Office-Based Blue Laser Therapy for Vocal Fold Leukoplakia: A Preliminary Report of 12 Cases.

Objective: To report the efficacy of office-based blue laser therapy for vocal fold leukoplakia. Study Design: A retrospective case series. Setting: A tertiary care center. Methods: A retrospective chart review of patients with vocal fold leukoplakia who underwent office-based blue laser therapy between July 2019 and October 2022 was conducted. The video recordings of their laryngeal examination and their voice evaluation were analyzed before and after surgical intervention. Results: A total of 10 patients, eight with unilateral disease and 2 with bilateral disease, were included in this study. In total, 12 vocal folds with leukoplakia were treated. Nine had a single session and 3 had 2 sessions due to incomplete regression of the lesion after the first laser therapy session. Following treatment, 9 regressed completely (75%) and 3 regressed partially (25%). The mean Voice Handicap Index-10 (VHI-10) score decreased significantly from 15.4 ± 12.9 preoperatively to 3.8 ± 2.86 after surgery (p = .023). There was a statistically significant decrease in the means of grade, roughness, breathiness, asthenia, and strain (p < .05). There was also a statistically significant decrease in the jitter and shimmer percent (p = .008 and p = .048, respectively) and a significant increase in the maximum phonation time from 9.63 ± 3.83 to 13.54 ± 5.92 seconds (p = .039). Conclusion: This preliminary study indicates that office-based blue laser therapy is an effective treatment modality for vocal fold leukoplakia.

The Effect of Monaurally Fitted Hearing Aid Use on the Evolution of Presbycusis.

OBJECTIVE: The effect of hearing aid use on the evolution of presbycusis has not been well described in the literature, with only a handful of publications addressing this topic. This paper aims to evaluate the long-term use of amplification and its effect on pure-tone thresholds and word recognition scores. METHOD: Monaurally fitted patients were followed with serial audiograms. Data was collected from hearing aid centers. Seventy-seven patients with presbycusis met the inclusion criteria and participated in the present study. The progression of hearing loss in both pure tone thresholds and word recognition scores were compared between the hearing aid ears (HA), and the non-hearing aid ears (NHA). Pure tone thresholds were analyzed by comparing the pure tone average at the initial and last audiograms. Word Recognition Scores (WRS) were analyzed using the model of Thornton and Raffin (1978), and by comparing the change in the absolute values of WRS from the initial to the last audiogram between the HA ear and the NHA ear. RESULTS: No significant difference in pure-tone thresholds between the HA ear and NHA ear was found at the last audiogram (P = .696), even after dividing the patients into groups based on the duration of amplification. Both methods of analysis of patients' WRS showed a statistically significant worsening in NHA (P < .05). CONCLUSION: The present study supports the previously defined auditory deprivation effect on non-fitted ears, which showed worsening of word recognition over time and no effect on pure tone average. It provides an additional argument for the counseling of patients with presbycusis considering amplification, and highlights the importance of bilateral amplification in preserving the residual hearing of hearing impaired patients.

Unsedated Office-Based Thulium Laser Therapy in Patients With Vocal Fold Cysts.

The objective is to report 3 cases of vocal fold cysts treated with thulium laser in an office setting under local anesthesia. The surgical technique, which consists of surgical marsupialization, is described in detail with emphasis on the laser setting. All 3 patients had complete regression of the lesion and marked improvement in voice quality and good closure of the vocal folds during phonation. The authors review the literature on the application of laser therapy in an office setting and advocate this as an alternative treatment option for patients with vocal fold cysts who are at high risk for general anesthesia or unwilling to undergo the conventional microsurgery.

Post-lingual non-syndromic hearing loss phenotype: a polygenic case with 2 biallelic mutations in MYO15A and MITF.

BACKGROUND: Hearing loss (HL) represents the most common congenital sensory impairment with an incidence of 1-5 per 1000 live births. Non-syndromic hearing loss (NSHL) is an isolated finding that is not part of any other disorder accounting for 70% of all genetic hearing loss cases. METHODS: In the current study, we reported a polygenic mode of inheritance in an NSHL consanguineous family using exome sequencing technology and we evaluated the possible effect of the detected single nucleotide variants (SNVs) using in silico methods. RESULTS: Two bi-allelic SNVs were detected in the affected patients; a MYO15A (. p.V485A) variant, and a novel MITF (p.P338L) variant. Along with these homozygous mutations, we detected two heterozygous variants in well described hearing loss genes (MYO7A and MYH14). The novel MITF p. Pro338Leu missense mutation was predicted to change the protein structure and function. CONCLUSION: A novel MITF mutation along with a previously described MYO15A mutation segregate with an autosomal recessive non-syndromic HL case with a post-lingual onset. The findings highlight the importance of carrying whole exome sequencing for a comprehensive assessment of HL genetic heterogeneity.

Prevalence of Dysphagia in Patients With Non-neoplastic Vocal Fold Pathology.

