RESUMO
OBJECTIVE: The aim of the present study was to investigate hyaluronic acid (HA) concentrations in vocal folds among patients with Reinke's edema. STUDY DESIGN: Prospective and experimental study. SETTING: Single tertiary center. METHODS: An HA binding protein isolated from bovine nasal cartilage was used to identify and isolate the HA from samples. Plates coated with biotin-conjugated binding protein and streptavidin-europium conjugate were sequentially incubated with 18 Reinke's edema samples and 11 female vocal fold cover samples from cadavers (the superficial layer of the lamina propria; control group). After the release of europium from streptavidin in enhancement solution, final fluorescence was measured in a fluorometer. RESULTS: The mean HA concentration in Reinke's edema vocal folds was significantly higher than that in the control vocal folds (9.2 × 103 vs 0.9 × 103µg/g). CONCLUSION: Vocal fold covers affected by Reinke's edema present a higher concentration of HA than do vocal fold covers with no edema.
Assuntos
Edema/metabolismo , Ácido Hialurônico/metabolismo , Prega Vocal/metabolismo , Adulto , Idoso , Cadáver , Feminino , Humanos , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Botulinum toxin type A (BTA) injection in intrinsic laryngeal musculature may result in dysphagia and consequent loss of quality of life (QOL) in a percentage of patients. This study aims to evaluate pharyngeal motility as a putative cause for this change in swallow quality in light of high-resolution manometry (HRM). Twenty patients (95% females, median age 66 years) underwent high-resolution manometry before and after BTA injection. Dysphagia was evaluated based on a QOL dedicated questionnaire (SWAL-QOL) before and after BTA injection. Pharyngeal motility at the topography of the vellum, epiglottis, and upper esophageal sphincter (UES) were recorded. Eleven (55%) subjects had worsened QOL after BTA injection. In patients with worsened QOL, UES extension decreased (p = 0.005), UES residual pressure increased (p = 0.02), UES basal pressure decreased (p = 0.04), and velopharynx contraction duration decreased (p = 0.04). UES residual pressure increased (p = 0.01), velopharynx peak pressure (p = 0.04) and upstroke (p = 0.007) decreased in patients with maintained QOL. There was no difference between groups when comparing pre-injection values. UES extension (p = 0.01) and UES maximum relaxation time (p = 0.03) was lower in the group with worsened QOL after BTA as compared to no change in QOL. Pharyngeal motility as measured by HRM was not a predictor for post procedure dysphagia and the changes in motility after BTA injection does not seem to be a strong contributor to dysphagia.