Interarytenoid botulinum toxin injection for recalcitrant vocal process granuloma

Fink, Daniel; Achkar, Jihad; Franco, Ramon A.; Song, Phil Hyun

doi:10.1002/lary.23915

Cited by 31 publications

(29 citation statements)

References 19 publications

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“…Various treatments for vocal fold granulomas include gastric acid suppression, speech therapy, intralesional or inhaled steroid therapy, botulinum toxin injections, or some combination of the aforementioned. [3][4][5][6] Recent use of the in-office potassium titanyl phosphate (KTP) laser has also been described. 7 Surgical excision is typically reserved for patients who fail medical therapy, present with large symptomatic granulomas, or have acute airway obstruction.…”

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confidence: 99%

Ideal Particle Sizes for Inhaled Steroids Targeting Vocal Granulomas: Preliminary Study Using Computational Fluid Dynamics

Perkins

Basu

Garcia

et al. 2017

Otolaryngol.--head neck surg.

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Objectives Vocal fold granulomas are benign lesions of the larynx commonly caused by gastroesophageal reflux, intubation, and phonotrauma. Current medical therapy includes inhaled corticosteroids to target inflammation that leads to granuloma formation. Particle sizes of commonly prescribed inhalers range over 1 to 4 µm. The study objective was to use computational fluid dynamics to investigate deposition patterns over a range of particle sizes of inhaled corticosteroids targeting the larynx and vocal fold granulomas. Study Design Retrospective, case-specific computational study. Setting Tertiary academic center. Subjects/Methods A 3-dimensional anatomically realistic computational model of a normal adult airway from mouth to trachea was constructed from 3 computed tomography scans. Virtual granulomas of varying sizes and positions along the vocal fold were incorporated into the base model. Assuming steady-state, inspiratory, turbulent airflow at 30 L/min, computational fluid dynamics was used to simulate respiratory transport and deposition of inhaled corticosteroid particles ranging over 1 to 20 µm. Results Laryngeal deposition in the base model peaked for particle sizes 8 to 10 µm (2.8%-3.5%). Ideal sizes ranged over 6 to 10, 7 to 13, and 7 to 14 µm for small, medium, and large granuloma sizes, respectively. Glottic deposition was maximal at 10.8% for 9-µm-sized particles for the large posterior granuloma, 3 times the normal model (3.5%). Conclusion As the virtual granuloma size increased and the location became more posterior, glottic deposition and ideal particle size generally increased. This preliminary study suggests that inhalers with larger particle sizes, such as fluticasone propionate dry-powder inhaler, may improve laryngeal drug deposition. Most commercially available inhalers have smaller particles than suggested here.

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confidence: 99%

Ideal Particle Sizes for Inhaled Steroids Targeting Vocal Granulomas: Preliminary Study Using Computational Fluid Dynamics

Perkins

Basu

Garcia

et al. 2017

Otolaryngol.--head neck surg.

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“…2 Another well-documented use of botulinum toxin for laryngeal disease is in the treatment of refractory or recurrent vocal fold granuloma. 3 The use of botulinum toxin injection to treat airway symptoms in bilateral vocal fold paralysis has been sparsely documented in the clinical literature. 4 One case report by Filho and Rosen 5 describes a patient with bilateral vocal fold paralysis who responded to injection of 10 units of Botox unilaterally into the left thyroarytenoid/lateral cricoarytenoid muscle complex.…”

Section: Discussionmentioning

confidence: 99%

Cricothyroid Muscle Botulinum Toxin Injection to Improve Airway for Bilateral Recurrent Laryngeal Nerve Paralysis, A Case Series

2016

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“…Etiopathogenesis of LG is still undetermined and it is attributed to three predisposing factors: laryngopharyngeal reflux disease, laryngeal intubation and vocal abuse. If none of these causes are found, it is considered idiopathic (8). It is predominant in male subjects, except in cases associated with laryngeal intubation, which has higher incidence in female cases (7,5).…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Female Patient with Laryngeal Granuloma

Simovic

Vulović

Stojanovic

et al. 2017

Serbian Journal of Experimental and Clinical Research

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Interarytenoid botulinum toxin injection for recalcitrant vocal process granuloma

Abstract: Botulinum toxin injection into the interarytenoid muscle appears to be a safe and effective modality for treating recalcitrant vocal process granuloma.

Cited by 31 publications

References 19 publications

Ideal Particle Sizes for Inhaled Steroids Targeting Vocal Granulomas: Preliminary Study Using Computational Fluid Dynamics

Ideal Particle Sizes for Inhaled Steroids Targeting Vocal Granulomas: Preliminary Study Using Computational Fluid Dynamics

Cricothyroid Muscle Botulinum Toxin Injection to Improve Airway for Bilateral Recurrent Laryngeal Nerve Paralysis, A Case Series

A Case Report of Female Patient with Laryngeal Granuloma

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