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To explore the risk of obstructive sleep apnea (OSA) in patients with primary muscle tension dysphonia (MTD). The medical records of patients diagnosed with primary MTD between November 2021 and March 2023, were reviewed. The risk of having OSA was assessed by looking at the scores of two validated questionnaires, namely the STOP-BANG questionnaire and the Berlin questionnaire. A total of 40 patients with primary MTD were enrolled in this study, including 16 females (40%) and 24 males (60%). The mean total STOP-BANG score was 3.57 ± 1.67. Seventeen of the study group had intermediate risk of OSA, and 14 had high risk, accounting for 77.5% of patients with primary MTD. When using the Berlin questionnaire, the mean total score was 1.65 ± 0.95, and 67.5% of the study group had a score > 2 and were at high risk of having OSA. The results of this study indicate that patients with primary MTD are at moderate to severe risk of having OSA., Competing Interests: Conflict of InterestThe authors have no relevant financial or non-financial interests to disclose., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose: To investigate the subjective effect of office-based blue laser therapy for inferior turbinate hypertrophy in patients with nasal obstruction., Methods: Patients with nasal obstruction who underwent office-based blue laser for the inferior turbinate hypertrophy between October 2022 and December 2023 were included in the study. The two outcome measures used to gauge the improvement in nasal obstruction and success of surgery were the Nasal Obstruction Symptom Evaluation (NOSE) scale and the Visual Analogue Scale (VAS). Patient's level of comfort during the procedure was also rated using a 10-point VAS scale., Results: A total of 14 patients were included in this study. The mean age of the study group was 41.47 ± 18.52 and the F/M ratio was 4.67. All patients reported significant improvement in nasal breathing. The mean NOSE score decreased significantly from 13.07 ± 3.89 pre-operatively to 2.64 ± 2.43 post-operatively (p = 0.002). Similarly, the mean VAS score decreased from 7.43 ± 0.85 to 2.0 ± 1.57 (p = 0.002) following surgery. The procedure was well-tolerated by all participants and the mean total score ranged from 6 to 9 with an average of 7.59 ± 1.34., Conclusion: Office-based blue laser therapy for inferior turbinate hypertrophy may be an effective treatment modality for nasal obstruction from the patient's perspective. Although the procedures were tolerated well with no complications noted, these results should be cautiously interpreted until studies using objective measures are conducted., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Adductor Spasmodic Dysphonia (ADSD) is the most common form of spasmodic dysphonia. It encompasses various symptoms affecting voice and speech. The objective of this study is to report the management of patients with ADSD using the transnasal endoscopic approach for laryngeal Botulinum Toxin (Botox) injection., Materials and Methods: A retrospective chart review of patients with ADSD who underwent transnasal endoscopic laryngeal Botox injection was conducted. Voice outcome measures included the Voice Handicap Index-10 (VHI-10) score and the degree of speech fluency., Results: Eight patients with ADSD who underwent 20 office-based transnasal endoscopic laryngeal Botox injections were included. The most commonly injected sites were the thyroarytenoid muscle (TA) and the false vocal fold in 95% and 55% of the cases, respectively. The mean dose of injected Botox was 2.48 ± 0.55 IU in the TA muscle, and 2.14 ± 0.53 IU in the false vocal fold. The mean amount of Botox injected in the larynx was 7.16 ± 2.42 IU. The mean follow-up period was 17.7 ± 13.3 months. There was marked improvement in speech fluency in 64.7% of the cases and mild improvement in one third of the cases. Marked improvement in speech fluency was recorded in 64.7% of the cases and mild improvement in one third of the cases. The mean VHI-10 score of patients dropped significantly from 22.47±4.08 to 15±4.69 following treatment (p<0.001)., Conclusions: The transnasal endoscopic approach is an effective and well-tolerated approach for laryngeal Botox injection in patients with ADSD., (© 2024 Mashhad University of Medical Sciences.)

