ABSTRACT
OBJECTIVES/HYPOTHESIS: Vocal fold polyps and nodules are common benign laryngeal lesions. Currently, the Japanese health insurance system covers surgical interventions. However, the establishment of more cost-effective conservative methods is required, because healthcare costs are viewed as a major concern, and the government and taxpayers are demanding more economical, effective treatments. In this situation, more suitable vocal hygiene education may be important for the success of cost-effective conservative treatment. In this study, we developed a novel reinforced vocal hygiene education program and compared the results of this program with those of previous methods of teaching vocal hygiene. STUDY DESIGN: Multicenter randomized controlled trial. METHODS: Patients who visited a National Hospital Organization (NHO) hospital for the surgical indication of hoarseness were included in the study. Before undergoing surgery, 200 patients with benign vocal fold lesions (vocal fold polyps/nodules) were enrolled and randomly allocated to the NHO-style vocal hygiene educational program (intervention group) or control education program (control group). Two months after enrollment, the patients in both groups underwent laryngeal fiberscopic examinations to determine whether the benign lesions had resolved or whether surgery was indicated for the vocal fold polyps/nodules. RESULTS: After 2 months, in the intervention group, the proportion of lesion resolution (61.3%) was significantly greater than that in the control group (26.3%) (P < .001, Fisher exact test). CONCLUSIONS: Our results clearly indicate that the quality and features of the education program could affect the outcome of the intervention. We found that a reinforced vocal hygiene education program increased the rate of the resolution of benign vocal fold polyps and nodules in a multicenter randomized clinical trial. LEVEL OF EVIDENCE: 1b Laryngoscope, 2593-2599, 2018.
Subject(s)
Conservative Treatment/methods , Hygiene/education , Laryngeal Diseases/therapy , Patient Education as Topic/methods , Polyps/therapy , Program Evaluation , Female , Humans , Laryngeal Diseases/pathology , Laryngoscopy/statistics & numerical data , Male , Middle Aged , Polyps/pathology , Treatment Outcome , Vocal Cords/pathologyABSTRACT
Schwanomatosis is the third most common form of neurofibromatosis. Schwanomatosis affecting the vagus nerve is particularly rare. In this report, we describe an extremely rare case bilateral vagus nerve schwanomatosis in a 45-year-old male patient. The patient initially presented with bilateral neck tumors and hoarseness arising after thoracic surgery. We performed left neck surgery in order to diagnose and resect the remaining tumors followed by laryngeal framework surgery to improve vocal cord closure and symptoms of hoarseness. Voice recovery was successfully achieved after surgery. An appropriate diagnosis and surgical tumor resection followed by phonosurgery improved patient quality of life in this rare case.
Subject(s)
Neoplasms, Multiple Primary/diagnostic imaging , Nerve Sheath Neoplasms/diagnostic imaging , Neurilemmoma/diagnostic imaging , Vagus Nerve Diseases/diagnostic imaging , Hoarseness/etiology , Hoarseness/physiopathology , Humans , Laryngoplasty , Male , Middle Aged , Neoplasms, Multiple Primary/complications , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/physiopathology , Nerve Sheath Neoplasms/complications , Nerve Sheath Neoplasms/pathology , Nerve Sheath Neoplasms/physiopathology , Neurilemmoma/complications , Neurilemmoma/pathology , Neurilemmoma/physiopathology , Recovery of Function , Vagus Nerve Diseases/complications , Vagus Nerve Diseases/pathology , Vagus Nerve Diseases/physiopathology , Vocal CordsABSTRACT
BACKGROUND: Vestibular rehabilitation is useful to alleviate chronic dizziness in patients with vestibular dysfunction. It aims to induce neuronal plasticity in the central nervous system (especially in the cerebellum) to promote vestibular compensation. Transcranial cerebellar direct current stimulation (tcDCS) reportedly enhances cerebellar function. OBJECTIVE/HYPOTHESIS: We investigated whether vestibular rehabilitation partially combined with tcDCS is superior to the use of rehabilitation alone for the alleviation of dizziness. METHODS: Patients with chronic dizziness due to vestibular dysfunction received rehabilitation concurrently with either 20-min tcDCS or sham stimulation for 5 days. Pre- and post-intervention (at 1 month) dizziness handicap inventory (DHI) scores and psychometric and motor parameters were compared. RESULTS: Sixteen patients completed the study. DHI scores in the tcDCS group showed significant improvement over those in the sham group (Mann-Whitney U test, p = 0.033). CONCLUSION: Vestibular rehabilitation partially combined with tcDCS appears to be a promising approach.
