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1: B-ENT. 2006;2(2):51-4. Links

Papillomatosis of the larynx: treatment with CO2 laser.

Mesolella M, Motta G,Laguardia M, Galli V.

ENT Department, University Federico II, Naples, Italy.

OBJECTIVES: We report our experience treating papillomatosis of the larynx using CO2 laser which has a lower risk of post surgical complications. Papillomatosis has a high incidence of recurrence after surgical treatment. METHODS: We treated 42 patients (10 adults and 32 children) affected by multiple papillomatosis of the larynx. Smaller papillomas were vaporized with a 7-8 Watt CO2 laser and larger papillomas were resected at the base of their implantation. A strict follow-up during the first 3 years after surgical treatment was necessary to manage recurrences with CO2 laser endoscopy. RESULTS: All patients presented with recurrences after the first surgical treatment, but within 18-60 months all patients presented a solution of their pathology. Post-operative complications were observed in patients who did not comply with the strict follow-up protocol and presented with large lesions requiring more invasive surgery. CONCLUSIONS: CO2 laser endoscopy, although it did not prevent recurrences of papillomatosis in the larynx, is a valid surgical approach in the management of this pathology.

PMID: 16910287 [PubMed - indexed for MEDLINE]

1: Eur Arch Otorhinolaryngol. 2007 Apr 20; [Epub ahead of print]   Links

Twenty-five years experience with laser surgery for head and neck tumors : Report of an international symposium, Gottingen, Germany, 2005.

Jackel MC, Martin A, Steiner W.

ENT Department, Hospital of Darmstadt, Darmstadt, Germany.

During the last 25 years, the treatment of tumors arising in the upper aerodigestive tract has changed fundamentally. Whereas surgery in the 1970s aimed at radical block resection and defect repair from outside, the establishment of transoral laser microsurgery marked a new era of organ- and function-preserving therapy. An international symposium, held on 10 and 11 June 2005 in Gottingen, was dedicated to a critical review and assessment of the current role of laser surgery for the treatment of head and neck cancer. Experts from five continents presented their experiences and scientific results and had an intensive exchange with participants from different countries. The topics of the symposium were focused on the surgical principles of laser resection, the oncological and functional results in comparison with traditional therapy, the difficulties and limits of laser surgery in distinct anatomical regions and on the role of radiotherapy. This report summarizes the most important results and statements and gives an overview of actual developments. The names and addresses of the participants mentioned in this report are appended below.

PMID: 17447079 [PubMed - as supplied by publisher]

1: Med J Malaysia. 2006 Aug;61(3):377-9. Links

Laser tonsillotomy in children with tonsillar hyperplasia.

Baharudin A, Shahid H, Rhendra MZ.

Department of Otolaryngology - Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.

Tonsillectomy in children is performed on a regular basis in ENT. The indications are chronic tonsillitis, sleep apnea to deeper structures. The natural history of tonsillar hyperplasia is regression when a child is six years beyond. In children with bilateral tonsillar hyperplasia we studied the use of laser as an alternative procedure to reduce the bulk of the tonsillar mass. Children with symptoms of bilateral tonsillar hyperplasia underwent laser tonsillotomy. The tonsils were dissected using carbon dioxide (CO2) laser. The tonsillar bed was left untouched. Intraoperative and postoperative conditions were noted.

PMID: 17240597 [PubMed - indexed for MEDLINE]

1: Eur Arch Otorhinolaryngol. 2007 Apr 6; [Epub ahead of print]   Links

Long-term results in patients after combined laser total arytenoidectomy with posterior cordectomy for bilateral vocal cord paralysis.

Misiolek M, Ziora D,Namyslowski G, Misiolek H, Kucia J, Scierski W, Kozielski J, Warmuzinski K.

ENT Department, Silesian Medical University, Sklodowskiej-Curie 10, 41-800, Zabrze, Poland, misiol@mp.pl .

The problem of ventilation efficiency after total laser arytenoidectomy with posterior cordectomy due to bilateral vocal cord paralysis is discussed. There are a number of views on the usefulness and efficacy of different surgical procedures aimed at widening the glottis, but the studies concerning the long-term functional results are still lacking. The objective of the study is to evaluate the durability of ventilation results in patients after laser arytenoidectomy with posterior cordectomy based on the comparison between the early postoperative results and those assessed after a period of 5 years. Thirty patients (24 females, 6 males) aged between 30 and 80 (mean 58.5) with bilateral vocal cord paralysis after thyroid surgery, who underwent laser arytenoidectomy with posterior cordectomy, were analyzed. Ventilation tests were performed immediately after the operation and 5 years later with Body-Master Laab (Jaeger). The actual and predicted values of FVC, FEF(25), FEF(50), FEF(75), PEF, MMEF(75/25), AREA(Ex), sR(T0T), R(T0T) were compared and analyzed. Also, the values of the inspiratory parameters FIV(1), FIF(50), PIF and the coefficients FEF(50)/FIF(50) and FIV(1)/FEV(1) were assessed. Moreover, subjective evaluation was performed based on a questionnaire. The statistical analysis reveals a significant decrease in FIV(1), FIF(50), PIF and FIV(1)/FEV(1). FEF(50)/FIF(50) and sR(T0T) (actual and predicted values) increased significantly after 5 years from the operation. However, the patients did not complain nor was this tendency reflected in their answers to the questionnaire. The probable reasons for such ventilation results are discussed. The role of phoniatric rehabilitation and the time elapsed is emphasized. In general, it can be concluded that laser arytenoidectomy with posterior cordectomy is a durable and effective procedure, although the objective assessment does not fully match the patient's subjective impression.

