<scp>In‐Office</scp> Superior Laryngeal Nerve Block for Paralaryngeal Pain and Odynophonia

Tibbetts, Kathleen M.; Dion, Gregory R.; Dominguez, Laura M.; Loochtan, Michael J.; Simpson, C. Blake

doi:10.1002/lary.29780

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…Several studies have utilized flexible laryngoscopy and videostroboscopy for the diagnosis and management of iVPG, including Devaney et al among many others 3,7,9,11,15–18 . This is consistent with diagnostic tests performed by respondents from our survey, as the most common modalities of diagnostic workup were videostroboscopy (88%) and flexible laryngoscopy (54%), as respondents reported that VPG is diagnosed clinically through visualization.…”

Section: Discussionsupporting

confidence: 86%

Management of Idiopathic Vocal Process Granuloma: A Survey of Academic Laryngologists

Boyce,

Schmidt,

Gilbert

2023

The Laryngoscope

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ObjectivesVocal process granulomas (VPGs) are benign laryngeal lesions that may manifest as ulcerated regions of the vocal fold or nodular polypoid lesions. Gold standard treatments for idiopathic VPG are yet to be established at this time. This study evaluated clinical decision‐making and outcomes in the treatment of VPG patients based on experiences of academic laryngologists across the United States.MethodsA 21‐question survey was developed to evaluate each respondent's specific VPG patient population, clinical decision‐making in treating VPG, and corresponding treatment outcomes. The survey was distributed to 168 laryngologists at academic institutions across the United States. Data were analyzed through the Qualtrics platform.ResultsA total of 106 responses were analyzed, with a completion rate of 63.1%. Etiology of VPG was most commonly attributed to phonotrauma (96.2%) and reflux (71.8%). Primary first‐line treatment was most commonly antireflux medications (92%). Other common first line treatments included voice therapy (58.8%) and inhaled steroids (42.5%). With these treatments, the majority of laryngologists report that recurrence is uncommon (68.4%). Dysphonia was cited as the most frequent long‐term sequelae at 27.8%.ConclusionsVPG treatment strategies continue to be controversial across the United States with many treatments described in the literature with variable application in the practice of academic laryngologists today. Based on survey results, antireflux medications and voice therapy may be the most widely used and most effective treatment options. Establishment of gold standard therapy for VPG as well as further research into recurrent or persistent VPG despite antireflux and voice therapy should be explored.Level of Evidence5 Laryngoscope, 2023

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Section: Discussionsupporting

confidence: 86%

Management of Idiopathic Vocal Process Granuloma: A Survey of Academic Laryngologists

Boyce,

Schmidt,

Gilbert

2023

The Laryngoscope

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“…The recent publication by Tibbets et al supports use of the SLN block for paralaryngeal pain with 82% of patients reporting improvement. 14 This was higher than that observed in our study, with 59% reporting improvement. This can likely be attributed to the number of injections performed.…”

Section: Discussioncontrasting

confidence: 76%

“…As a first step, we recently demonstrated an improvement in paralaryngeal pain in 23 of 28 patients undergoing an average of 2.5 injections. 14 The objective of this multi-institutional study is to add to the body of literature on SLN block outcomes for treating neurogenic cough and to evaluate the effect of the SLN block on other ILS symptoms, including dysphonia related to laryngeal hypersensitivity, paralaryngeal pain, ILO, and isolated globus pharyngeus. We hypothesized that SLN block would provide symptomatic benefit across several ILS symptoms at short-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Indications and Short-Term Outcomes for In-Office Therapeutic Superior Laryngeal Nerve Block

