bvand086/sciwritingdataset · Datasets at Hugging Face

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average VHI-10 and VFI scores began to downtrend to27.5/C610.2 and 42.9 /C616.4 but did not achieve the range
of published minimally important clinical difference (MCID)f o re i t h e rq u e s t i o n n a i r e .
36,37However, by 1 month, the
change in the average VHI-10 and VFI scores re ﬂected a
signiﬁcant decrease compared to baseline, beyond the
MCID range of a four-to-six-point decrease in total score.With repeat monthly injections both the average VHI-10and
VFI scores continued to decrease signi ﬁcantly with sub-
sequent follow-up evaluations at the two and three-month
timepoints
Interestingly, at the four-month timepoint, both
the VHI-10 and VFI scores continued to decrease, but onlythe VHI-10 score was signi ﬁcantly lower than baseline
It is
i m p o r t a n tt on o t et h a to n l y ﬁve patients have reached this
point in the study
Therefore, it is perhaps too early to com-ment on the longevity of serial PRP injections in terms oftheir impact on these patient-reported outcomes.
Our preliminary work contains encouraging outcome
trends that may point to positive outcome longevityregarding voice quality in patients treated with serialPRP injections
Continued patient follow-up and enroll-ment will further elucidate the therapeutic role of PRP inlaryngology
Determining the safety of PRP treatment isa crucial step toward characterizing its use in patientcare with respect to outpatient laryngeal procedures.While this work builds on earlier efforts from our institu-tion outlining the technical feasibility and safety of PRPinjections, ongoing enrollment will continue to substanti-ate our early ﬁndings.
21While the contralateral vocal fold
served as a control, incorporating a volume-occupyingcontrol such as saline or platelet-poor plasma could bebeneﬁcial in de ﬁni
tively attributing vocal improvements
to the bioactive components in PRP.
The trial contains clear limitations
The subjective
nature of patient-reported voice outcomes limits the scopeof meaningful conclusions about the procedure ’s long-
term ef ﬁcacy
To that end, patient experiences need to be
correlated to objective anatomical changes and voiceparameters
By the current trial design, patients willbe followed-up for a minimum of 12 months after the con-cluding injection
Future work will assess objectiveoutcome measurement from video stroboscopic evaluationwhich will provide a functional clinical correlate to bolster
the results thus far
More work is also needed to deter-
mine the optimal timing of PRP treatment and thenumber of injections needed to provide optimal effect.
CONCLUSION
The absence of any reported safety events during the
application and follow-up period for 43 unilateral vocalfold injections using PRP indicates its safety for use inthe ambulatory care setting
The standardized approach
of PRP preparation and application to the vocal folds rep-resents a safe therapeutic approach for patients withvocal fold atrophy or scar
Subjective improvements invocal quality were accompanied by signi ﬁcant decreases
in VHI-10 and VFI questionnaire scores in patientsincluded in this trial
The overall trend of the patient-reported outcome measures indicates voice improvementsbeyond the limits of the MCID for these measures
Whilethese results persisted for most patients during the trial,a few did report a gradual decline in voice quality afterreceiving a PRP injection
Additional follow-up will deter-mine the true longevity and extent to which in-of ﬁce PRP
injections affect objective voice parameters
Ongoingenrollment in the clinical trial will continue to assess thesafety and therapeutic bene ﬁts of serial PRP injections.
BIBLIOGRAPHY
1
Welham NV, Choi SH, Dailey SH, Ford CN, Jiang JJ, Bless DM
Prospec-
tive multi-arm evaluation of surgical treatments for vocal fold scar andpathologic sulcus vocalis
Laryngoscope
2011;121(6):1252-1260.
2
Benninger MS, Alessi D, Archer S, et al
Vocal fold scarring: current con-
cepts and management
Otolaryngol Head Neck Surg
1996;115(5):
474-482.
3
Tang SS, Thibeault SL
Vocal fold injury and repair
In: Sataloff RT,
ed.Professional Voice: The Science and Art of Clinical Care
San Diego,
CA: Plural Publsihing; 2017:235-245.
4
Rapoport SK, Menier J, Grant N
Voice changes in the elderly
Otolaryngol
Clin N Am
2018;51(4):759-768.
5
Bradley J, Johns MM III
Chapter 49: the aging voice
Sataloff ’s Comprehen-
sive Textbook of Otolaryngology: Head & Neck Surgery: Head and NeckSurgery
New Delhi, India: Jaypee Brothers Medical Publishers; 2014.
6
Crawley BK, Dehom S, Thiel C, et al
Assessment of clinical and social char-
acteristics that distinguish Presbylaryngis from pathologic Presbyphoniain elderly individuals
JAMA Otolaryngol Head Neck Surg
2018;144(7):
566-571.
7
Carroll TL, Dezube A, Bauman LA, Mallur PS
Using trial vocal fold injec-
tion to select vocal fold scar patients who may bene ﬁt from more durable
augmentation
Ann Otol Rhinol Laryngol
2018;127(2):105-112.
8
Mallur PS, Rosen CA
Vocal fold injection: review of indications, techniques,
and materials for augmentation
Clin Exp Otorhinolaryngol
2010;3(4):
177-182.

average VHI-10 and VFI scores began to downtrend to27.5/C610.2 and 42.9 /C616.4 but did not achieve the range

of published minimally important clinical difference (MCID)f o re i t h e rq u e s t i o n n a i r e .

