Differences between the Perilaryngeal Pressure Pain Thresholds in Asymptomatic Women, Women With Bruxism, and Women With Odynophonia.

OBJECTIVE: This study was aimed at comparing perilaryngeal pressure pain thresholds (PPT) among asymptomatic women, women with bruxism, and women with odynophonia. DESIGN: Observational cross-sectional study. METHODS: Eighty-four women whose age mean was 23.75 (SD, 3.02) years were grouped according to inclusion and exclusion criteria into a group of asymptomatic women (G1), another group of women with bruxism (G2), and another of women with odynophonia (G3). Palpation was used to identify regions of interest for this study, and an analog algometer was used to evaluate perilaryngeal PPT in the previously localized regions. Each PPT evaluation was done twice. RESULTS: G1 PPT mean were between 1.35 (SD, 0.20) and 2.29 (SD, 0.28) kg/cm2, G2 PPT mean were found between 0.85 (SD, 0.12) and 1.78 (SD, 0.23) kg/cm2, and G3 PPT mean were located between 0.71 (SD, 0.11) and 1.45 (SD, 0.19) kg/cm2. Differences were observed between PPT in the three groups evaluated (P < 0.05). The intra-evaluator agreement between the evaluations performed fluctuated between 60.71% (κ = 0.51) and 92.86% (κ = 0.91). CONCLUSIONS: There are significant differences between the perilaryngeal PPT of asymptomatic women, women with bruxism, and women with odynophonia. Asymptomatic women had the highest PPT, while odynophonia sufferers had the lowest.

Odinofonía: una actualización clínica

Introducción: En la actualidad, la odinofonía es considerada como un síntoma más dentro de los desórdenes de la voz y, por lo mismo, su estudio ha tenido una relevancia menor en comparación a la investigación del dolor expresado en otras regiones del cuerpo humano. Objetivo: Actualizar el concepto de odinofonía, según los últimos hallazgos que explican su etiología, evaluación y manejo terapéutico. Método: Se buscaron trabajos en las bases de datos PubMed, Scopus, ScienceDirect y SciELO. Se seleccionaron artículos según diversos criterios, que incluyeron la fecha de publicación, el diseño y el objetivo. Resultados: La etiología de la odinofonía incluye, según criterios de intensidad y cronicidad del dolor, a la odinofonía primaria y secundaria. La evaluación de la odinofonía comprende una detallada entrevista clínica; la identificación, mediante escalas e índices, de su frecuencia, intensidad y duración; y la aplicación de herramientas como la algometría, para reconocer el grado de sensibilidad de los tejidos afectados. La intervención de la odinofonía depende de su naturaleza (primaria o secundaria) y, en general, incluye al abordaje educativo, sintomático, biomecánico y psicosocial. Conclusión: La literatura actual posiciona a la odinofonía como una condición compleja, cuya etiología, evaluación e intervención aún carecen de total comprensión.

Introduction: At present, odynophonia is considered one more symptom within voice disorders and, therefore, its study has had less relevance if compared to the research of pain expressed in other regions of the human body. Objective: To update the concept of odynophonia, according to the latest findings that explain its etiology, evaluation and therapeutic management. Methodology: The databases PubMed, Scopus, ScienceDirect, and SciELO were searched. Articles were selected according to various criteria, including date of publication, design and objective. Results: The etiology of odynophonia, according to criteria of intensity and chronicity of pain, includes primary and secondary odynophonia. The evaluation of odynophonia entails a detailed clinical interview; the identification of its frequency, intensity and duration using scales and indexes; and the application of tools such as algometry, to recognize the degree of sensitivity of the affected tissues. The intervention of odynophonia depends on its nature (primary or secondary) and, in general, includes educational, symptomatic, biomechanical and psychosocial approaches. Conclusion: Current literature positions odynophonia as a complex condition, whose etiology, evaluation, and intervention are still not fully understood.