Dermoid and epidermoid cysts are congenital or acquired benign developmental cysts that uncommonly occur in the head and neck region. These cysts represent less than 0.01% of all cysts of the oral cavity and can be found on the tongue, lips and other oral mucosa locations. The palate is less frequently affected with most reported cysts being limited to the soft palate. In this study, we report a case of a dermoid cyst of the hard palate, and discuss its management with a review of the literature., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the prevalence of phonatory disorders and their impact on quality of life in a cohort of patients with fibromyalgia (FMS), and to review the literature., Study Design: Prospective cohort study., Methods: All adult patients presenting to the rheumatology clinic at a tertiary referral center between January 2024 and April 2024 and diagnosed with FMS were prospectively recruited. The primary outcome measure used to screen for dysphonia was the Voice Handicap Index-10 (VHI-10). All patients were also asked to fill the Fibromyalgia Rapid Screening Tool (FiRST) and the short form of the McGill pain questionnaire (SF-MPQ)., Results: A total of 70 female patients were included, divided equally into a study and control group (n = 35). The mean FiRST score and the mean SF-MPQ score were significantly higher in the study group compared to the control group (6.20 ± 1.05 vs 1.26 ± 1.65) and (26.14 ± 13.16 vs 2.6 ± 4.23), respectively. There was a statistically significant difference in the mean VHI-10 score between the study group and the control group (8.51 ± 7.66 vs 0.74 ± 0.98; P < 0.001). More than one third of patients in the study group had a VHI-10 score above 11 (37.1%) compared to none in the control group (P < 0.001). There was a strong positive correlation between the VHI-10 score and the FiRST and SF-MPQ scores (r = 0.612; P < 0.001 and r = 0.794; P < 0.001, respectively)., Conclusion: The findings suggest that two out five patients with FMS have vocal complaints that impact their quality of life. Healthcare providers need to recognize these phonatory disorders, that are often masked by other systemic manifestations of the disease., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

The authors have conducted a retrospective analysis based on two cases of patients with intra-tracheal pathologies who received treatment from the same surgeon at a tertiary referral center. The effective management of airways in patients with intra-tracheal lesions necessitates close collaboration between surgeons and anesthesiologists. Factors such as the size, location, rigidity of the tumor, and the remaining tracheal lumen space should be carefully considered. In situations where there is near complete obstruction of the trachea and a substantial risk of worsened respiratory function, resorting to cardiopulmonary bypass or extracorporeal membrane oxygenation is advisable. This pilot study aims at devising an algorithm for the airway management of intra-tracheal lesions, although a larger case cohort is needed to assess its applicability and effectiveness., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Saudi Journal of Anesthesia.)

