Surgical and Nonsurgical Lines of Treatment of Reinke's Edema: A Systematic Literature Review.

OBJECTIVES: The aim of this study was to carry out a systematic review of different surgical and nonsurgical lines of treatment of Reinke's edema to identify the effectiveness and the guidelines described to use each of them. METHODS: We searched PubMed and Coherence for randomized controlled trials and case reports studies did on adult humans aged from 18 to 80 years, from January 1997 to December 2018. We included studies that treated patients with Reinke's edema by one and/or combinations of the following interventions: cold steel microlaryngeal phonosurgery, microdebrider, CO2 laser, photoangiolytic laser, voice therapy, Steroid and Hyaluronidase injection. We selected studies that assessed patients pre- and post-treatment by at least one of the following measures: subjective assessment of the patient's voice by the voice handicap index, perceptual analysis of the voice by GRBAS scale, video laryngeoscopic examination of the VFs and the lesion, aerodynamic measures, and acoustic analysis of the voice by the computerized speech lab. We assessed quality of the included studies with the Cochrane risk of bias assessment Tool. RESULTS: After removal of duplicates, research yielded 262 studies. Of 217 abstracts and titles, 36 full-text articles were read, and one study was added through hand search, resulting in 10 included studies. CONCLUSIONS: Most of literature analyzed were deficient to address the effectiveness of any of the six lines included in this study. This is mainly due to the small number of the included articles and the small sample size in most of these studies. We found only 10 articles that reported the effectiveness based on comparing the results of before and after treatment. In addition, the variability of outcome measures used and the lack of the comprehensive assessment of the patient's voice, vocal image in most of the included studies made it hard to us to compare the results of any of the included studies. More researches with larger sample size and accurate randomization are needed for further accurate assessment of the effectiveness of the surgical and nonsurgical lines of treatment of Reinke's edema. The future researches should take in their consideration the use of an agreed comprehensive assessment protocol for assessing and comparing the outcome measures before and after treatment.

'Exploring stuttering severity in the Egyptian Arabic speaking children who stutter: A correlation study of Bloodstein classification of stuttering severity and the stuttering severity instrument for children and Adults-Arabic Version'.

OBJECTIVE: The aim of this study was to explore the magnitude of stuttering severity in the Egyptian Arabic speaking children who stutter (CWS) by corelating stuttering severity grades assessed by Bloodstein classification of stuttering severity (BLS) and by the stuttering severity instrument for children and adults-Arabic version (ASSI). METHODS: 58 Egyptian Arabic speaking CWS aged 5-9 years and 9 months, were selected conveniently upon inclusion and exclusion criteria from patients frequented at the Phoniatrics clinic of El-Demerdash hospital (Ain Shams University). Through an observational cross-sectional study, the selected children underwent the Ain Shams university assessment protocol of fluency disorders, including clinician's assessment of stuttering severity by BLS classification and ASSI. The correlation between the grade of stuttering severity by BLS classification and ASSI were analyzed by Spearman's correlation coefficient and regression analysis. RESULTS: Significant positive correlation was found between grades of stuttering severity measured by BLS classification and ASSI. Among children with mild, moderate and severe degrees of stuttering by BLS classification, the score of their ASSI decrease as the child's age increases. The age of the participated CWS was significantly inversely related to the score of ASSI, yet it is not related to the grades of BLS classification. The age of onset of stuttering was not related to stuttering severity whether measured by BLS classification or ASSI. CONCLUSION: There is a significant positive relationship between stuttering severity measured by BLS classification and ASSI. Speech disfluencies counted by ASSI decreases as the child's age increases, in relation to stuttering severity by BLS classification. Clinicians should depend on more than one tool while assessing stuttering severity.