Local Steroid Injection via the Cricothyroid Membrane in Patients With a Vocal Nodule
Local Steroid Injection via the Cricothyroid Membrane in Patients With a Vocal Nodule
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DOI：
10.1001/archoto.2011.168
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发表时间：
2011-10-01
影响因子：
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通讯作者：
Jin, Sung-Min
中科院分区：
文献类型：
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作者：
Lee, Sang-Hyuk;Yeo, Jang-Ok;Jin, Sung-Min
目的：分析经环甲膜声带小结内注射类固醇的有效性和安全性。类固醇直接进入喉局部给药已被报道在许多喉diseases with different methods.Design：前瞻性病例系列在学术三级护理hospital.Patients：80例声带小结患者在2008年12月和2010年5月之间入组。干预措施：曲安奈德注射通过环甲膜与经鼻可弯曲喉镜患者在坐位。主要结果测量：声带小结前和注射后2周和4周进行了评估;客观和主观评估的改善。结果：注射后第四周，35例患者（44%）的结节消失，39例患者（49%）出现改善。注射类固醇后，抖动、微光、最大发声时间和平均声音障碍指数也显著改善（P <0.05）。6名与声音相关的职业患者在第二周（8%）表现出改善，但结节在4周后复发。4例患者出现轻度声带萎缩，2例患者表现出白色斑块形成的声带自发解决1至2个月后injecting.Conclusions：局部类固醇注射通过环甲膜是一个有用的和安全的治疗选择声带小结。然而，声带小结主要是由过度的声音使用引起的;因此，除非声音使用模式改变，否则小结可以复发。需要对这种治疗技术进行进一步研究，包括长期随访。
Objective: To analyze the usefulness and safety of a steroid injection into vocal nodules via the cricothyroid membrane. Local administration of steroid directly into the larynx has been reported in many laryngeal diseases with different methods.Design: Prospective case series at an academic tertiary care hospital.Patients: Eighty patients with vocal nodules were enrolled between December 2008 and May 2010. Interventions: Triamcinolone acetonide was injected through the cricothyroid membrane with a transnasal flexible laryngoscope to patients in a sitting position.Main Outcome Measures: Vocal nodules were evaluated before and 2 and 4 weeks after the injection; improvement was assessed both objectively and subjectively.Results: The nodules disappeared in 35 patients by the fourth week after the injection (44%), and 39 patients showed improvement (49%). Jitter, shimmer, maximum phonation time, and mean voice handicap index also improved significantly after the steroid injection (P < .05 for all). Six patients with voice-related occupations showed improvement at the second week (8%), but the nodules had recurred after 4 weeks. Four patients experienced mild vocal fold atrophy, and 2 patients showed a white plaque formation on the vocal fold that resolved spontaneously 1 to 2 months after the injection.Conclusions: A local steroid injection via the cricothyroid membrane is a useful and safe treatment option for vocal nodules. However, vocal nodules are caused mainly by excessive voice use; therefore, nodules can recur unless the voice use pattern changes. Further study of this treatment technique, including long-term follow-up, is needed.