Comparison of therapeutic effects of steroid injection by benign vocal fold lesion type

Takahashi, Satoka; Kanazawa, Takemichi; Hasegawa, Tomohiro; Hirosaki, Mayu; Komazawa, Daigo; Konomi, Ujimoto; Nimura, Yoshitsugu; Sakaguchi, Yu; Nozawa, Miki; Yamauchi, Tomohiko; Watanabe, Yûsuke

doi:10.1080/00016489.2021.1995895

Cited by 14 publications

(31 citation statements)

References 22 publications

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“…At our department, intracordal steroid injection has been used for treating vocal fold scarring refractory to voice therapy. 13 In recent times, the number of patients receiving bFGF injection have been increasing. Both injections have positive effects on vocal fold scarring, but the treatment administered was subjectively chosen according to the judgment of the treating physician and the wishes of the patient, and there were no precise indication criteria.…”

Section: Discussionmentioning

confidence: 99%

“…The therapeutic effects of intracordal steroid injection for benign vocal fold lesions have been reported in many studies, including systematic reviews. 13 , 28 , 29 , 30 However, most studies include patients with various lesions, and few focus only on vocal fold scarring. Vocal fold scarring is expected to be more refractory to this regimen than other benign vocal fold lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Vocal fold scarring is expected to be more refractory to this regimen than other benign vocal fold lesions. 13 …”

Section: Discussionmentioning

confidence: 99%

“…The doses of triamcinolone acetonide or bFGF were determined according to the manufacturer's instructions and previous studies. 13 , 18 To detect possible allergic reactions, the vocal folds were checked using a fiberscope 1 h after injection. Participants were instructed to rest their voices on the day of the injection but were allowed to use their voices from the following day onwards according to our previously reported injection protocol.…”

Section: Methodsmentioning

confidence: 99%

“…Steroid injection is widely used to treat benign vocal fold lesions, including vocal fold scarring. 10 , 11 , 12 , 13 Steroid injection alters cytokine secretion, which could decrease fibrosis, thereby improving the vibratory ability of the vocal folds. 11 , 14 Steroid injection immediately following trauma reportedly causes decreased collagen deposition, leading to decreased fibrosis.…”

Section: Introductionmentioning

confidence: 99%

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Intracordal injection therapy for vocal fold scarring: Steroid versus basic fibroblast growth factor

Nozawa

Takahashi

Kanazawa

et al. 2022

Laryngoscope Investig Oto

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Objectives Vocal fold scarring is caused by replacement of vocal fold mucosa with fibrous tissue due to repeated inflammation or trauma. It can lead to severe dysphonia. It is currently treated conservatively and with phonosurgery and intracordal injections. Intracordal injection of steroid or basic fibroblast growth factor (bFGF) has been recently found to be useful for treating vocal fold scarring that does not respond to voice therapy. Methods This retrospective study involved the administration of steroid injection and bFGF injection bilaterally under local anesthesia in 16 patients each. Laboratory measurements of voice parameters were performed before and 3–6 months after injection. Results In the steroid injection group, the Voice Handicap Index (VHI) score significantly improved from 57.1 to 40.5, total Grade, Roughness, Breathiness, Asthenia, Strain (tGRBAS) score significantly improved from 4.2 to 2.6, and mean speech fundamental frequency (SFF) increased from 192.5 to 211.4 dB, but there was no improvement in maximum phonation time (MPT) and mean airflow rate (MFR). In the bFGF injection group, significant improvements in the VHI score (from 53.3 to 35.7), MPT (from 16.9 to 21.8 s) and MFR (from 314.6 to 210.5 ml/s) were seen; however, the tGRBAS score did not improve. In addition, the SFF significantly decreased from 178.1 to 160.5 Hz. Conclusion These results suggest that both steroid and bFGF injections are effective for treating vocal fold scarring, with steroids improving voice quality and bFGF improving glottic closure, thereby contributing to improvements in VHI scores. Level of Evidence 4.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Vocal fold scarring is expected to be more refractory to this regimen than other benign vocal fold lesions. 13 …”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Intracordal injection therapy for vocal fold scarring: Steroid versus basic fibroblast growth factor

