title: Local steroid injection via the cricothyroid membrane in patients with a vocal nodule.
abstract: OBJECTIVE
  To analyze the usefulness and safety of a steroid injection into vocal nodules via the cricothyroid membrane. Local administration of steroid directly into the larynx has been reported in many laryngeal diseases with different methods.
  
  
  METHODS
  Prospective case series at an academic tertiary care hospital.
  
  
  METHODS
  Eighty patients with vocal nodules were enrolled between December 2008 and May 2010.
  
  
  METHODS
  Triamcinolone acetonide was injected through the cricothyroid membrane with a transnasal flexible laryngoscope to patients in a sitting position.
  
  
  METHODS
  Vocal nodules were evaluated before and 2 and 4 weeks after the injection; improvement was assessed both objectively and subjectively.
  
  
  RESULTS
  The nodules disappeared in 35 patients by the fourth week after the injection (44%), and 39 patients showed improvement (49%). Jitter, shimmer, maximum phonation time, and mean voice handicap index also improved significantly after the steroid injection (P < .05 for all). Six patients with voice-related occupations showed improvement at the second week (8%), but the nodules had recurred after 4 weeks. Four patients experienced mild vocal fold atrophy, and 2 patients showed a white plaque formation on the vocal fold that resolved spontaneously 1 to 2 months after the injection.
  
  
  CONCLUSIONS
  A local steroid injection via the cricothyroid membrane is a useful and safe treatment option for vocal nodules. However, vocal nodules are caused mainly by excessive voice use; therefore, nodules can recur unless the voice use pattern changes. Further study of this treatment technique, including long-term follow-up, is needed.
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyeong-dong, Jongno-gu, Seoul, South Korea.
authors: Sang-Hyuk
authors: SH
authors: Lee
authors: Jang-Ok
authors: JO
authors: Yeo
authors: Jeong-Im
authors: JI
authors: Choi
authors: Hee-Jin
authors: HJ
authors: Jin
authors: Jin-Pyeong
authors: JP
authors: Kim
authors: Seung-Hoon
authors: SH
authors: Woo
authors: Sung-Min
authors: SM
authors: Jin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections / Q000379:methods*; D007818:Laryngeal Diseases / Q000188:drug therapy* / Q000473:pathology; D007821:Laryngeal Muscles; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014827:Vocal Cords; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide