Local anesthesia with blue-dyed lidocaine for a better patient's tolerance during office-based laryngology procedures: how I do it.

BACKGROUND: In-office laryngological procedures became common alternatives to general anesthesia for biopsies, injection laryngoplasties, and laser procedures. The limiting step remains the laryngeal anesthesia whose quality can influence patients' and operators' comfort. METHODS: We propose to dye the lidocaine with methylene blue and do an instillation through a catheter introduced in the video-endoscope's operating channel, which permits a progressive anesthesia focused on the larynx, avoiding an unwanted pharyngeal anesthesia and any tracheal irritation. CONCLUSION: Using blue-dyed lidocaine can help reduce the volume of anesthesia required for an office-based laryngology intervention, improving patients' and surgeon's comfort and reducing anesthesia's side effects.

Paracrine Effects of Adipose-Derived Cellular Therapies in an in Vitro Fibrogenesis Model of Human Vocal Fold Scarring.

OBJECTIVES/HYPOTHESIS: Vocal folds (VF) scarring leads to severe dysphonia which negatively impacts daily life of patients. Current therapeutic options are limited due in large part to the high complexity of the micro-structure of the VF. Innovative therapies derived from adipose tissue such as stromal vascular fraction (SVF) or adipose derived stromal/ stem cells (ASC) are currently being evaluated in this indication and paracrine anti-fibrotic effects are considered as predominant mechanisms. METHODS: The paracrine anti-fibrotic effects of SVF and ASC from healthy donors were tested in an innovative in vitro fibrogenesis model employing human VF fiboblasts (hVFF) and the principles of macromolecular crowding (MMC). Biosynthesis of collogen and alpha-smooth-muscle actin (αSMA) expression in hVFF were quantified after five days of indirect coculture with ASC or SVF using silver stain, western blot and RT-qPCR analysis. RESULTS: Fibrogenesis was promoted by addition of transforming growth factor beta 1 (TGFß1) combined with MMC characterized by an enhanced deposition of fibrillar collagens and the acquisition of a myofibroblast phenotype (overexpression of αSMA). Adipose-derived therapies led to a reduction in the αSMA expression and the collagen content was lower in hVFF co-cultivated with SVF. CONCLUSIONS: ASC and SVF promoted significant prevention of fibrosis in an in vitro fibrogenesis model through paracrine mechanisms, supporting further development of adipose-derived cellular therapies in VF scarring.

Transmission of droplet-conveyed infectious agents such as SARS-CoV-2 by speech and vocal exercises during speech therapy: preliminary experiment concerning airflow velocity.

PURPOSE: Infectious agents, such as SARS-CoV-2, can be carried by droplets expelled during breathing. The spatial dissemination of droplets varies according to their initial velocity. After a short literature review, our goal was to determine the velocity of the exhaled air during vocal exercises. METHODS: A propylene glycol cloud produced by 2 e-cigarettes' users allowed visualization of the exhaled air emitted during vocal exercises. Airflow velocities were measured during the first 200 ms of a long exhalation, a sustained vowel /a/ and varied vocal exercises. For the long exhalation and the sustained vowel /a/, the decrease of airflow velocity was measured until 3 s. Results were compared with a Computational Fluid Dynamics (CFD) study using boundary conditions consistent with our experimental study. RESULTS: Regarding the production of vowels, higher velocities were found in loud and whispered voices than in normal voice. Voiced consonants like /ʒ/ or /v/ generated higher velocities than vowels. Some voiceless consonants, e.g., /t/ generated high velocities, but long exhalation had the highest velocities. Semi-occluded vocal tract exercises generated faster airflow velocities than loud speech, with a decreased velocity during voicing. The initial velocity quickly decreased as was shown during a long exhalation or a sustained vowel /a/. Velocities were consistent with the CFD data. CONCLUSION: Initial velocity of the exhaled air is a key factor influencing droplets trajectory. Our study revealed that vocal exercises produce a slower airflow than long exhalation. Speech therapy should, therefore, not be associated with an increased risk of contamination when implementing standard recommendations.

Commentary about mesenchymal stem cells and scarred vocal folds.

A commentary to "Hertegård, S., Nagubothu, S.R., Malmström, E. et al. Treatment of vocal fold scarring with autologous bone marrow-derived human mesenchymal stromal cells - first phase I/II human clinical study. Stem Cell Res Ther 11, 128 (2020)" concerning the surgical intervention including a scar resection, the use of the Voice Handicap Index, the surgical and regulatory points of view regarding the inclusion of patients with laryngeal carcinomas history, and the side effects of bone marrow harvesting.

Feasibility of First Injection of Autologous Adipose Tissue-Derived Stromal Vascular Fraction in Human Scarred Vocal Folds: A Nonrandomized Controlled Trial.