PMID: 17415581 [PubMed - as supplied by publisher]

1: Adv Otorhinolaryngol. 2007;65:267-72.   Links

Transient depression of inner ear function after stapedotomy: skeeter versus CO(2) laser technique.

Somers T, Vercruysse JP, Zarowski A, Verstreken M, Schatteman I, Offeciers FE.

University ENT Department, Sint-Augustinus Hospital, Wilrijk, Belgium. thomas.somers@gvagroup.be

Performing stapes surgery for otosclerosis is known to be potentially irreversibly harmful to the inner ear function in about 1% of the cases. An early postoperative transient depression of the bone conduction thresholds is frequently detected after stapes surgery. The purpose of this study was to compare the evolution of bone conduction thresholds after primary stapedotomy with two different techniques: skeeter versus CO(2) laser stapedotomy. Audiological data of 336 otosclerosis operations performed by 2 surgeons between 1997 and 2003 were subjected to analysis. The calibrated hole in the footplate was performed randomly either with the skeeter drill or with the CO(2) laser. Preoperative bone conduction thresholds were compared with the postoperative levels (day 2-3, week 2, week 6 and month 6) in all patients. Evolution of the bone conduction was compared for the two studied subgroups (laser versus skeeter).

PMID: 17245057 [PubMed - indexed for MEDLINE]

Eur Arch Otorhinolaryngol. 2007 Apr 6; [Epub ahead of print]  Links

Long-term results in patients after combined laser total arytenoidectomy with posterior cordectomy for bilateral vocal cord paralysis.

Misiolek M, Ziora D, Namyslowski G, Misiolek H, Kucia J, Scierski W, Kozielski J, Warmuzinski K.

ENT Department, Silesian Medical University, Sklodowskiej-Curie 10, 41-800, Zabrze, Poland, misiol@mp.pl .

The problem of ventilation efficiency after total laser arytenoidectomy with posterior cordectomy due to bilateral vocal cord paralysis is discussed. There are a number of views on the usefulness and efficacy of different surgical procedures aimed at widening the glottis, but the studies concerning the long-term functional results are still lacking. The objective of the study is to evaluate the durability of ventilation results in patients after laser arytenoidectomy with posterior cordectomy based on the comparison between the early postoperative results and those assessed after a period of 5 years. Thirty patients (24 females, 6 males) aged between 30 and 80 (mean 58.5) with bilateral vocal cord paralysis after thyroid surgery, who underwent laser arytenoidectomy with posterior cordectomy, were analyzed. Ventilation tests were performed immediately after the operation and 5 years later with Body-Master Laab (Jaeger). The actual and predicted values of FVC, FEF(25), FEF(50), FEF(75), PEF, MMEF(75/25), AREA(Ex), sR(T0T), R(T0T) were compared and analyzed. Also, the values of the inspiratory parameters FIV(1), FIF(50), PIF and the coefficients FEF(50)/FIF(50) and FIV(1)/FEV(1) were assessed. Moreover, subjective evaluation was performed based on a questionnaire. The statistical analysis reveals a significant decrease in FIV(1), FIF(50), PIF and FIV(1)/FEV(1). FEF(50)/FIF(50) and sR(T0T) (actual and predicted values) increased significantly after 5 years from the operation. However, the patients did not complain nor was this tendency reflected in their answers to the questionnaire. The probable reasons for such ventilation results are discussed. The role of phoniatric rehabilitation and the time elapsed is emphasized. In general, it can be concluded that laser arytenoidectomy with posterior cordectomy is a durable and effective procedure, although the objective assessment does not fully match the patient's subjective impression.

PMID: 17415581 [PubMed - as supplied by publisher]

Related Links

Welcome to TLC - Tinnitus Laser Centre

TLC is a Swedish non-profit association with the aim of promoting the knowledge about Laser Therapy of tinnitus. Tinnitus is a very seriuos, debilitating and widespread phenomenon. Medicine has so far tried many therapies and they seem to have only one trait in common - they are not very successful. Laser therapy is not yet an established therapy for tinnitus, but taking the positive anecdotal reports into account, coupled with a number of positive clinical studies, we feel this is an area well worth of further exploration.

The cause of tinnitus is controversial, indicating that there is no absolute knowledge. In our experience there are three typical situations:

  1. The tinnitus is caused by a brain damage
  2. The tinnitus is caused by an acute or chronic acoustic trauma to the inner ear
  3. The tinnitus is caused by stress and consequent muscular spasm

For no 1 there is no therapy known to us
For no 2 irradiadiation directed towards the innear ear can be performed, in order to stimulate the "tired" cells in this region. Acute injuries respond well.
For no 3 relaxation therapy, physiotherapy, adjustment of the teeth (occlusion), bite splints and laser therapy to the involved muscles is recommended

Therapy
TLC in itself does not treat patients, nor does it give advice to patients. On our web site there are links to clinics performing Tinnitus Laser Therapy, but these clinics are not TLC operations.
.
The literature
Low level laser therapy (LLLT) has been suggested as a possible therapy for tinnitus. Several studies have used Ginkgo biloba infusions in combination with LLLT, the former being a widespread but not well documented therapy for tinnitus. The number of studies are few and they will be briefly described in the following.

