CONCLUSIONS: In conclusion, the findings of this study indicated that the occurrence of POST can be reduced by using either the cuff pressure gauge approach or the automated cuff controller method. The automated cuff controller monitoring can potentially decrease the severity of POST and hoarseness. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Extramedullary plasmacytoma of the larynx - Case report.

Extramedullary plasmacytoma of the larynx is an extremely rare entity accounting for 0.04-0.45% of malignant tumours of the larynx. The objective of this clinical case report is to highlight the diagnosis and management of a unique case such as this. A 77-year-old gentleman presented with complaints of hoarseness for 1 year. Computed tomography image revealed a soft tissue mass lesion involving the right true vocal cord. Direct laryngoscopic biopsy was performed and subjected to histopathological examination, which showed collection of plasma cells. Immunohistochemistry confirmed the presence of Kappa and Lambda cells. Multiple myeloma (MM) was ruled out. The patient received radical intent radiation therapy using 3DCRT technique with a dose of 50Gy in 25# over 5 weeks. He experienced improvement in hoarseness on subsequent follow-up visits. At 1-year follow up, positron emission tomography computed tomography showed near total resolution of disease with no progression to MM. Radiation therapy alone is known to achieve good local control, recurrence free survival, and organ preservation in such cases.

The effects of video double-lumen tubes on intubation complications in patients undergoing thoracic surgery: A randomised controlled study.

BACKGROUND: Tracheal injuries, vocal cord injuries, sore throat and hoarseness are common complications of double-lumen tube (DLT) intubation. OBJECTIVE: This study aimed to evaluate the effects of 'video double-lumen tubes' (VDLTs) on intubation complications in patients undergoing thoracic surgery. DESIGN: A randomised controlled study. SETTINGT: Xuzhou Cancer Hospital, Xuzhou, China, from January 2023 to June 2023. PATIENTS: One hundred eighty-two patients undergoing elective thoracic surgery with one-lung ventilation were randomised into two groups: 90 in the DLT group and 92 in the VDLT group. INTERVENTION: VDLT was selected for intubation in the VDLT group, and DLT was selected for intubation in the DLT group. A fibreoptic bronchoscope (FOB) was used to record tracheal and vocal cord injuries. MAIN OUTCOME MEASURES: The primary outcomes were the incidence of moderate-to-severe tracheal injury and the incidence of vocal cord injury. The secondary outcomes included the incidence and severity of postoperative 24 and 48 h sore throat and hoarseness. RESULTS: The incidence of moderate-to-severe tracheal injury was 32/90 (35.6%) in the DLT group, and 45/92 (48.9%) in the VDLT group ( P  = 0.077; relative risk 1.38, 95% CI, 0.97 to 1.95). The incidence of vocal cord injury was 31/90 (34.4%) and 34/92 (37%) in the DLT and VDLT groups, respectively ( P  = 0.449). The incidence of postoperative 24 h sore throat and hoarseness was significantly higher in the VDLT group than in the DLT group (for sore throat: P  = 0.032, relative risk 1.63, 95% CI, 1.03 to 2.57; for hoarseness: P  = 0.018, relative risk 1.48, 95% CI, 1.06 to 2.06). CONCLUSION: There was no statistically significant difference in the incidence of moderate-to-severe tracheal injury and vocal cord injury between DLTs and VDLTs. While improving the first-attempt success rate, intubation with VDLT increased the incidence of postoperative 24 h sore throat and hoarseness. TRIAL REGISTRATION: Chinese Clinical Trial Registry identifier: ChiCTR2300067348.

Ease of endotracheal intubation with the conventional polyvinyl chloride endotracheal tube versus wire-reinforced flexometallic tube through the intubating laryngeal mask airway: A comparative study.