OBJECTIVES: To examine the prevalence of dysphagia in patients presenting with dysphonia and diagnosed with non-neoplastic vocal fold pathology. METHODS: A total of 45 patients presenting with dysphonia and diagnosed with non-neoplastic vocal fold pathology and a control group matched according to age and gender were included. Patients with recent history of respiratory tract infection, laryngeal surgery or manipulation, neurologic disorders, head and neck tumors, or history of chemotherapy/radiotherapy were excluded. The primary outcome measure for dysphagia was Eating Assessment Tool-10. Patients with a score above three were considered to have dysphagia. RESULTS: The 45 patients were stratified as 18 males and 27 females, with an overall mean age of 48.23 ± 14.65 years. The most common vocal fold pathology was Reinke edema (28.8%), followed by laryngitis (24.4%), and vocal fold nodules (17.7%) and polyps (13.33%). Out of 45 patients with dysphonia, 37.7% had dysphagia and out of 25 controls, 8% had dysphagia as evidenced by an Eating Assessment Tool-10 score of above three. This prevalence is higher than normative values reported in the literature (16%-22%). CONCLUSIONS: The high prevalence of dysphagia in patients with non-neoplastic vocal fold pathology alludes to the pathogenic role of laryngeal behavior in the development of obstructive swallowing symptoms. The potential benefit of voice and swallowing therapy in the treatment of these patients should be considered.

The OTOGL p.Arg925* Variant is Associated with Moderate Hearing Loss in a Syrian Nonconsanguineous Family.

AIM: To screen for the genetic basis of congenital hearing loss in a Syrian family. METHODS: A Syrian patient living in Lebanon presented with moderate congenital hearing loss. The patient's large nonconsanguineous family was recruited. DNA was extracted from blood samples and sent for whole-exome sequencing. A detailed clinical examination along with audiograms was obtained for all subjects. RESULTS: Hearing loss was noted to be mild to moderate in the low and mid frequencies, sloping to moderate to severe in the high frequencies for all affected members. Results of DNA analysis showed the presence of a previously described p.Arg925* mutation in the OTOGL gene on both alleles in affected family members, whereas nonaffected members either had the wild type or one copy of the mutated allele. DISCUSSION: Mutations affecting the OTOGL gene have been recently connected with nonsyndromic sensorineural hearing loss. Seven such mutations have already been described. The p.Arg925* reported in this study has been found once in a French family. The current report is the first to describe this mutation in a Middle Eastern family.

Inverted papilloma of the ethmoid sinus Case report and review of the literature.

Importance: Description of a primary inverted papilloma of the ethmoid sinus. This has never been documented before in the literature. Observation: The clinical presentation, along with the radiographic features, gross findings and management will be discussed. Conclusions and Relevance: In contrast to the vast majority of cases that present with nasal complaints, the clinical presentation of an inverted papilloma confined to the ethmoid sinus was incidental. Radiologic findings are nonspecific. Functional endoscopic sinus surgery with total removal of the mass is the therapy of choice to reach a final pathologic diagnosis, prevent recurrence and other sequelae.

Adaptation of the Arabic Version of the Tinnitus Handicap Inventory.

OBJECTIVE: To translate the Tinnitus Handicap Inventory (THI) into literary Arabic to come up with a unified Arabic version and to determine its validity and reliability in assessing the quality of life of Arabic-speaking patients with tinnitus. STUDY DESIGN: Clinical measurement study. SETTING: Tertiary care center. SUBJECTS AND METHODS: The original English THI was translated into literary Arabic by a forward- and back-translation process according to the published guidelines for cross-cultural adaptation of health-related quality-of-life measures and applied to 100 patients with chronic tinnitus. Internal consistency reliability was then assessed by calculating Cronbach's alpha coefficient. Pearson correlation coefficients were also calculated for the different scales and the different baseline characteristics. RESULTS: Results showed high internal consistency and reliability coefficients (total THI: 0.93, functional subscale: 0.86, emotional subscale: 0.86, catastrophic subscale: 0.66) comparable to those of the original English THI. CONCLUSION: The Arabic version of the THI is a valid and reliable tool for the assessment of the impact of tinnitus on the quality of life of Arabic-speaking patients with the complaint of chronic tinnitus.

Streptococcus mutans antigen I/II binds to α5ß1 integrins via its A-domain and increases ß1 integrins expression on periodontal ligament fibroblast cells.

The cell wall anchored protein I/II of Streptococcus mutans plays a significant role in colonizing the dental structures and induces the synthesis of proinflammatory cytokines after binding to α5ß1 integrins of host cells. Whilst the signalling pathways triggered by bound protein I/II and leading to the release of proinflammatory cytokines has been extensively studied, the molecular mechanisms of binding of protein I/II to this host cell factor remain more elusive. Using a panel of purified recombinant polypeptides corresponding to defined domains of the streptococcal protein I/II, we aimed to better characterize protein I/II-α5ß1 integrins interaction. Our results show that the A region plays a major role in binding of protein I/II to α5ß1 integrin. Using specific inhibitors, we demonstrated that this interaction requires ß subunits of the integrin and that the glycosylated residues of the integrin interact with the V-region of the protein I/IIf. Periodontal fibroblasts (PDL-Fb) express ß1-integrins on their cell membrane. Stimulation with protein I/II increases the expression of ß1-integrins. These data suggest a modulatory effect of the streptococcal protein I/II on expression of integrins by PDL-Fb. This might have important implication for understanding the role of PDL-Fb cells in periradicular inflammation.

Streptococcal antigen I/II binds to extracellular proteins through intermolecular beta-sheets.

One of the functions associated with the oral streptococcal surface protein I/II is to bind to human extracellular matrix molecules or blood components, which could act as opportunistic ligands in pathological circumstances. In order to understand the relative specificity of the binding repertoire of this bacterial adhesin, we examined by infrared measurements the mode of binding of the protein I/II from Streptococcus mutans OMZ175 (I/IIf) to fibronectin and fibrinogen. This approach revealed the beta-structure forming capacity of I/IIf upon interaction with both proteins. The forming of intermolecular beta-structures may provide a non-selective way of interaction between I/IIf and its possible targets.