Office-based blue laser therapy for inferior turbinate hypertrophy: a pilot study.

PURPOSE: To investigate the subjective effect of office-based blue laser therapy for inferior turbinate hypertrophy in patients with nasal obstruction. METHODS: Patients with nasal obstruction who underwent office-based blue laser for the inferior turbinate hypertrophy between October 2022 and December 2023 were included in the study. The two outcome measures used to gauge the improvement in nasal obstruction and success of surgery were the Nasal Obstruction Symptom Evaluation (NOSE) scale and the Visual Analogue Scale (VAS). Patient's level of comfort during the procedure was also rated using a 10-point VAS scale. RESULTS: A total of 14 patients were included in this study. The mean age of the study group was 41.47 ± 18.52 and the F/M ratio was 4.67. All patients reported significant improvement in nasal breathing. The mean NOSE score decreased significantly from 13.07 ± 3.89 pre-operatively to 2.64 ± 2.43 post-operatively (p = 0.002). Similarly, the mean VAS score decreased from 7.43 ± 0.85 to 2.0 ± 1.57 (p = 0.002) following surgery. The procedure was well-tolerated by all participants and the mean total score ranged from 6 to 9 with an average of 7.59 ± 1.34. CONCLUSION: Office-based blue laser therapy for inferior turbinate hypertrophy may be an effective treatment modality for nasal obstruction from the patient's perspective. Although the procedures were tolerated well with no complications noted, these results should be cautiously interpreted until studies using objective measures are conducted.

Risk of Fibromyalgia in Patients with Primary Muscle Tension Dysphonia: A Prospective Pilot Study.

OBJECTIVE: To investigate the risk of fibromyalgia in patients with primary muscle tension dysphonia (MTD) in comparison to subjects with no dysphonia. STUDY DESIGN: Prospective cohort study. METHODS: The medical records and video recordings of all patients presenting to the Voice and Swallowing unit at a tertiary referral center between October 2022 and October 2023 and who were diagnosed with primary MTD were prospectively reviewed. The risk of fibromyalgia was assessed using the "Fibromyalgia Rapid Screening Tool" (FiRST). Demographic data included age, gender, history of smoking, and history of high vocal load. The impact of dysphonia on quality of life was also analyzed using the Voice Handicap Index-10 (VHI-10). RESULTS: A total of 42 patients who had filled the FiRST questionnaire were enrolled in this study. These included 20 patients diagnosed with primary MTD and 22 healthy subjects with no history of dysphonia and normal laryngeal examination. Forty percent of the study group tested positive using the FiRST questionnaire as compared to only 9.1% in the control group. The difference between the two groups was statistically significant (P = 0.03). The risk of having fibromyalgia was 6.67 times among patients with primary MTD in comparison to controls (RR=6.67; 95% CI [1.21-36.74]). CONCLUSION: The results of this investigation indicate that the risk of fibromyalgia is significantly higher in patients with primary MTD vs controls. A holistic approach in the diagnosis and treatment of MTD is advocated.

Arytenoid Cartilage Collapse During Inhalation in Awake Patients with Intermediate/High Risk of Obstructive Sleep Apnea: A Retrospective Analysis of Sixty-Four Patients.

OBJECTIVE: To assess the prevalence of arytenoid cartilage collapse (ACC) during deep inhalation in awake patients with intermediate/high risk of obstructive sleep apnea (OSA). STUDY DESIGN: Retrospective case-control study. METHODS: The medical records and video recordings of awake flexible endoscopic examination of patients with history of OSA who presented to the sleep apnea clinic in a tertiary referral medical center between June 2022 and December 2022, were reviewed. All patients had filled the STOP-BANG questionnaire and had intermediate/high risk of having OSA. A group of patients matched by age and gender and with no history of OSA were used as controls. RESULTS: A total of 95 patients, 64 with a history of OSA and 31 with no history of OSA, were included. Among the study group, 37.5% (n = 24) had a STOP-BANG score between 3 and 4 and were considered to be at an intermediate risk of OSA while the remaining had a score more than 5 and were considered to be at high risk of OSA. There was a significant difference in the prevalence of ACC between the study group and controls (32.8% vs 12.9%, respectively, P < 0.001). CONCLUSION: The prevalence of ACC was significantly higher in patients with intermediate/high risk of OSA in comparison to healthy controls with no history of OSA. When present, ACC should raise the physician's suspicion for OSA and probably prompt further investigation such as a sleep study.