Intramuscular lipomas, typically found in subcutaneous tissue, rarely affect deeper muscular planes, especially those of the head and neck region. The following are 3 cases of intramuscular lipomas involving the sternocleidomastoid muscle. The first 2 patients presented with painless, palpable masses confirmed by diagnostic imaging as well-circumscribed intramuscular lipomas. One was treated surgically, while the other was managed conservatively with monitoring and close follow-up. The third patient reported dysphagia associated with occasional dyspnea and mild pain. The mass was identified as infiltrative lipoma and was resected surgically. Complete tumor removal with no recurrence at 6 months was observed for the first and last cases. The second case was serially followed at 3 and 6 months with no interval changes. We report the largest case series on intramuscular lipomas of the sternocleidomastoid muscle to enhance our understanding of this rare entity., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Purpose  This article aims to identify patient- and surgery-related factors that could predict the development of postoperative central diabetes insipidus (DI). Methods  This is a retrospective case-control study conducted at a single-institution tertiary referral center. Patients undergoing endoscopic endonasal skull base surgery for pituitary adenoma between November 2018 and April 2023 were recruited. The main outcome measures collected include age, gender, comorbidities, tumor type, postoperative DI, intraoperative and postoperative cerebrospinal fluid (CSF) leak, flow of CSF leak, number of layers required for repair, the use of nasal packing, and hospital length of stay. Results  A total of 20 patients developed DI postoperatively. Patients' demographic and comorbidity profile did not correlate with DI development. The encounter of an intraoperative CSF leak was correlated with postop DI (chi-square (1) = 18.35, p  < 0.001) with a relative risk (RR) of 2.7 (confidence interval [CI] = 1.37-5.28). The use of nasal packs was also correlated with postop DI (chi-square (1) = 10.17, p  = 0.001) with a RR of 1.8 (CI = 1.15-2.87). Defects requiring a two or more layers for reconstruction also correlated with postop DI compared to single layer repairs (chi-square (1) = 12.15, p  < 0.001) irrelevant of the materials used. Development of DI postop correlated with an increased hospital length of stay ( t (64) = -3.35, p  = 0.001). Conclusion  The physician should be careful when evaluating patients with pituitary adenomas in the postoperative period, particularly those with intraoperative CSF leak, nasal packing, and those who underwent multilayer reconstruction of the surgical defect., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective: To determine the prevalence of laryngeal muscle tension in patients with sinonasal diseases., Methods: The medical records and video-recordings of patients with a history of sinonasal disease were reviewed to identify one of four muscle tension patterns during phonation. A control group with no history of sinonasal diseases was matched according to age and gender., Results: Seventy-seven patients were divided into a study group ( n = 47) and a control group ( n = 30). In the study group, 29 patients had at least one muscle tension pattern compared with only 9 in the control group ( p = 0.007). The most common muscle tension patterns observed in the study and control groups were muscle tension patterns II and III. In the study group, 79.3 per cent of patients with at least one muscle tension pattern reported dysphonia compared with only 33.3 per cent in the control group., Conclusion: Patients with sinonasal diseases are more likely to exhibit laryngeal muscle tension and dysphonia in comparison with healthy subjects.

Purpose: To report the efficacy of blue laser in the treatment of vocal fold polyps and Reinke's edema in an office setting., Methods: The medical records and video-recordings of patients who underwent office-based blue laser therapy in a tertiary referral center for vocal fold polyps and/or Reinke's edema were reviewed. The primary outcome measures were the Voice Handicap Index-10 (VHI-10) score and disease regression. Acoustic and aerodynamic parameters were also analyzed., Results: Thirty-five patients (21 with vocal fold polyps and 14 with Reinke's edema) were included and a total of 47 lesions were treated. Out of the 35 patients, 7 patients were lost for follow-up. The mean VHI-10 score dropped significantly after surgery by 17.41 ± 8.67 points (p < 0.001). The endoscopic examinations of 38 lesions were reviewed (17 vocal fold polyps and 21 Reinke's edema) before and up to 6 months after laser therapy. In the subgroup with vocal fold polyps (N = 17), there was complete disease regression in 13 and partial in 4. In the subgroup with Reinke's edema (N = 21), there was complete disease regression in 7 and partial disease regression in 14. For patients with vocal fold polyp, there was a significant decrease in shimmer and a significant increase in maximum phonation time postoperatively. For patients with Reinke's edema, there was a significant decrease in shimmer and noise-to-harmonic ratio following treatment., Conclusion: Office-based blue laser therapy is an effective treatment for vocal fold polyps and Reinke's edema leading to complete or partial disease regression. All patients had improvement in voice quality., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To investigate the risk of fibromyalgia in patients with primary muscle tension dysphonia (MTD) in comparison to subjects with no dysphonia., Study Design: Prospective cohort study., Methods: The medical records and video recordings of all patients presenting to the Voice and Swallowing unit at a tertiary referral center between October 2022 and October 2023 and who were diagnosed with primary MTD were prospectively reviewed. The risk of fibromyalgia was assessed using the "Fibromyalgia Rapid Screening Tool" (FiRST). Demographic data included age, gender, history of smoking, and history of high vocal load. The impact of dysphonia on quality of life was also analyzed using the Voice Handicap Index-10 (VHI-10)., Results: A total of 42 patients who had filled the FiRST questionnaire were enrolled in this study. These included 20 patients diagnosed with primary MTD and 22 healthy subjects with no history of dysphonia and normal laryngeal examination. Forty percent of the study group tested positive using the FiRST questionnaire as compared to only 9.1% in the control group. The difference between the two groups was statistically significant (P = 0.03). The risk of having fibromyalgia was 6.67 times among patients with primary MTD in comparison to controls (RR=6.67; 95% CI [1.21-36.74])., Conclusion: The results of this investigation indicate that the risk of fibromyalgia is significantly higher in patients with primary MTD vs controls. A holistic approach in the diagnosis and treatment of MTD is advocated., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the prevalence of arytenoid cartilage collapse (ACC) during deep inhalation in awake patients with intermediate/high risk of obstructive sleep apnea (OSA)., Study Design: Retrospective case-control study., Methods: The medical records and video recordings of awake flexible endoscopic examination of patients with history of OSA who presented to the sleep apnea clinic in a tertiary referral medical center between June 2022 and December 2022, were reviewed. All patients had filled the STOP-BANG questionnaire and had intermediate/high risk of having OSA. A group of patients matched by age and gender and with no history of OSA were used as controls., Results: A total of 95 patients, 64 with a history of OSA and 31 with no history of OSA, were included. Among the study group, 37.5% (n = 24) had a STOP-BANG score between 3 and 4 and were considered to be at an intermediate risk of OSA while the remaining had a score more than 5 and were considered to be at high risk of OSA. There was a significant difference in the prevalence of ACC between the study group and controls (32.8% vs 12.9%, respectively, P < 0.001)., Conclusion: The prevalence of ACC was significantly higher in patients with intermediate/high risk of OSA in comparison to healthy controls with no history of OSA. When present, ACC should raise the physician's suspicion for OSA and probably prompt further investigation such as a sleep study., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Spontaneous oropharyngeal bleeding is an uncommon but serious medical emergency mainly caused by accidental trauma or post-tonsillectomy. In extremely rare cases, it can be attributed to arterial pseudoaneurysm (PA) of head and neck vessels. The authors present the case of a young female patient presenting with recurring spontaneous oropharyngeal bleeding who was found to have a lingual artery PA on angiography. Due to the active nature of the hemorrhage and extensive blood loss, embolization of the tonsillar branch of the lingual artery was successfully performed. When evaluating patients with spontaneous oropharyngeal bleeding, one should suspect the presence of an arterial PA, especially if the bleeding recurs following initial conventional interventions., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To investigate the sensitivity of laryngeal findings in predicting high-grade dysplasia/carcinoma in situ (CIS) and squamous cell carcinoma (SCC) in patients with vocal fold leukoplakia., Methods: A retrospective review of the medical records and video recordings of the laryngeal examination of patients with vocal fold leukoplakia who underwent un-sedated office-based laryngeal biopsy in a tertiary referral center between January 2022 and August 2023 was conducted. Laryngeal findings included the size, surface, projection, and edges of the lesion. Vocal fold leukoplakia was classified according to the WHO as benign, low-grade dysplasia, high-grade dysplasia/CIS, and squamous cell carcinoma., Results: Seventy patients with 100 vocal fold leukoplakia were included. Size was found to have the highest sensitivity with an AUC of 0.730 (95% CI [0.618-0.842], p  = 0.002) followed by surface and projection with AUCs of 0.672 (95% CI [0.548-0.795], p  = 0.019) and 0.675 (95% CI [0.546-0.804], p  = 0.017), respectively. Furthermore, the odds of diagnosing high-risk lesions (high-grade dysplasia/CIS and SCC) were the greatest when the lesion was large and rough (OR = 10.28; 95% CI [3.08-34.36])., Conclusion: The morphological features of vocal fold leukoplakia may assist the physician in predicting the risk of malignancy. Large and rough lesions were more likely to harbor high-grade dysplasia/CIS and SCC compared to small and smooth lesions., Competing Interests: The authors have no conflict of interest to declare., (© 2024 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Introduction: Diabetes mellitus type 2 is a growing health concern that affects several systems in the body, among which is the phonatory apparatus. Voice may be affected in view of the high prevalence of myopathy and neuropathy in diseased subjects. The authors aimed to answer the following question: does type 2 diabetes have an effect on voice?, Methods: The systematic review included search terms such as "speech, voice, larynx, glucose, diabetes, and hyperglycemia." The search strategy yielded 221 articles, only five of which satisfied the inclusion criteria. Articles were considered for inclusion using the PRISMA method. Analysis included 321 patients with type 2 diabetes mellitus and 171 controls. All studies included were case-control studies except for one study which was an observational cohort. Six parameters were chosen as endpoints for the systematic review and meta-analysis: the presence/absence of voice complaints, fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time., Results: There was no significant difference in the prevalence of voice complaints (i.e., hoarseness) between diabetic patients and control groups. There was also no significant difference in any of the acoustic and aerodynamic measures between patients with type 2 diabetes and controls. These findings can be ascribed to the high resilience of the laryngeal muscles to the adverse effect of systemic diseases., Conclusion: There is no consensus in the literature that the prevalence of voice symptoms in diabetic patients is significantly higher than that reported in healthy subjects., (© 2023 S. Karger AG, Basel.)