Witt [3] is one of the pioneers in this field, but to the knowledge of the author his results have not been published in any peer-review journal. Witt combines infusion of Gingko biloba (Egb 761, 17.5 mg dry extract per 5 ml amouple)) and laser. This may be a favourable combination but an evaluation of the contribution of the laser is not possible. More than 500 patients have been treated since 1989 and Witt claims that more than 60% of the patients have reached a considerable or total relief . The laser used is a combination of HeNe 12 mW/GaAs 5 x 10 mW. Treatment technique not stated.

Swoboda [4] did not find any significant effect of Gingo/laser. However, the ginkgo infusion used was at a homeopathic level (D3 = 1:1000 dilution), acc. to Witt.

Partheniadis-Stumpf [5] also failed to find any effect from the combined ginkgo (6 ml Tebonin) infusion and laser. However, the laser was applied at a distance of one cm above the mastoid. The non-contact mode reduces penetration considerably and the mastoid is not ideal for reaching the inner ear.

Plath [6] treated 40 tinnitus patients with 50 mg Ginkgo biloba. 20 patients received sham laser irradiation, 20 real laser. A HeNe 12 mW/GaAs 5 x 15 mW GaAs laser was used, irradiation procedure approximately the same as for Partheniadis-Stumpf. In this study, 50% of the patients reported a reduction of the tinnitus of more than 10 dB, compared with 5% in the control group, in both self-assessment and audiometric findings.

A similar study has been performed by von Wedel [7]. 155 patients were treated with Ginkgo infusion (5 ml Syxyl D3) and laser. The outcome was negative. No information about the type of laser, treatment technique or dosage is given, making an evaluation impossible.

Shiomi [8] has investigated the effect of infrared laser applied directly into the meatus acusticus, 21 J, once a week for 10 weeks. The result of this non-controlled study is as follows: 26% of the patients reported improved duration, 58% reduced loudness and 55% reported a general reduction in annoyance.

The same author [9] has also examined the effect of light on the cochlea, using guinea pigs. Direct laser irradiation was administred to the cochlea through the round window and the amplitude of CAP was reduced to 53-83% immediately after the onset of irradiation. The amplitude then returned to the original level. The results of this investigation suggest that LLLT might lessen tinnitus by suppressing the abnormal excitation of the 8th nerve or the organ of Corti.

More or less the same parameters were used in a controled study by Mirtz [10] but in this case there was no significant effect.

Wilden [11] [12] has applied a different method where the dose has been increased considerably. A set consisting of one HeNe laser and three powerful GaAlAs lasers is used, covering a large area over and around the ear, in the non-contact mode. Doses between 3.000 and 5.000 J are given each session. Laser is applied as a monotherapy. More than 800 patients have been treated with this concept and positive effects are reported, even for vertigo. Recent injuries in "the disco generation" are more easily treated than long-term chronic conditions. In a separate study [13] Wilden reports improvment of the hearing capacity of these patients, as evaluated by audiometry.

Beyer [14] has performed a very exact ex-vivo laser penetration study. Based on these findings it was possible to calculate the energy needed to obtain a dose of 4 J/cm2 in the cochlea itself. 30 patient were treated five times within 2 weeks. One group was irradiated with 635 nm diode laser, the other with 830 nm diode laser. By self-assessment around 40% of the patients reported a slight to significant attenuation of the tinnitus loudness of the irradiated ear. This study has been followed by a double blind study.

Prochazka [15] has evaluated the effect of combined Egb 761 Ginkgo infusion and laser in a double blind study. 37 patients were divided into three groups. One group had Egb 761 only, one Egb761 and placebo laser, one Egb761 and real laser, 830 nm. The results in the three groups were as follows: no effect 29/26/19, less than 50% relief 44/48/29, more than 50% relief 18/26/36, no more tinnitus 9/0/26. Irradiation was performed over the mastoid and over the meatus acusticus, twice a week, 8-10 sessions, total 175 J.

Rogowski [16] divided a group of 32 tinnitus patients into one group receiving LLLT and one receiving a placebo procedure. Dose, wavelength and treatment technique not stated in the available English abstract. The effect was evaluated through VAS. Within the patient group transiently evoked otoacoustic emissions (TEOAE) were measured before, during and after therapy. No significant difference between laser and placebo was found in annoyance or loudness of the tinnitus and in changes of TEOAE amplitude. These results indicate that there is no relationship between the effect of low-power laser and changes in cochlear micromechanics.

A few other indications in otorhinolaryngology have been treated with low level lasers, even with intravenous irradiation. [17-20]

It is obvious that the available literature on laser therapy of tinnitus is scarse and ambiguous. Some studies have used a combination of Ginkgo and laser, others laser as monotherapy. Differences in wavelengths, pulsing, dosage and treatment technique makes a firm evaluation impossible. However, the positive results reported in some studies do merit attention and further research. Recent clinical experience also suggests that the doses necessary for successful outcome of the therapy have to be increased considerably. Tinnitus is a grave condition, sometimes leading to suicide. It is also an increasing problem and the existing treatment modalities offered to tinnitus patients are not very effective. Young persons suffering from acoustic chocks (concerts, discos) can be more successfully treated with laser therapy. Understandably enough, a long standing condition in elderly persons is a severe condition taking 10-20 sessions to influence.