Background The I-LMA ventilates while providing a port for blind insertion of an endotracheal tube. The ILMA Fastrach is used especially for intubating in a difficult airway scenario. Its accompanying endotracheal tube is not economical nor readily available. In comparison, two alternative endotracheal tubes - polyvinyl chloride and wire-reinforced tubes were used for tracheal intubation through the ILMA. AIMS AND OBJECTIVES: The aim of our study was to compare the ease of intubation when using conventional PVC tubes versus the wire-reinforced flexometallic tubes with the ILMA-FastrachTM. The number of attempts, time taken and additional maneuvers were noted. Intra-operative hemodynamic changes, post-operative sore throat, bleeding and hoarseness of voice was recorded over a period of 24 hours. METHODOLOGY: After informed consent, 60 ASA I-II patients undergoing elective surgeries under general anesthesia were allocated to undergo blind intubation with the PVC tube or the wire-reinforced flexometallic tube. RESULTS: More attempts were required for successful intubation using the wire-reinforced tube than the PVC tube with 76.7% passing in the first attempt in the PVC, and 53.3% passing in the first attempt in the flexometallic group. (P = 0.4). Average time for intubation in the PVC group: 28.24 ± 7.22 seconds. Average time for intubation in the flexometallic tube: 45.8 ± 15.78 sec. Occurrence of post-operative sore throat was 13.3% in the PVC group and 26.6% in the flexometallic group, with minimal hoarseness of voice 3.3% in the PVC group and 10% in the flexometallic group. There was also a slightly higher hemodynamic response in those who were intubated with the flexometallic tube than a PVC tube. CONCLUSION: Intubating via the ILMA-Fastrach with the PVC tube offered better intubating conditions with regards to lesser time taken, lesser attempts, less manipulation, and less hemodynamic variations as compared to the patients who were intubated using the wire-reinforced tube.

Résumé Arrière-plan: L'I-LMA ventile tout en fournissant un port pour l'insertion aveugle d'une sonde endotrachéale. L'ILMA Fastrach est utilisé notamment pour l'intubation dans un scénario de voies respiratoires difficiles. La sonde endotrachéale qui l'accompagne n'est ni économique ni facilement disponible. En comparaison, deux tubes endotrachéaux alternatifs ­ du chlorure de polyvinyle et des tubes renforcés de fil ­ ont été utilisés pour l'intubation trachéale via l'ILMA. Buts et objectifs: Le but de notre étude était de comparer la facilité d'intubation lors de l'utilisation de tubes en PVC conventionnels par rapport aux tubes flexométalliques renforcés de fil avec l'ILMA-FastrachTM. Le nombre de tentatives, le temps nécessaire et les manÓuvres supplémentaires ont été notés. Les changements hémodynamiques peropératoires, les maux de gorge postopératoires, les saignements et l'enrouement de la voix ont été enregistrés sur une période de 24 heures. Méthodologie: Après consentement éclairé, 60 patients ASA I-II subissant des interventions chirurgicales électives sous anesthésie générale ont été affectés à une intubation aveugle avec le tube en PVC ou le tube flexométallique renforcé de fil. Résultats: Plus de tentatives ont été nécessaires pour réussir l'intubation à l'aide du tube renforcé par fil métallique qu'avec le tube PVC, avec 76,7 % de réussite lors de la première tentative dans le groupe PVC et 53,3 % de réussite lors de la première tentative dans le groupe flexométallique. (P = 0,4). Temps moyen d'intubation dans le groupe PVC : 28,24 ± 7,22 secondes. Temps moyen d'intubation dans le tube flexométallique : 45,8 ± 15,78 sec. La survenue de maux de gorge postopératoires était de 13,3 % dans le groupe PVC et de 26,6 % dans le groupe flexométallique, avec un enrouement minime de la voix de 3,3 % dans le groupe PVC et de 10 % dans le groupe flexométallique. Il y avait également une réponse hémodynamique légèrement plus élevée chez ceux qui étaient intubés avec le tube flexométallique qu'avec un tube en PVC. Conclusion: L'intubation via l'ILMA-Fastrach avec le tube en PVC offrait de meilleures conditions d'intubation en ce qui concerne moins de temps, moins de tentatives, moins de manipulations et moins de variations hémodynamiques par rapport aux patients intubés à l'aide du tube renforcé de fil Mots-clés: Facilité d'intubation, sonde endotrachéale flexométallique, masque laryngé d'intubation des voies respiratoires, sonde endotrachéale en polychlorure de vinyle.

Squamous Cell Carcinoma of the Supraglottis Presenting as Hoarseness.