Nozawa

Takahashi

Kanazawa

et al. 2022

Laryngoscope Investig Oto

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Glucocorticoid Dose Dependency on Gene Expression in Vocal Fold Fibroblasts and Macrophages

et al. 2022

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Objective Glucocorticoids (GCs) modulate multiple cellular activities including inflammatory and fibrotic responses. Outcomes of GC treatment for laryngeal disease vary, affording opportunity to optimize treatment. In the current study, three clinically employed GCs were evaluated to identify optimal in vitro concentrations at which GCs mediate favorable anti‐inflammatory and fibrotic effects in multiple cell types. We hypothesize a therapeutic window will emerge as a foundation for optimized therapeutic strategies for patients with laryngeal disease. Study Design In vitro. Methods Human vocal fold fibroblasts and human macrophages derived from THP‐1 monocytes were treated with 0.03–1000 nM dexamethasone, 0.3–10,000 nM methylprednisolone, and 0.3–10,000 nM triamcinolone in combination with interferon‐γ, tumor necrosis factor‐α, or interleukin‐4. Real‐time polymerase chain reaction was performed to analyze inflammatory (CXCL10, CXCl11, PTGS2, TNF, IL1B) and fibrotic (CCN2, LOX, TGM2) genes, and TSC22D3, a target gene of GC signaling. EC50 and IC50 to alter inflammatory and fibrotic gene expression was calculated. Results Interferon‐γ and tumor necrosis factor‐α increased inflammatory gene expression in both cell types; this response was reduced by GCs. Interleukin‐4 increased LOX and TGM2 expression in macrophages; this response was also reduced by GCs. GCs induced TSC22D3 and CCN2 expression independent of cytokine treatment. EC50 for each GC to upregulate CCN2 was higher than the IC50 to downregulate other genes. Conclusion Lower concentrations of GCs repressed inflammatory gene expression and only moderately induced genes involved in fibrosis. These data warrant consideration as a foundation for optimized clinical care paradigms to reduce inflammation and mitigate fibrosis. Level of Evidence NA Laryngoscope, 133:1169–1175, 2023

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Dose‐Dependent Glucocorticoid Regulation of Transcription Factors in Vocal Fold Fibroblasts and Macrophages

et al. 2023

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ObjectiveVariable outcomes of glucocorticoid (GC) therapy for laryngeal disease are putatively due to diverse interactions of the GC receptor (GR) with cell signaling pathways, limited consideration regarding concentration‐dependent effects, and inconsistent selection of GCs. In the current study, we evaluated the concentration‐dependent effects of three frequently administered GCs on transcription factors with an emphasis on the phosphorylation of GR at Ser203 and Ser211 regulating the nuclear translocation of GR. This study provides foundational data regarding the diverse functions of GCs to optimize therapeutic approaches.Study designIn vitro.MethodsHuman vocal fold fibroblasts and THP1‐derived macrophages were treated with different concentrations of dexamethasone, methylprednisolone, and triamcinolone in combination with IFN‐γ, TNF‐α, or IL4. Phosphorylated STAT1, NF‐κB family molecules, and phosphorylated STAT6 were analyzed by Western blotting. Ser211‐phosphorylated GR (S211‐pGR) levels relative to GAPDH and Ser203‐phosphorylated GR (S203‐pGR) were also analyzed.ResultsGCs differentially altered phosphorylated STAT1 and NF‐κB family molecules in different cell types under IFN‐γ and TNF‐α stimuli. GCs did not alter phosphorylated STAT6 in IL4‐treated macrophages. The three GCs were nearly equivalent. A lower concentration of dexamethasone increased S211‐pGR/GAPDH ratios relative to increased S211‐pGR/S203‐pGR ratios regardless of cell type and treatment.ConclusionThe three GCs employed in two cell lines had nearly equivalent effects on transcription factor regulation. Relatively high levels of Ser203‐phosphorylation at low GC concentrations may be related to concentration‐dependent differential effects of GCs in the two cell lines.Level of EvidenceNA Laryngoscope, 133:2704–2711, 2023

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Comparison of therapeutic effects of steroid injection by benign vocal fold lesion type

Cited by 14 publications

References 22 publications

Intracordal injection therapy for vocal fold scarring: Steroid versus basic fibroblast growth factor

Intracordal injection therapy for vocal fold scarring: Steroid versus basic fibroblast growth factor

Glucocorticoid Dose Dependency on Gene Expression in Vocal Fold Fibroblasts and Macrophages

Dose‐Dependent Glucocorticoid Regulation of Transcription Factors in Vocal Fold Fibroblasts and Macrophages

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