Consecuencias de la sobrecarga vocal en el umbral doloroso de los tejidos perilaríngeos / Vocal overload consequences on the pressure pain threshold of the perilaryngeal tissues

Introducción: La sobrecarga vocal produce una serie de efectos en los pliegues vocales, donde destacan lesiones y síntomas funcionales. Sin embargo, sus efectos en los tejidos perilaríngeos se conocen escasamente. Esto impide la completa comprensión de fenómenos expresados con su daño, como la odinofonía.ObjetivoDescribir el umbral de presión de los tejidos perilaríngeos previo y posterior a sobrecarga vocal. Material y método: Se analizó una muestra compuesta por 35 mujeres, cuyo promedio de edad fue de 24.1 ± 2.06 años. La investigación constó de tres partes, donde se evaluaron antes y después de sobrecarga vocal los umbrales de presión de los tejidos perilaríngeos. Resultados: Los umbrales de presión de los tejidos perilaríngeos previos a la tarea de sobrecarga vocal fluctuaron entre los 1,140 y 1,857 g, mientras que, posteriormente a ella, se encontraron entre los 1,105 y 1,802 g. Los cambios existentes en cada una de las estructuras evaluadas fueron significativos (p < 0.05). Conclusiones: Los umbrales de presión de la región perilaríngea son menores a los existentes en otros tejidos del sistema estomatognático, como el músculo masetero. Adicionalmente, las tareas de sobrecarga vocal los reducen significativamente.(AU)

Introduction: Vocal overload causes a series of effects in the vocal folds, where injuries and functional symptoms stand out. However, its effects on perilaryngeal tissues are poorly known. This prevents the complete understanding of phenomena arising from their damage, such as odynophonia.ObjectiveTo describe the pressure threshold of the perilaryngeal tissues before and after vocal overload. Material and method: A sample composed of 35 women was analysed, whose average age was 24.1 ± 2.06 years. The investigation consisted of three parts, where the pressure thresholds of the perilaryngeal tissues were evaluated before and after vocal overload. Results: The pressure thresholds of the perilaryngeal tissues prior to the task of vocal overload ranged between 1140 and 1857 grams, and between 1105 and 1802 grams after it. The existing changes in each of the evaluated structures were significant (p < .05). Conclusions: The pressure thresholds of the perilaryngeal region are lower than other tissues from the stomatognathic system, such as the masseter muscle. In addition, the vocal overloading tasks reduced them in a significant way.(AU)

In-Office Superior Laryngeal Nerve Block for Paralaryngeal Pain and Odynophonia.

OBJECTIVES: Pain localized to the thyrohyoid region may be due to neuralgia of the superior laryngeal nerve (SLN), inflammation of the thyrohyoid complex, or a voice disorder. We present outcomes of treatment of paralaryngeal pain and odynophonia with SLN block. STUDY DESIGN: Retrospective Review. METHODS: A retrospective chart review of patients undergoing in-office SLN block for paralaryngeal pain between 2015 and 2018 at two tertiary care centers was conducted. Patient demographics, indications, and response to treatment were analyzed. RESULTS: Thirty-eight patients underwent blockade of the internal branch of the SLN for paralaryngeal pain, with 10 excluded for incomplete medical records. Eighty-two percent (23/28) reported an improvement in their symptoms. Patients underwent an average of 2.5 blocks (SD = 1.88, range 1-8), with 10 patients (36%) undergoing a single procedure. Of the 18 patients who underwent multiple blocks, nine had eventual cessation of symptoms (50%) compared to resolution in 6/10 undergoing a single injection. Eleven patients (39%) noted odynophonia related to vocal effort, and all of these patients had improvement in or resolution of their symptoms and were more likely to improve compared to those without odynophonia (P = .006). Of the four patients who had a vocal process granuloma (VPG) at presentation, three had complete resolution of the lesion at follow-up. CONCLUSION: In-office SLN block is effective in the treatment of paralaryngeal pain. It may be used as an adjunct in the treatment of vocal process granulomas, as well as voice disorders where odynophonia is a prominent symptom. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:401-405, 2022.