References:
[3] Witt U, Felix C. Selektive photo-Biochemotherapie in der Kombination Laser und Ginkgo-Pflanzenextrakt nach der Methode Witt. Neue Möglichkeiten bei Innerohrstörungen. [Selective photo-biochemotherapy in the combination of laser and gingkoplan extracts acc. to the Witt method] (1989). Unpublished material.
[4] Swoboda R, Schott a. Behandlung neurotologischer Erkrankungen mit Gingko biloba Hevert, Hyperforat und Low-Power-Laser-Therapie. [Treatment of neurotologic diseases with Gingko biloba and low level laser therapy] Medizinische Akademie Erfurt. (1992)
[5] Partheniadis-Stumpf M, Maurer J, Mann W. Titel: Soft laser therapy in combination with tebonin i.v. in tinnitus. [in German)] Laryngorhinootologie 1993; 72(1):28-31
[6] Plath P, Olivier J. Results of combined low-power laser therapy and extracts of Ginkgo biloba in cases of sensorineural hearing loss and tinnitus. Adv Otorhinolaryngol.1995;49:101-4
[7] von Wedel H, Calero L, Walger M et al. Soft-laser/Ginkgo therapy in chronic tinnitus. A placebo-controlled study. Adv Otorhinolaryngol.1995;49:105-8
[8] Shiomi Y, Takahashi H, Honjo I, Kojima H, Naito Y, Fujiki N: Efficacy of transmeatal low power laser irradiation on tinnitus: a preliminary report. Auris Nasus Larynx 1997;24(1):39-42.
[9] Shiomi Y et al. [Effect of low power laser irradiation on inner ear] [in Japanese]. Pract Otol (Kyoto). 1994; 87: 1135-1140.
[10] Mirz F, Zachariae R, Andersen S E et al. The low-power laser in the treatment of tinnitus. Clin Otolaryngol 1999; 24: 346-354.
[11] Wilden L. The effect of low level laser light on innear ear diseases. In: Low Level Laser Therapy, Clinical Practice and Scientific Background. Jan Tunér and Lars Hode. Prima Books in Sweden AB (1999). ISBN 91-630-7616-0.
[12] Wilden L, Dindinger D. Treatment of chronic diseases of the inner ear with low level laser therapy (LLLT): pilot project. Laser Therapy. 1996; 8: 209-21210
[13] Wilden L, Ellerbrock D. Verbesserung der Hörkapazität durch Low-Level-Laser-Licht (LLLL). [Amelioration of the hearing capacity by low-level-laser-light (LLL)]. Lasermedizin. 1999; 14: 129-138.
[14] Beyer W et al. Light dosimetry and preliminary clinical results for low level laser therapy in cochlear dysfunction. Proc. Laser Florence '99.
[15] Prochazka M, Tejnska R. Comprehensive therapy of patients suffering from tinnitus. Proc. Laser Florence '99.
[16] Rogowski-M, Mnich-S, Gindzienska-E, Lazarczyk-B. [Low-power laser in the treatment of tinnitus - a placebo-controlled study] . Laser niskoenergetyczny w leczeniu szumow usznych-badania porownawcze z placebo. Otolaryngologia polska. [Otolaryngol-Pol]. 1999; 53 (3): 315-20
[17] Mishenkin N V et al. [Effects of helium-neon laser energy on the tissues of the middle ear in the presence of biological fluids and drug solutions]. [in Russian] Vest Otorinolaringol. 1990; 5: 18-21
[18] Bogomilskii M R et al. [Effect of low-energy laser irradiation on the functional state of the acoustic analyzer]. [in Russian] Vest Otorinolaryngol. 1989; 2: 29-34.
[19] Palchun V T et al. [Low-energy laser irradiation in the combined treatment of sensorineural hearing loss and Ménière's disease]. [in Russian] Vestnik Otorinolaryngol. 1996; 1: 23-25.
[20] Ribari O et al. [Closure of tympanic perforations with low-energy HeNe laser irradiation]. [in German] Acta Chir Academ Scient Hungariacae. 1980; 3: 229-238.

TLC research
Medical therapies of tinnitus have one thing in common: their effect is very limited (a survey in Swedish about various therapies is found under the link "Detta har provats"). With the positive anecdotal reports in mind and with the inspiration of the few positive studies, we feel that Laser Therapy for tinnitus is well worth investigating without prejudice. The following is a summary of TLC initiated research:

  1. Stockholm, private hospital. Finished. 15 consecutive tinnitus patients were given 200 mW 820 nm laser via a thin optical cord, very close to the ear drum and under visual control, total 24 J and 10-15 sessions. The idea was to check the studies [8] and [10] but with higher degree of dosage control. Through the small fiber the energy density was higher and the visual control close to the ear drum actually made the dosage inside the inner ear higher than in the other studies. The laser was a custom made Irradia Mid Laser, Stokholm. The outcome was negative, 2. one reason probably the fact that no differential diagnosis of the patients were made.
  2. Stockholm, private hospital. The LEnergy 275co (Laser Evolution, Germany) is a stetoscope-like laser with red 780 nm laser light being directed into both ears simultaneously, 45 mW each. 20 patients will be treated. All patients have suspected aocustic trauma and no history of clenching or sore masticatory muscles. The idea is to pinpoint patients where the problem is likely to be centred in the inner ear, not in the muscles or in the spine. Patients will use the LEnergy 60 minutes daily, except Sundays, for one month. Study started in September 2000 and will take one year.
  3. 3. Stockholm, Department of Odontology, Karolinska Institutet, Huddinge. Clincal examination of patients with tinnitus and temporo-mandibular-disorders. These patients have been treated rather successfully in this department through occlusal adjustment and in some cases bite splints. Laser Therapy has proved to improve and speed up the outcome of this therapy considerably. The laser used is a LASOTRONIC MED700, 820 nm, 300 mW. Ongoing for one year. Controlled study planned.
  4. 4. Ystad, governmental dental clinic. Patients with Ménière´s disease have successfully been treated in this clinic, through TMD therapies. When the laser is used on an involved muscle, the tone of the tinnitus will change character in many cases. A "Tinnitus simulator" has been invented. The patient will adjust this "tinnitus generator" until it emits the same sound as the sound in the patient´s ear/ears. The laser will then be applied and the patient will again adjust the "TinSim" to the new sound. Theory: the TinSim will show: 1) the condition in the muscle affects the tinnutus sensation and 2) the laser affects the muscle. Start: February 2001. The laser used is a LASOTRONIC MED700, 820 nm, 300 mW.

Further research
TLC is interested in sharing its experiences with other researchers

1: Pediatr Pulmonol. 2007 Jan;42(1):89-92.   Links

Endoscopic Nd:YAG laser therapy of infantile subglottic hemangioma.

Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.

Of the many therapeutic modalities that have been developed for infantile subglottic hemangioma (ISH), the most common technique is endoscopic excision with carbon dioxide laser, used alone or combined with other therapeutic techniques. A staged procedure has been proposed as the preferred choice for patients with severe airway obstruction. Nevertheless, ever since the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser was developed, this modality has been considered feasible to treat vascular tumor in the airway due to good hemostasis power. We present two cases of ISH with severe airway obstruction that underwent endoscopic surgery using an one-stage Nd:YAG laser approach. Details of the laser characteristics and surgery techniques are described in this article. (c) 2006 Wiley-Liss, Inc.

PMID: 17106903 [PubMed - indexed for MEDLINE]

1: Folia Phoniatr Logop. 2005 Jul-Aug;57(4):202-15.   Links

[Laser measuring device for phonation]

[Article in German]

Poliklinik fur Hor-, Stimm- und Sprachheilkunde, Universitatsklinikum Hamburg-Eppendorf, Hamburg, Deutschland. g.schade@uke.uni-hamburg.de

INTRODUCTION: Clinical examinations with short-interval, color-filtered double-flash stroboscopy enable us to estimate the movements of the vocal fold edges during phonation. So-called 'displacement bands' show the degree of the vibratory amplitude in these images. Using the two-point light projection method the displacement bands can be measured with very high accuracy. A combination of these two methods was used for velocity measurements of the vocal fold movements within the phonatory cycle. The aim of the study was to explore the influence of change in sound pressure level (SPL) and fundamental frequency (F0) on the velocity of the horizontal amplitude of the vocal folds during phonation. MATERIAL AND METHODS: 40 healthy volunteers (31 women, 9 men, average age 24.8 years) were examined. During the special videostroboscopy with short-interval, color-filtered double flashes laser spots were projected onto the vocal folds by an endoscopic two-point light projection device. The subjects had to change their SPL and F0 following a test protocol. During phonation they had to produce tones in low, middle and high chest voice as well as in falsetto register. Each subject was asked to do this in a soft, a modal, a loud and a very loud manner. Images of the phonatory cycle showing the vocal folds immediately before collision were measured separately at three different positions. About 15,000 single measurements were evaluated. RESULTS: The measured velocity of the horizontal amplitude during the closing phase of the vocal folds in chest voice was 30-160 cm/s. An increase in SPL resulted in an increasing velocity of the displacement bands. A change in F0 did not lead to statistically relevant changes in the measured velocity. CONCLUSION: A combination of short-interval, color-filtered double-flash stroboscopy and a two-point light projection method enables measurements of the velocity of vocal fold movements. The SPL is the important factor for the velocity change within the phonatory cycle. F0 seems not to covary with the velocity of the horizontal amplitude during the closing phase of the phonatory cycle. Copyright (c) 2005 S. Karger AG, Basel.

PMID: 16037696 [PubMed - indexed for MEDLINE]

1: Ann Otol Rhinol Laryngol. 2005 Mar;114(3):198-201. Links

Pulsed dye laser treatment of laryngeal granulomas.

Center for Voice and Swallowing Disorders, Department of Otolaryngology, Wake Forest University Medical Center, Winston-Salem, North Carolina 27157, USA.

Laryngeal granulomas are effectively treated with antireflux therapy and speech therapy. Failure to respond leads to treatment with Botox or surgical excision. We report on the use of the pulsed dye laser for treating chronic granulomas that do not respond to standard therapy. We performed a retrospective review from September 2002 to September 2003. Patients identified with chronic granulomas that were not responding to standard therapy were treated in our office with the pulsed dye laser. Ten patients were identified; the mean age was 58 years. Two patients underwent more than one pulsed dye laser treatment. Five of the 10 had resolution of their lesions, and 3 had a partial response. Two were unchanged. The average follow-up was 6 months, and there were no complications. We conclude that in-office use of the pulsed dye laser is a relatively safe and effective method for treating laryngeal granulomas that do not respond to antireflux therapy and speech therapy.