Gray,

Hoffman,

Yang

et al. 2023

Ann Otol Rhinol Laryngol

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Objective: Superior laryngeal nerve (SLN) block consists of injection of steroid and anesthetic at the internal branch of the SLN entry site. Prior case series have demonstrated beneficial effects on neurogenic cough. SLN blocks have also recently shown benefit for paralaryngeal pain. We describe short-term outcomes for multiple symptoms of irritable larynx syndrome (ILS) including neurogenic cough, dysphonia related to laryngeal hypersensitivity, inducible laryngeal obstruction (ILO), paralaryngeal pain, and isolated globus. Methods: Retrospective review from 2 institutions of patients undergoing a single SLN block for the indications listed. Variables include age, sex, indication(s), known vagus neuropathy, and patient-reported outcomes at short-term follow-up. Results: A total of 209 patients were included (59 males, 150 females; age: 58 ± 13 years). Twenty-six patients (12%) had a history of a vagus nerve injury. Indications included neurogenic cough (n = 149), dysphonia related to laryngeal hypersensitivity (n = 66), paralaryngeal pain (n = 50), ILO (n = 23), and isolated globus (n = 3). Some patients had multiple indications. Significant improvements in patient-reported measures occurred after a single SLN block within 2 to 4 weeks for neurogenic cough (cough severity index; 25.2 ± 11.2 to 19.0 ± 12.8; P < .001), dysphonia (voice handicap index-10; 22.1 ± 12.2-18.0 ± 13.3; P = .005), and ILO (dyspnea index; 21.0 ± 14.9-14.7 ± 15.7; P = .017). Subjective pain improved in 23 of 39 patients with paralaryngeal pain. There was no observed improvement for isolated globus. Presence of known vagal neuropathy or therapy around the time of SLN block did not affect outcome. Conclusion: SLN block can be an effective component of treatment for a variety of ILS symptoms. Patients may experience some improvement after 1 injection. Lay Summary: Symptoms of irritable larynx syndrome, such as neurogenic cough, paralaryngeal pain, inducible laryngeal obstruction, and dysphonia related to laryngeal hypersensitivity can be challenging to manage. In-office Superior Laryngeal Nerve blocks can serve as a quick, well tolerated, adjunctive treatment with positive short-term outcomes. Level of evidence: 4

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“…Ultrasound guided superior laryngeal nerve block with clear location and less local soft tissue damage will not cause tracheal wall bleeding and hematoma formation, and the use of local anesthetics is limited. It can be performed with sufficient sedation and analgesia, making patients feel better [ 30 , 31 ]. In the current research reports, superior laryngeal nerve block is mainly used in the treatment of difficult airway, and the treatment of postoperative sore throat and neurogenic cough [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided medial branch of the superior laryngeal nerve block to reduce peri-operative opioids dosage and accelerate patient recovery

Kang,

Wu,

Liu

et al. 2023

PLoS ONE

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Background To explore whether the medial branch block of superior laryngeal nerve can reduce the stress response of patients undergoing intubation and further reduce the dosage of opioids. Methods 80 patients undergoing gynecological laparoscopic surgery were selected, and randomly divided into 4 groups. All patients in the experimental groups received bilateral internal branch of superior laryngeal nerve block and transversus abdominis plane block. But the dosage of sufentanil used for anesthesia induction in the group A, B, and C was 0.4, 0.2, and 0μg/kg, respectively. Group D do not underwent supralaryngeal nerve block and the dosage of sufentanil was 0.4μg/kg. The heart rate (HR) and mean arterial pressure(MAP) were recorded at the time of entering the operating room(T1), before intubation after induction(T2), immediately after intubation(T3), 5min after intubation(T4), before extubation(T5), immediately after extubation(T6), 5min after extubation(T7). We also recorded the stay time in the recovery room, the number of cases of postoperative sore throat, the number of cases of nausea and vomiting, the first intestinal exhaust time, the length of hospital stay after operation. Results The HR of group A, C and D at T3 was significantly higher than that at T2(P < 0.01), while the HR of group B had no significant change. The HR of group A, C and D at T4 was lower than that at T3(P < 0.01), while the HR of group B had no obvious change. The HR of group C and D at T3 was significantly higher than that at T1 (P < 0.01). The MAP of group A and D at T4 was significantly lower than that at T1 (P<0.001). The first postoperative intestinal exhaust time in group A, B and C was significantly shorter than that in group D. The length of hospital stay after operation in group B and C was shorter than that in group D. Conclusions Ultrasound-guided superior laryngeal nerve block combined with 0.2μg/kg sufentanil can reduce the intubation reaction, have better hemodynamic stability, reduce the first postoperative intestinal exhaust time and postoperative hospital stay, thereby accelerating the postoperative recovery of patients.

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In‐Office Superior Laryngeal Nerve Block for Paralaryngeal Pain and Odynophonia

Cited by 9 publications

References 20 publications

Management of Idiopathic Vocal Process Granuloma: A Survey of Academic Laryngologists

Management of Idiopathic Vocal Process Granuloma: A Survey of Academic Laryngologists

Indications and Short-Term Outcomes for In-Office Therapeutic Superior Laryngeal Nerve Block

Ultrasound-guided medial branch of the superior laryngeal nerve block to reduce peri-operative opioids dosage and accelerate patient recovery

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