36,37However, by 1 month, the

change in the average VHI-10 and VFI scores re ﬂected a

signiﬁcant decrease compared to baseline, beyond the

MCID range of a four-to-six-point decrease in total score.With repeat monthly injections both the average VHI-10and

VFI scores continued to decrease signi ﬁcantly with sub-

sequent follow-up evaluations at the two and three-month

timepoints

Interestingly, at the four-month timepoint, both

the VHI-10 and VFI scores continued to decrease, but onlythe VHI-10 score was signi ﬁcantly lower than baseline

It is

i m p o r t a n tt on o t et h a to n l y ﬁve patients have reached this

point in the study

Therefore, it is perhaps too early to com-ment on the longevity of serial PRP injections in terms oftheir impact on these patient-reported outcomes.

Our preliminary work contains encouraging outcome

trends that may point to positive outcome longevityregarding voice quality in patients treated with serialPRP injections

Continued patient follow-up and enroll-ment will further elucidate the therapeutic role of PRP inlaryngology

Determining the safety of PRP treatment isa crucial step toward characterizing its use in patientcare with respect to outpatient laryngeal procedures.While this work builds on earlier efforts from our institu-tion outlining the technical feasibility and safety of PRPinjections, ongoing enrollment will continue to substanti-ate our early ﬁndings.

21While the contralateral vocal fold

served as a control, incorporating a volume-occupyingcontrol such as saline or platelet-poor plasma could bebeneﬁcial in de ﬁni

tively attributing vocal improvements

to the bioactive components in PRP.

The trial contains clear limitations

The subjective

nature of patient-reported voice outcomes limits the scopeof meaningful conclusions about the procedure ’s long-

term ef ﬁcacy

To that end, patient experiences need to be

correlated to objective anatomical changes and voiceparameters

By the current trial design, patients willbe followed-up for a minimum of 12 months after the con-cluding injection

Future work will assess objectiveoutcome measurement from video stroboscopic evaluationwhich will provide a functional clinical correlate to bolster

the results thus far

More work is also needed to deter-

mine the optimal timing of PRP treatment and thenumber of injections needed to provide optimal effect.

CONCLUSION

The absence of any reported safety events during the

application and follow-up period for 43 unilateral vocalfold injections using PRP indicates its safety for use inthe ambulatory care setting

The standardized approach

of PRP preparation and application to the vocal folds rep-resents a safe therapeutic approach for patients withvocal fold atrophy or scar

Subjective improvements invocal quality were accompanied by signi ﬁcant decreases

in VHI-10 and VFI questionnaire scores in patientsincluded in this trial

The overall trend of the patient-reported outcome measures indicates voice improvementsbeyond the limits of the MCID for these measures

Whilethese results persisted for most patients during the trial,a few did report a gradual decline in voice quality afterreceiving a PRP injection

Additional follow-up will deter-mine the true longevity and extent to which in-of ﬁce PRP

injections affect objective voice parameters

Ongoingenrollment in the clinical trial will continue to assess thesafety and therapeutic bene ﬁts of serial PRP injections.

BIBLIOGRAPHY

1

Welham NV, Choi SH, Dailey SH, Ford CN, Jiang JJ, Bless DM

Prospec-

tive multi-arm evaluation of surgical treatments for vocal fold scar andpathologic sulcus vocalis

Laryngoscope

2011;121(6):1252-1260.

2

Benninger MS, Alessi D, Archer S, et al

Vocal fold scarring: current con-

cepts and management

Otolaryngol Head Neck Surg

1996;115(5):

474-482.

3

Tang SS, Thibeault SL

Vocal fold injury and repair

In: Sataloff RT,

ed.Professional Voice: The Science and Art of Clinical Care

San Diego,

CA: Plural Publsihing; 2017:235-245.

4

Rapoport SK, Menier J, Grant N

Voice changes in the elderly

Otolaryngol

Clin N Am

2018;51(4):759-768.

5

Bradley J, Johns MM III

Chapter 49: the aging voice

Sataloff ’s Comprehen-

sive Textbook of Otolaryngology: Head & Neck Surgery: Head and NeckSurgery

New Delhi, India: Jaypee Brothers Medical Publishers; 2014.

6

Crawley BK, Dehom S, Thiel C, et al

Assessment of clinical and social char-

acteristics that distinguish Presbylaryngis from pathologic Presbyphoniain elderly individuals

JAMA Otolaryngol Head Neck Surg

2018;144(7):

566-571.

7

Carroll TL, Dezube A, Bauman LA, Mallur PS

Using trial vocal fold injec-

tion to select vocal fold scar patients who may bene ﬁt from more durable

augmentation

Ann Otol Rhinol Laryngol

2018;127(2):105-112.

8

Mallur PS, Rosen CA

Vocal fold injection: review of indications, techniques,

and materials for augmentation

Clin Exp Otorhinolaryngol

2010;3(4):

177-182.