PMID: 15825568 [PubMed - indexed for MEDLINE]

1: J Photochem Photobiol B. 2004 Sep 8;75(3):137-44.   Links

Intranasal irradiation with the xenon chloride ultraviolet B laser improves allergic rhinitis.

Department of Dermatology and Allergology, University of Szeged, P.O. Box 427, H-6701 Szeged, Hungary.

We earlier reported that the 308 nm xenon chloride (XeCl) ultraviolet B (UVB) laser is highly effective for the treatment of inflammatory skin diseases. Since UVB irradiation has been shown to exert both local and systemic immunosuppression, we investigated the clinical efficacy of UVB irradiation in allergic rhinitis. In an open study, groups of patients with severe allergic rhinitis received intranasal irradiation with a 308 nm XeCl UVB excimer laser for two weeks. In the low-dose group (n=10), treatment was given twice weekly, starting with 0.25x the individual minimal erythema dose (MED), whereas patients in the medium-dose group (n=8) were treated four times weekly, starting with 0.4x MED. In each group, the dosage was gradually increased. Evaluation was based on the symptom scores. The effect of the XeCl laser on the skin prick test reaction was also studied. In the low-dose group, seven patients completed the study, and there was no improvement in the nasal symptoms. In the medium-dose group, the XeCl UVB irradiation significantly inhibited the rhinorrhoea, the sneezing, the nasal obstruction and the total nasal score (p<0.05). The XeCl UVB excimer laser also inhibited the allergen-induced skin prick test in a dose-dependent manner. These results suggest that the XeCl UVB excimer laser might serve as a new therapeutic tool in the treatment of allergic rhinitis.

PMID: 15341927 [PubMed - indexed for MEDLINE]

1: Ter Arkh. 2004;76(3):20-3. Links

[Efficacy of noninvasive hemolaserotherapy in patients with bronchial asthma and concomitant rhinosinusitis

Nikitin AV, Treshchalina IuB.

AIM: To study efficacy of low-intensive infrared laser radiation impact on the tympanic membrane in patients with bronchial asthma (BA) and concomitant rhinosinusitis (RS). MATERIAL AND METHODS: 78 patients with moderate BA of a mixed type and concomitant chronic RS were divided into 3 groups: group 1 patients received medication plus infrared laser radiation of the tympanic membrane and paranasal sinuses; group 2 patients were exposed to supravenous laser radiation (0.63 mcm); group 3 received pharmacotherapy alone. The effect of the treatment was assessed by spirometry, peakflowmetry and paranasal sinuses findings. RESULTS: The highest response was achieved in group 1 which manifested with positive changes in clinical, device and spirometric data on BA and x-ray data on RS courses. The least effective treatment was observed in group 3. CONCLUSION: Use of infrared laser radiation of the tympanic membrane and paranasal sinuses projection in the treatment of BA patients with RS is effective, nontoxic and easy to use both in hospitals and outpatient departments.

PMID: 15108453 [PubMed - indexed for MEDLINE]

1: Lasers Med Sci. 2003;18(3):154-61.   Links

Transmeatal cochlear laser (TCL) treatment of cochlear dysfunction: a feasibility study for chronic tinnitus.

Department of Otolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, D-81377 Munich, FRG. drtauber@yahoo.de

Low-level-laser-therapy (LLLT) targeting the inner ear has been discussed as a therapeutic procedure for cochlear dysfunction such as chronic cochlear tinnitus or sensorineural hearing loss. Former studies demonstrate dose-dependent biological and physiological effects of LLLT such as enhanced recovery of peripheral nerve injuries, which could be of therapeutic interest in cochlear dysfunction. To date, in patients with chronic tinnitus mastoidal and transmeatal irradiation has been performed without systematic dosimetric assessment. However, light-dosimetric studies on human temporal bones demonstrated that controlled application of laserlight to the human cochlea depends on defined radiator position within the external auditory meatus. This feasibility study first presents a laser application system enabling dose-controlled transmeatal cochlear laser-irradiation (TCL), as well as preliminary clinical results in patients with chronic cochlear tinnitus. The novel laser TCL-system, consisting of four diode lasers (lambda=635 nm-830 nm) and a new specific head-set applicator, was developed on the basis of dosimetric data from a former light-dosimetric study. In a preliminary clinical study, the TCL-system was applied to 35 patients with chronic tinnitus and sensorineural hearing loss. The chronic symptoms persisted after standard therapeutic procedures for at least six months, while retrocochlear or middle-ear pathologies have been ruled out. The patients were randomised and received five single diode laser treatments (lambda=635 nm, 7.8 mW cw, n=17 and lambda=830 nm, 20 mW cw, n=18) with a space irradiation of 4 J/cm2 site of maximal cochlear injury. For evaluation of laser-induced effects complete otolaryngologic examinations with audiometry, tinnitus masking and matching, and a tinnitus-self-assessment were performed before, during and after the laser-irradiation. The first clinical use of the TCL-system has been well tolerated without side-effects and produced no observable damage to the external, middle or inner ear. Changes of tinnitus loudness and tinnitus matching have been described. After a follow-up period of six months tinnitus loudness was attenuated in 13 of 35 irradiated patients, while two of 35 patients reported their tinnitus as totally absent. Hearing threshold levels and middle ear function remained unchanged. Further investigations by large double-blind placebo-controlled studies are mandatory for clinical evaluation of the presented TCL-system and its therapeutic effectiveness in acute and chronic cochlear dysfunction.