The authors aimed to develop an extensive preoperative checklist of CT scan findings during endoscopic access to the ventral skull base and implement it in clinical practice. A comprehensive literature review was conducted to identify the radiological landmarks crucial to endoscopic skull base surgery. Four electronic databases were searched: PubMed, MEDLINE, EMBASE, and Google Scholar using search terms/keywords such as "radiological landmarks," "endoscopic skull base surgery," "CT scan," "pituitary surgery," "anatomical variations," "internal carotid," "optic nerve," "sphenoid sinus," "pneumatization," "dehiscence," and "protrusion". Inclusion criteria were limited to original articles and systematic reviews published in English, between the years 2000 and 2021, which pertained to the radiological landmarks to be identified during endoscopic skull base surgery. Full-text articles were retrieved and collated into a narrative review focused on a 12-item checklist the authors agreed upon. The mnemonic "O ROAD TO SELLA" was used to represent the checklist and include the following landmarks: Sphenoid O stium, Sphenoid R ostrum, O nodi cells, A natomic variations of the sphenoid sinus, D istance between the carotids, T umor characteristics, O ptic nerve dehiscence/protrusion, S eptation/insertion of the sphenoid sinus, E ntrance to the sellar floor, L ateral recess of the sphenoid sinus, c L inoid process pneumatization, and internal carotid A rtery dehiscence/protrusion. The checklist is designed to be used by attending physicians, fellows, and residents and the authors intend to implement it into electronic medical records at the institution's medical center to monitor the outcomes of EEPS after implementation., Competing Interests: Conflict of interestThe authors have no financial or non-financial interests to disclose., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objective: Bilateral vocal fold paralysis can be a disabling condition with an adverse impact on quality of life. Various glottal widening procedures to secure the airway have been described. These include total or partial arytenoidectomy with or without reinnervation, cordotomy, arytenoidopexy, and others. A review of the literature shows one case of office-based partial arytenoidectomy that was performed successfully using the thulium laser but no other in-office procedures for the treatment of bilateral vocal fold paralysis., Study Design: Retrospective case series with literature review., Methods: This report presents two patients with bilateral vocal fold paralysis who underwent office-based blue laser posterior cordectomy. The blue laser is a new photoangiolytic laser (wavelength of 445 nm) with good hemostatic and cutting properties. The surgical technique of office-based posterior cordectomy using the blue laser is described with a review of the literature on arytenoidectomy/posterior cordectomy., Results: Both procedures were well tolerated and patients showed marked improvement in breathing manifested by an increase in glottal gap on laryngeal examination with no worsening in voice quality. Long-term follow-up showed no interval changes in both cases., Conclusion: The authors of this manuscript advocate office-based posterior cordectomy using the laser in patients who are at high risk for general anesthesia or who refuse to go to the operating room, and potentially for other patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

