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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectve: Functional endoscopic sinus surgery is primarily aimed at restoring the natural physiology of the paranasal sinuses to achieve efective mucociliary clearance and proper ventilation. This can be hindered by various factors, including host-related, environmental, and iatrogenic factors. Preservation of the sinus mucosa is fundamental for the success of the surgery. Sinus mucosal prolapse, resulting from intraoperative mucosal trauma, can lead to sinus ostium obstruction and impaired drainage. Methods: In this pilot study, the authors describe a novel technique for the intraoperative management of sinus mucosal prolapse arising from endoscopic sinus surgery. This method entails the use of a balloon catheter expander to infate and support the maxillary sinus mucosa, thereby limiting the occurrence of preventable prolapse-related complications. Results: The authors applied this surgical technique to a cohort of 11 patients. All patients developed prolapse afecting the posterosuperior region of the maxillary sinus mucosa. Each patient was followed up for at least 3 weeks following the surgery, and endoscopic assessment postoperatively revealed absent mucosal prolapse in all patients, highlighting the success and positive outcomes of the technique. The sinus mucosa retained its appropriate positioning, efectively draping the sinus wall in uninterrupted continuity with the maxillary antrostomy. Conclusion: The authors advocate the use of a Foley catheter as a cost-efective and readily available alternative to the traditional balloon sinus catheter expander. [ABSTRACT FROM AUTHOR]

This article discusses the use of various techniques to reduce the occurrence of cerebrospinal fluid (CSF) leaks after pituitary surgery. The study examines the experience of a single institution over a five-year period, focusing on the use of intraoperative lumbar drains and repair techniques. The results show that the lumbar drain was used in all cases, with post-operative use in 24.2% of patients. CSF leaks were encountered intraoperatively in 28.8% of cases and postoperatively in only 4.5% of cases. Different repair techniques, such as naso-septal flaps and surgical sealants, were used depending on the size of the defect. The study also found that certain patient characteristics, such as a pre-op diagnosis of CAD and/or dyslipidemia, were associated with a higher rate of intraoperative CSF leak. The use of navigation during surgery did not significantly affect the risk of CSF leak. The article concludes that simple closure with a single sealant layer or a graft or flap is appropriate in cases with limited resources, and that patient comorbidities and intraoperative flow rate should be considered when deciding on a reconstruction technique. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the risk factors for developing diabetes insipidus (DI) after endonasal endoscopic pituitary macroadenoma resection. The study analyzes a cohort of 19 patients who developed postoperative DI out of 66 patients who underwent the procedure. The results indicate that high flow cerebrospinal fluid (CSF) leaks during surgery, the use of nasal packs, and the need for multiple layers of reconstruction are correlated with the development of DI. The study suggests that careful postoperative monitoring of patients with these risk factors can help reduce complications and readmission rates. [Extracted from the article]

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 [ABSTRACT FROM AUTHOR]

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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.)

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.)