Prevalence of Self-Reported Dysphonia and Dysphagia in Patients with Allergy.

OBJECTIVE: To investigate the prevalence of self-reported dysphonia and dysphagia in patients with positive allergy test in comparison to patients with negative allergy tests. SUBJECTS AND METHODS: A total of 52 patients who presented to the allergy clinic of a tertiary medical referral center for skin testing between June 2019 and December 2019 were were recruited for this study. Demographic data included age, gender, history of smoking, family history for eczema, atopy, asthma, food and drug allergy. A control group of 20 subjects was matched according to age and gender. All subjects were asked to fill the voice handicap index -10 and the eating assessment tool (EAT-10) questionnaires. RESULTS: Thirty-six of 52 patients were positive for at least one allergen, and 23 tested positive for at least three allergens. On the other hand, there was no significant difference in the mean score of VHI-10 in patients with allergy to at least one allergen, in comparison to patients with no allergy (3.667 vs 3.066, respectively, P value 0.307). Similarly, there was no significant difference in the mean score of EAT-10 between the two groups (0.305 vs 0.00, respectively, P value 0.270). There was also no significant difference in the mean score of VHI-10 in patients with allergy to at least three allergens in comparison to patients with no allergy (3.304 vs 3.066, respectively, P-value 0.603). Similarly, there was no significant difference in the mean score of EAT-10 between the two groups (0.435 vs 0.00, respectively, P-value 0.667). There was a significant difference in mean VHI-10 scores between patients testing positive for at least one allergen and the control group (P = 0.0002). CONCLUSION: The results of this investigation did not show any significance in the prevalence of self-reported dysphonia and dysphagia in patients with positive allergy skin testing in comparison to those with negative allergy skin-testing. More clinical studies on the prevalence of self-reported phonatory complaints in patients with allergy are warranted.

Prevalence of Laryngopharyngeal Reflux Related Symptoms in Patients With Allergy.

OBJECTIVE: To describe the prevalence of laryngopharyngeal reflux (LPR)-related symptoms in allergy patient using the Reflux Symptom Index (RSI) by Belafsky et al and the Reflux Symptom Score (RSS) by Lechien et al. SUBJECTS AND METHODS: A total of 84 patients were enrolled in this study. Fifty-two consecutive patients were asked to fill RSI. Similarly, 32 patients were asked to fill RSS. Demographic data included age, gender, history of smoking, family history for eczema, atopy, asthma, food and drug allergy. RESULTS: Fifty-seven of the 84 patients were positive for at least one allergen and hence were diagnosed with allergy. Of the 52 patients who received the RSI, 36 patients were allergic to at least one allergen (36/52). Of the 32 patients who filled the RSS, 21 tested positive for at least one allergen (21/32). There was no significant difference in the number of positive RSI scores (>13) between patients with allergy to at least one allergen in comparison to patients with no allergy (P = 0.329). There was a significant difference in the number of positive RSS scores (>13) between patients with allergy to at least one allergen in comparison to patients with no allergy (P-value 0.0345). The odds of having RSS >13 in an allergic patient was significant (OR = 5.6, CI 95% = 1.15-27.37). CONCLUSION: The results of this study provide evidence that patients with allergy have increased incidence of LPR related symptoms using the RSS. The cross-cutting in the clinical picture of patients with allergy and LPR stresses the need for objective testing such as double probe Ph-metry and impedance to diagnose this latter. Future studies are needed to explore further the cause-effect relationship between allergy and LPR.