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., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Obstructive sleep apnea (OSA) is associated with many chronic diseases among which is laryngopharyngeal reflux disease (LPRD)., Objective: To investigate the prevalence of laryngopharyngeal reflux (LPR)-related symptoms in patients with OSA using the Reflux Symptoms Score (RSS) and Reflux Symptom Index (RSI)., Methods: The medical records and video-recordings of patients with OSA who presented to a tertiary referral center were reviewed. The diagnosis of OSA was made using the STOP-BANG questionnaire and/or polysomnography. The prevalence of LPR-related symptoms was assessed using both the RSS and RSI questionnaires., Results: Thirty-nine patients were included in this study. Twenty-seven patients (69.2%) had a positive RSS in comparison to only 7 (17.9%) using the RSI ( p  = .052). Subgroup analysis of those who had polysomnography ( n  = 24) showed that 18 patients (75%) had a positive RSS in comparison to only 5 patients (20.8%) using the RSI. Patients in the high-risk category for OSA were also found to have a higher prevalence of LPR-related symptoms using both the RSS and RSI questionnaires in comparison to those in the lower risk categories., Conclusion: The results of this investigation indicate that the prevalence of LPR-related symptoms is higher using the RSS in comparison to the RSI.

Objective: The purpose of this study is to review the current literature on the effect of hypovitaminosis D on voice., Study Design: Narrative review., Methods: The literature search from electronic databases included PubMed/MEDLINE, EMBASE, SCOPUS, and Google Scholar. Search terms included voice, voice quality, voice disorders, larynx, laryngology, acoustic analysis, vitamin D, calcitriol, cholecalciferol, vitamin D deficiency, and vitamin D insufficiency. All studies on patients with vitamin D deficiency, which included subjective and objective voice assessments, were reviewed., Results: A total of 39 studies were retrieved. Only four studies met the above-mentioned inclusion criteria and hence were included in this review. The total number of subjects analyzed was 466. The subjective voice outcome measures used were the Voice Handicap Index-10 (VHI-10), self-reported phonatory symptoms, and the GRBAS scale. Objective voice outcome measures included fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, maximum phonation time, and dysphonia severity index., Conclusion: Vitamin D deficiency has no significant effect on laryngeal muscles. There was no statistically significant difference in VHI-10 score, self-reported dysphonia, perceptual voice evaluation scores, or any of the acoustic measures between those with or without vitamin D deficiency., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

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., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

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., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

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., Competing Interests: The authors declare that there is no conflict of interest., (© 2023 The Authors. OTO Open published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: To report patient tolerance in office-based blue laser therapy for vocal fold lesions., Methods: A retrospective review of the medical records of patients who underwent office-based blue laser therapy for lesions of the vocal folds between November 2021 and February 2023 was conducted. A total of 48 patients were included. Patient tolerance was assessed using the Iowa Satisfaction with Anesthesia Scale (IOWA). Patient tolerance was analyzed in relation to patients' demographic characteristics, disease type and severity, and procedure-related factors., Results: The mean tolerance score of the study group was 1.51 ± 1.1. There was a significant difference in the mean tolerance score between smokers and non-smokers ( p  = .038). Patients with vocal fold cyst ( n  = 3) had the highest mean tolerance score followed by patients with vocal fold polyps ( n  = 15). There was a nonsignificant difference in the mean tolerance score between benign lesions of the vocal folds and leukoplakia. Patients with lesions extending to more than half the vocal fold had less tolerance than those with lesions limited to less than half the vocal fold (1.91 vs. 1.27, p value .041). There was a moderate and significant negative correlation between vocal fold movement VAS, swallowing VAS, and tolerance score. The mean total duration of the procedures was 10.38 ± 4.8 min. There was a mild negative correlation between the duration of the procedure and tolerance., Conclusion: Office-based blue laser therapy for vocal fold lesions is a well-tolerated procedure. Patient should be instructed how to breathe quietly and avoid swallows to improve tolerance to surgery., Level of Evidence: 4., Competing Interests: The authors have no conflicts of interest to declare that are relevant to the content of this article., (© 2023 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