Hoarseness is a well-known condition in primary care offices, with over 1% of primary care visits secondary to this ailment.1 The most common causes are acute laryngitis (40%), functional dysphonia (30%), benign and malignant tumors (2.2 to 30%), neurogenic factors such as vocal cord paralysis (8%), physiological aging (2%), and psychogenic factors (2.2%). Most of these cases are secondary to viral infections and do not require antibiotics on most occasions. These viral infections subside after 1 to 2 weeks, and in the case of persistent hoarseness (above 4 weeks) the American Academy of Otolaryngology recommends direct visualization with a laryngoscopy before treatment with proton pump inhibitors, antibiotics, or steroids. Our patient presented with prolonged hoarseness (greater than eight weeks) but had a quick turn around time interval between primary care visit and laryngoscopy evaluation (less than 2 weeks). This led to her diagnosis and treatment with chemo and radiation therapy within three months of diagnosis with Squamous Cell Carcinoma of the Supraglottis. The Primary care physician serves as the number one point of visitation by sufferers of hoarseness. It is important that they are knowledgeable and up to date with recommendations and guidelines for managing this condition, as unwarranted delay can affect overall outcome on the part of the patient. This is especially important in patients such as ours with high risk factors including Nicotine dependence, alcohol use, asbestos exposure, and HPV infection.

La voix rauque est une condition bien connue dans les cabinets de soins primaires, avec plus de 1 % des visites en soins primaires dues à ce problème. Les causes les plus courantes sont la laryngite aiguë (40%), la dysphonie fonctionnelle (30 %), les tumeurs bénignes et malignes (2,2 à 30 %), les facteurs neurogènes tels que la paralysie des cordes vocales (8 %), le vieillissement physiologique (2 %) et les facteurs psychogènes (2,2 %). La plupart de ces cas sont dus à des infections virales et ne nécessitent pas d'antibiotiques dans la plupart des cas. Ces infections virales disparaissent après 1 à 2 semaines, et en cas de voix rauque persistante (plus de 4 semaines), l'American Academy of Otolaryngology recommande une visualisation directe avec une laryngoscopie avant le traitement par inhibiteurs de la pompe à protons, antibiotiques ou stéroïdes. Notre patiente présentait une voix rauque prolongée (plus de huit semaines), mais a bénéficié d'un délai rapide entre la visite en soins primaires et l'évaluation par laryngoscopie (moins de 2 semaines). Cela a conduit à son diagnostic et à son traitement par chimiothérapie et radiothérapie dans les trois mois suivant le diagnostic de carcinome épidermoïde du supraglotte. Le médecin de soins primaires est le premier point de visite pour les personnes souffrant de voix rauque. Il est important qu'ils soient informés et à jour des recommandations et des lignes directrices pour la prise en charge de cette condition, car un retard non justifié peut affecter le résultat global pour le patient. Ceci est particulièrement important chez les patients comme le nôtre présentant des facteurs de risque élevés, y compris la dépendance à la nicotine, la consommation d'alcool, l'exposition à l'amiante. MOTS-CLÉS: Laryngoscopie, Supraglotte, Larynx, Enrouement.

Comparative Efficacy and Safety of Radiofrequency Ablation and Microwave Ablation in the Treatment of Benign Thyroid Nodules: A Systematic Review and Meta-Analysis.

OBJECTIVE: The current body of evidence lacks clarity regarding the comparative efficacy and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) as minimally invasive treatments for benign thyroid nodules. The primary objective of this study is to clarify these concerns. MATERIALS AND METHODS: A comprehensive search was conducted using the Cochrane Library, Scopus, Europe PMC, and Medline databases until October 10th, 2023, using a combination of relevant keywords. This study incorporated literature that compared RFA and MWA for benign thyroid nodules. The primary outcome was the volume reduction ratio (VRR) from baseline to follow-up. Secondary outcomes were symptom score, cosmetic score, ablation time, major complications rate, hemorrhage, hoarseness, skin burn, cough, and sympathetic nerve injury. We used Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool to assess the risk of bias in the included studies. We employed random effects models to analyze the standardized mean difference (SMD) and odds ratio for the presentation of outcomes. RESULTS: Nine studies with 2707 nodules were included. The results of our meta-analysis indicated similar efficacy between RFA and MWA in terms of VRR during the 1 (SMD 0.06; 95% confidence interval [CI]: -0.13 to 0.26; P = 0.52) and 3 (SMD 0.11; 95% CI: -0.03 to 0.25; P = 0.12) months of follow-up. VRR was significantly higher in RFA than in MWA at the 6 (SMD 0.25; 95% CI: 0.06-0.43; P = 0.008) and 12 month of follow-up (SMD 0.38; 95% CI: 0.17 to 0.59; P < 0.001). There were no significant differences between RFA and MWA in symptom scores, cosmetic scores, or the incidence of complications, including hemorrhage, hoarseness, skin burn, cough, and sympathetic nerve injury. CONCLUSION: RFA showed a higher VRR than MWA at 6 and 12-month follow-ups, with a comparable safety profile.