Diferencias en el umbral de presión de los tejidos perilaríngeos entre pacientes con odinofonía e individuos asintomáticos / Differences in the perilaryngeal tissue pressure thresholds between patients with odynophonia and asymptomatic individuals

Introducción: La odinofonía se define como el dolor durante la fonación. Se trata de una molestia frecuente en los profesionales de la voz. Se ha estimado que quienes la sufren presentarían mayor sensibilidad perilaríngea; sin embargo, esta situación no ha sido del todo evidenciada. Objetivo: Comparar los umbrales de presión de los tejidos perilaríngeos entre pacientes con odinofonía e individuos asintomáticos. Material y método: Se incluyó a un total de 42 mujeres profesionales de la voz o estudiantes de carreras afines. De este total, se formaron 2grupos, el primero (G1) estuvo compuesto por 21 individuos asintomáticos (sin dolor durante la fonación), cuya edad era de 21.5±1.94 años. Mientras que el segundo (G2), con una edad promedio de 25.1±2.27 años, incluyó a 21 sujetos que presentaban dolor durante la fonación. A ambos grupos se los evaluó, mediante algometría, los umbrales de presión de los tejidos perilaríngeos. Resultado: Los umbrales de presión de las personas que sufren de odinofonía fluctuaron entre 300 a 2,000 g, mientras que en los individuos asintomáticos se encontraron entre 1,000 a 2,700 g. Conclusión: Los umbrales de presión perilaríngeos son significativamente más bajos en aquellos pacientes que sufren de odinofonía en comparación con quienes son asintomáticos.(AU)

Introduction: Odynophonia is defined as pain during phonation. Referring to frequent discomfort that professionals of the voice experience. It is estimated that those who suffer this symptom will present high perilaryngeal sensitivity; however, this situation has not been proved. Objective: The main objective of this investigation is to compare the perilaryngeal tissue pressure thresholds between patients with odynophonia and asymptomatic individuals. Material and method: A total of 42 female voice professionals and students with related careers were included. From this total, 2groups were extracted, the first (G1) was composed of 21 asymptomatic individuals (without pain during phonation), aged 21.5±1.94 years. Meanwhile, the second group (G2) comprised 21 subjects who presented pain during phonation with a mean age of 25.1±2.27 years. The perilaryngeal tissue pressure thresholds of both groups were evaluated through algometry. Results: The pressure threshold in those suffering from odynophonia fluctuated between 300 and 2,000 grams, while that of asymptomatic individuals were between 1,000 to 2,700 grams. Conclusion: Perilaryngeal tissue pressure thresholds were significantly lower in the patients suffering odynophonia in comparison with those who were asymptomatic.(AU)

Primary odynophonia: When pain is out of proportion to dysphonia.

OBJECTIVES/HYPOTHESIS: Odynophonia is generally regarded as a symptom of a voice disorder. However, a subset of patients with odynophonia have debilitating pain out of proportion to the relatively mild degree of dysphonia and are not responsive to voice therapy. The goals of this study were to 1) describe the symptomatology of this subset of patients and differentiate it from typical odynophonia, 2) propose alternate models to explain this phenomenon of primary odynophonia, and 3) present a new treatment paradigm based on the proposed models. STUDY DESIGN: Case series. METHODS: Inclusion criteria were complaint of persistent pain associated with voicing, normal vocal fold mobility, complete glottic closure, and limited or lack of response of pain to voice therapy. Presenting symptoms, voice evaluation, and treatment outcomes were reviewed. RESULTS: Eleven patients fit the inclusion criteria. The degree of pain did not follow the trajectory of vocal improvement with therapy. The pain was stagnant or worsened with voice exercises. The most dramatic improvement came about in one patient who received false vocal fold Botox injections, and another who received thyrohyoid lidocaine/triamcinolone injection. We propose that these patients had developed primary odynophonia, in which the pain had become self-sustaining and no longer responded to correction of hyperfunctional vocal behavior. The mechanism of pain persistence may involve superior laryngeal neuralgia, cartilaginous or ligamentous inflammation, and/or central sensitization. CONCLUSIONS: A minority of patients have primary odynophonia distinct from typical odynophonia. Direct treatment of pain may be advisable prior to or in conjunction with voice therapy. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E183-E189, 2020.