PMID: 14505199 [PubMed - indexed for MEDLINE]

1: Lasers Med Sci. 2003;18(2):100-3.   Links

Low-level 809 nm GaAlAs laser irradiation increases the proliferation rate of human laryngeal carcinoma cells in vitro.

Poliklinik fur Zahnarztliche Chirurgie, Johannes Gutenberg-University, Mainz, Germany. matthiaskreisler@web.de

The aim of the study was to investigate the effect of low-level 809 nm laser irradiation on the proliferation rate of human larynx carcinoma cells in vitro. Epithelial tumor cells were obtained from a laryngeal carcinoma and cultured under standard conditions. For laser treatment the cells were spread on 96-well tissue culture plates. Sixty-six cell cultures were irradiated with an 809 nm GaAlAs laser. Another 66 served as controls. Power output was 10 mW(cw) and the time of exposure 75-300 s per well, corresponding to an energy fluence of 1.96-7.84 J/cm2. Subsequent to laser treatment, the cultures were incubated for 72 h. The proliferation rate was determined by means of fluorescence activity of a redox indicator (Alamar Blue Assay) added to the cultures immediately after the respective treatment. The indicator is reduced by metabolic activity related to cellular growth. Proliferation was determined up to 72 h after laser application. The irradiated cells revealed a considerably higher proliferation activity. The differences were highly significant up to 72 h after irradiation (Mann-Whitney U test, p < 0.001). A cellular responsiveness of human laryngeal carcinoma cells to low-level laser irradiation is obvious. The cell line is therefore suitable for basic research investigations concerning the biological mechanisms of LLLT on cells.

PMID: 12928820 [PubMed - indexed for MEDLINE]

: Ann Otol Rhinol Laryngol. 2003 Apr;112(4):361-4. Links

Laryngocele resection by combined external and endoscopic laser approach.

Options in the management of laryngoceles include observation, endoscopic resection, and resection via an external approach. We introduce a combined endoscopic and external approach that we have employed on several occasions to ensure complete removal of the laryngocele and the saccule from which it originated. A case is presented to help define the technique.

PMID: 12731632 [PubMed - indexed for MEDLINE]

1: Lik Sprava. 1997 Sep-Oct;(5):170-2. Links

[A comparative evaluation of the efficacy of magneto- and laser therapy in patients with osteoarthrosis deformans]

[Article in Russian]

Selivonenko VG, Syvolap VD, Porada LV, Medvedeva VN, Boev SS, Morozov AI, Slin'ko VG, Berest SM, Garbuz LN, Sholokh SG.

A comparative evaluation of efficacy of magneto- and laser therapy was carried out in 82 patients with osteoarthrosis deformans. The magnetic field and laser irradiation dispelled the pain syndrome and synovitis manifestations. It is recommendable that the multiple-modality therapy of patients with osteoarthrosis deformans should involve magneto- and laser therapy (15 to 20 procedures per one course) that improve results of the treatment being received and allow the time of hospitalization to be reduced at an average by 5 bed-days. Laser appeared to be a very effective mode of treatment. No unfavourable side effects were recordable.

PMID: 9491734 [PubMed - indexed for MEDLINE]

: Braz Dent J. 2002;13(2):109-12. Links

Does LLLT stimulate laryngeal carcinoma cells? An in vitro study.

Pinheiro AL, do Nascliento SC, de Vieira AL, Rolim AB, da Silva PS, Brugnera A Jr.

Faculty of Dentistry, Federal University of Bahia, Salvador, BA, Brazil. albp@ufba.br

Low level laser therapy (LLLT) has been used successfully in biomedicine and some of the results are thought to be related to cell proliferation. The effects of LLLT on cell proliferation is debatable because studies have found both an increase and a decrease in proliferation of cell cultures. Cell culture is an excellent method to assess both effects and dose of treatment. The aim of this study was to assess the effect of 635nm and 670 nm laser irradiation of H.Ep.2 cells in vitro using MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide). The cells were obtained from squamous cell carcinoma (SCC) of the larynx and were routinely processed from defrost to the experimental condition. Twenty-four hours after transplantation the cells were irradiated with doses ranging from 0.04 to 0.48J/cm2 for seven consecutive days (5 mW diode lasers: 635nm or 670 nm, beam cross-section approximately 1 mm) at local light doses between 0.04 and 0.48 J/cm2. The results showed that 635nm laser light did not significantly stimulate the proliferation of H.Ep.2 cells at doses of 0.04 J/cm2 to 0.48 J/cm2, However, 670nm laser irradiation led to an increased cell proliferation when compared to both control and 635nm irradiated cells. The best cell proliferation was found with 670nm laser irradiated cultures exposed to doses of doses of 0.04 to 0.48 J/cm2. We conclude that both dose and wavelength are factors that may affect cell proliferation of H.Ep.2 cells.

PMID: 12238800 [PubMed - indexed for MEDLINE]

1: Int J Pediatr Otorhinolaryngol. 2002 Jun 17;64(2):143-57.   Links

A review of the current management of infantile subglottic haemangioma, including a comparison of CO(2) laser therapy versus tracheostomy.