Importance: Patients with scarred vocal folds, whether congenitally or after phonosurgery, often exhibit dysphonia that negatively affects daily life and is difficult to treat. The autologous adipose tissue-derived stromal vascular fraction (ADSVF) is a readily accessible source of cells with angiogenic, anti-inflammatory, immunomodulatory, and regenerative properties. Objective: To evaluate the feasibility and tolerability of local injections of autologous ADSVF in patients with scarred vocal folds. Design, Setting, and Participants: CELLCORDES (Innovative Treatment for Scarred Vocal Cords by Local Injection of Autologous Stromal Vascular Fraction) is a prospective, open-label, single-arm, single-center, nonrandomized controlled trial with a 12-month follow-up and patient enrollment from April 1, 2016, to June 30, 2017. Eight patients with severe dysphonia attributable to vocal fold scarring associated with a congenital malformation or resulting from microsurgical sequelae (voice handicap index score >60 of 120) completed the study. Data analysis was performed from September 1, 2018, to January 1, 2019. Interventions: Injection of ADSVF into 1 or 2 vocal folds. Main Outcomes and Measures: The primary outcomes were feasibility and the number and severity of adverse events associated with ADSVF-based therapy. The secondary outcomes were changes in vocal assessment, videolaryngostroboscopy, self-evaluation of dysphonia, and quality of life at 1, 6, and 12 months after cell therapy. Results: Seven women and 1 man (mean [SD] age, 44.6 [10.4] years) were enrolled in this study. Adverse events associated with liposuction and ADSVF injection occurred; most of them resolved spontaneously. One patient received minor treatment to drain local bruising, and another experienced a minor contour defect at the liposuction site. At 12 months, the voice handicap index score was improved in all patients, with a mean (SD) improvement from baseline of 40.1 (21.5) points. Seven patients (88%) were considered to be responders, defined as improvement by 18 points or more in the voice handicap index score (the minimum clinically important difference). Conclusions and Relevance: The findings suggest that autologous ADSVF injection in scarred vocal folds is feasible and tolerable. The findings require confirmation in a randomized clinical trial with a larger population. Trial Registration: ClinicalTrials.gov Identifier: NCT02622464.

Modified approach of the anterior commissure for transoral cordectomy in case of difficult exposure: a surgical innovation.

PURPOSE: To propose, in patients presenting a difficult laryngeal exposure, a surgical innovation allowing to perform a transoral laser cordectomy for cancers reaching the anterior commissure or the anterior third of vocal folds (according to the European Laryngological Society classification of laryngeal endoscopic cordectomies). METHODS: Our surgical technique consisted of adding to conventional cordectomies a modified relaxation thyroplasty proposed by Isshiki (type III), also called relaxation thyroplasty by a medial approach in the European Laryngological Society classification system. The anterior commissure retrusion is usually employed in the management of high-pitched voice disorders, but can also allow a better exposure of the anterior commissure. RESULTS: We described here this surgical innovation through the example of our first two patients. For both patients, the definitive histologic analysis showed negative microscopic margins and there was no post-operative complication. There was no need for a tracheostomy. They were allowed to take a normal diet after 2 days and were discharged after 4 days. The voice was breathy and hoarse as expected in case of extended cordectomy. CONCLUSIONS: This surgical innovation corresponding to the addition of an anterior commissure retrusion by a bilateral thyrotomy could be useful in the ELS classification of endoscopic cordectomies. It should allow surgeons to carry out a transoral CO2 laser cordectomy in patients with a T1 and sometimes T2 glottic carcinoma, even with a difficult laryngeal exposure.

Personality traits inventory in patients with vocal nodules.

The objective of the study was to analyze temperament and character in females with vocal nodules (VN) compared to a vocally healthy control population. 61 females were examined over a 17-month period for dysphonia with VN (mean age 46 years, duration of vocal complaints from 2 months to 6 years). 71 control females were recruited in their environment (mean age 34 years). The validated French Version of the Temperament and Character Inventory (TCI) was used. Patients with VN had significantly (p < 0,05) greater scores for Persistence and Novelty Seeking, particularly for the subscales exploratory excitability and extravagance. They had lower scores for Harm Avoidance, in particular fear of uncertainty, shyness and fatigability. Scores on Reward Dependence were not significantly different except for the subscale dependence, which were significantly lower in patients. No significant difference was found with regard to scores on Self-directedness, except for scores on the subscale self-acceptance, which were significantly lower in patients. Scores on Cooperativeness were not significantly different, except for the subscale helpfulness, which were significantly higher in patients. Patients had significant greater scores for Self-transcendence overall and specifically on the subscales self-forgetfulness and spiritual acceptance. Our findings suggested that women with VN are likely to have a passionate temperament, which might constitute an indirect predisposition to elevated vocal loading and greater risk for phonotrauma. The risk for developing or maintaining VN could be decreased by attending to those personality-specific maladaptive behaviors. A possible personalized approach to voice therapy could be organized on the basis of the TCI findings.