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., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

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., Competing Interests: DECLARATION OF COMPETING INTERESTS None., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To analyze voice outcomes and lesion regression in patients with Reinke's edema treated in the office with lasers., Study Design: Systematic review and meta-analysis METHODS: The search was performed in the Medline, Embase, Medline, Cochrane, and Google Scholar databases using the PRISMA 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 Reinke's edema measured through voice-handicap index, 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: The initial search identified 650 articles, 6 of which met the inclusion criteria and were analyzed. The total number of participants was 58. Meta-analysis showed significant improvement in VHI-10 scores after in-office laser therapy (95% CI, [-1.46; -0.75]). It also showed significant improvement in jitter, significant increase in fundamental frequency (95% CI, [0.52; 1.71]) and significant decrease in lesion size (95% CI, [-2.03; -0.35])., Conclusion: Office-based laser therapy is a reliable alternative to the traditional phono-microsurgery performed in the operating room. Patients show significant improvement in voice outcomes and laryngeal examination., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

This study aims to determine the current state of clinical trials regarding HPV-positive head and neck squamous cell carcinoma (HNSCC). Clinical trials were filtered to fit the study's aim using Clinicaltrials.gov: trials concerning HNSCC specifically those related to HPV done between January 2005 and December 2020 were extracted and information regarding location, duration, phases, patient recruitment, trial status, results, primary outcome, type of intervention and publication status were collected and analysed. As a result, 123 trials were included. North American countries (USA and Canada) conducted more than two-thirds of the trials (72.4%) compared to European countries and the rest of the world. Trials in phase II constituted more than half of those included in this study (53.7%). From the 123 trials included in this study, only 30 had their NCT identification number linked to publications, but less than half (46.7%) of the publications stemmed from trials with results. Drug combination was the most widely studied treatment modality. Despite falling in the middle of the spectrum with respect to the number of trials when compared to other diseases, our research highlights the need for even more trials tackling multiple aspects of HPV-positive HNSCC., Competing Interests: The authors declare that they have no conflicts of interest., (© the authors; licensee ecancermedicalscience.)

Introduction The pandemic of coronavirus disease 2019 (COVID-19) has caused over four million deaths, depleting resources and healthcare workers; therefore, in an attempt to stratify patients, the relationship between liver enzymes and clinical outcome was studied. This study aimed to assess the pattern and impact of liver enzymes on the clinical outcome of hospitalized patients with COVID-19 in Lebanon and look for possible confounding factors. Methodology This was a single-centered retrospective cohort study conducted between December 2020 and March 2021 on 230 patients diagnosed with COVID-19. Liver function tests (LFTs) and other laboratory values on admission and peak hospitalization were analyzed using SPSS. Results The prevalence of abnormal liver tests among the sample population with severe COVID-19 infection were as follows: aspartate aminotransferase (AST), 77%; alanine aminotransferase (ALT), 49%; alkaline phosphatase (ALP), 12%; and gamma-glutamyl transferase (GGT), 37%. A severe COVID-19 infection was more likely present in patients with abnormal levels of AST (p = 0.015), ALP (p = 0.03), and GGT (p = 0.022). ANOVA test revealed no significant relationship between AST levels at peak hospitalization and the treatments received by the patient. Conclusion Abnormal liver function tests of patients at admission may be an indicator of more severe disease. In the context of scarce resources created by the pandemic, it becomes essential to establish a reliable predictor for a severe outcome of COVID-19 infection and manage accordingly., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ibrahim et al.)