Chatrath P, Black M, Jani P, Albert DM, Bailey CM.

Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK. pchatrath@yahoo.com

OBJECTIVES: We reassessed the current practice and treatment options used in the management of subglottic haemangiomas (SGHs), including the place for open submucosal surgical excision, and have compared the results of different therapeutic modalities used for SGHs. METHODS: The two studies were conducted as separate exercises; (1) a retrospective review of 36 patients collected over a recent 8-year period to assess the current practice and treatment options in use; (2) a retrospective comparative study of a previous cohort of 51 patients with SGHs treated in one of four groups: (a) tracheostomy alone, (b) tracheostomy and CO(2) laser, (c) systemic steroids and CO(2) laser (no tracheostomy) and (d) intralesional steroid injection, CO(2) laser therapy, or both, followed by intubation. RESULTS: Systemic steroids were the most commonly used modality of treatment. Resolution of the SGH was achieved in 89% of cases at a mean follow up duration of 34 months. However, tracheostomy was required in 58% of cases, with a mean time from diagnosis to decannulation of 30 months. The time to resolution of SGHs does not appear to be reduced by laser therapy compared with treatment by tracheostomy alone. Intralesional steroid injection or laser therapy together with intubation was associated with avoidance of a tracheostomy in 66% of cases. Single-stage open surgical excision in two cases resulted in successful resolution of the SGH and discharge after a mean follow up period of 3 months. CONCLUSIONS: Despite the more widespread use of steroids and other treatment modalities, the requirement for tracheostomy has remained unchanged over the last 20 years. The use of laser therapy does not appear to confer any additional therapeutic benefit over and above tracheostomy alone in bringing about resolution of SGHs. Systemic steroids may reduce the size of the haemangioma but are associated with multiple adverse effects. The decision to use the above techniques must, therefore, be made in the light of these observations. Our early experience of single-stage excision suggests that this technique represents an exciting and promising surgical alternative, and its more widespread adoption may be the only way of further improving the outcome of patients with SGHs.

PMID: 12049827 [PubMed - indexed for MEDLINE]

1: Eur Arch Otorhinolaryngol. 2001 Sep;258(7):349-52.   Links

Photodynamic therapy of premalignant lesions and local recurrence of laryngeal and hypopharyngeal cancers.

Centre for Laser Diagnostics and Therapy, Department of Internal Diseases and Physical Medicine, Silesian Medical University, Katowice, Poland.

The main advantage of photodynamic therapy (PDT) in laryngology seems to be its non-invasiveness and the possibility of using it despite previous application of conventional methods. In the study, we gave PDT to two separate groups of patients, i.e. five patients with advanced tumour (four of them with local recurrence (squamous cell carcinoma) after surgery and radiotherapy and one with a primary hypopharyngeal tumour) and five patients with leucoplakia. In the first group delta-aminolaevulinic acid (ALA) was administered orally (dose 3 g), while in the second, an ointment containing 10% ALA was applied locally. In both groups prior to irradiation, the tissue level of protoporphyrin IX was verified using an adapted Xillix Life instrument. All treated lesions were irradiated with an argon-pumped dye laser (dose range 100-250 J/cm2, wavelength 635 nm). In the first group, partial response was obtained. In these advanced cases, diminution of cancerous ulcerations was observed. In the leucoplakia group, complete response was achieved in four out of five treated patients. On the basis of our preliminary results, PDT may be useful in eradicating premalignant lesions of the oral cavity and in the palliation of advanced lesions of the oropharynx and larynx.

PMID: 11699825 [PubMed - indexed for MEDLINE]

1: Acta Odontol Scand. 2006 Apr;64(2):89-96.   Links

Long-term effect on tinnitus by treatment of temporomandibular disorders: a two-year follow-up by questionnaire.

Department of Clinical Oral Physiology, Institute of Odontology, Karolinska Institutet, Huddinge, Sweden. marie.tullberg@brahekliniken.se

OBJECTIVE: The aim of the study was to investigate the presence of symptoms and signs of temporomandibular disorders (TMD) in patients with tinnitus and to evaluate the effect of TMD treatment on tinnitus in a long-term perspective in comparison with a control group of patients on a waiting list. MATERIAL AND METHODS: One-hundred-and-twenty patients with tinnitus were subjected to a clinical examination of the masticatory system and whether they had co-existing TMD to TMD treatment. Ninety-six patients had TMD, most frequently localized myalgia. Seventy-three of these completed the treatment and responded to a questionnaire 2 years later. Fifty patients with tinnitus who were on the waiting list served as a control group. RESULTS: Eighty percent of the patients had signs of TMD, most commonly myofascial pain. Forty-three percent of the patients reported that their tinnitus was improved at the 2-year follow-up, 39% that it was unchanged, and 17% that it was impaired compared to before the treatment. Twelve percent of the subjects in the control group reported that their tinnitus was improved compared to 2 years previously, 32% that it was unchanged, and 56% that it was impaired. The difference between groups was significant (chi(2): p<0.001). CONCLUSION: The results of this study showed that TMD symptoms and signs are frequent in patients with tinnitus and that TMD treatment has a good effect on tinnitus in a long-term perspective, especially in patients with fluctuating tinnitus.

PMID: 16546850 [PubMed - indexed for MEDLINE]