Treatment Efficacy of Local Anesthetic/Steroid Mixture Injection for Patients With Odynophonia

This is a double-blind, randomized, placebo-controlled trial. A total of 40 subjects will be randomized to experimental group (receiving bupivacaine/triamcinolone mixture) or control group (receiving saline injection). Two injections will be given one week apart. The primary outcome measure is the reduction in pain on the abbreviated McGill Pain Questionnaire (MPQ).

Study Overview

• Status: Withdrawn
• Conditions: Patients With a Diagnosis of Odynophonia
• Intervention / Treatment: Drug: Bupivacain; Other: Normal Saline

Detailed Description

This is a double-blind, randomized, placebo-controlled trial. A total of 40 subjects will be randomized to experimental group (receiving bupivacaine/triamcinolone mixture) or control group (receiving saline injection). Two injections will be given one week apart. The primary outcome measure is the reduction in pain on the abbreviated McGill Pain Questionnaire (MPQ).

The injection of a mixture of local anesthetic/steroid into the thyrohyoid membrane to target the internal branch of superior laryngeal nerve (SLN) has been shown to be effective for some patients with chronic cough. Although anecdotal experience suggests this injection may also be effective in alleviating neck pain in patients with odynophonia (pain associated with voicing), there are no prospective studies to define the efficacy of this injection for odynophonia. The purpose of the study is to conduct a randomized, placebo-controlled study on the effect of local anesthetic/steroid injection for patients with odynophonia.

Recruitment/Consent Patients with a diagnosis of odynophonia seen at the UT Southwestern Voice Center will be informed of the study and given the opportunity to participate. Consent will be carried out by the study team members.

Randomization Subjects will be assigned a Study ID sequentially by the study coordinator upon enrollment. Each study ID (from Subject 01 to Subject 40) will be a priori assigned to either the experimental group or the control group using a randomization function in Excel.

Blinding Subjects will be blinded to group assignment. The physicians who are the treating providers of the subjects and who will perform the injections will also be blinded to group assignment. At each clinic visit for a subject's injection, the study coordinator will inform the clinic nurse of the group assignment, and the nurse will draw up the corresponding 2 mL injectate (either the bupivacaine/triamcinolone mixture or saline) and wrap the syringe in foil. The syringe will then be provided to the physician for the injection.

Injections Injections will be performed in the usual fashion as for standard of care injections commonly performed. The subject will be seated in the exam chair with the chair slightly inclined to extend the neck.

Only unilateral injections will be performed even for patients with bilateral pain, so that the dose is the same for all subjects. Patients with bilateral pain will be asked to choose one side for the injection for the duration of the study. The patients will only be billed for a regular clinic visit and not for the actual injections.

Subjects in the Experimental Group will received a 2 mL injection consisting of 1 mL of 0.5% bupivacaine (5 mg bupivacaine-HCL) and 1 mL Kenalog-40 (40 mg triamcinolone acetonide). Subjects in the Control Group will receive 2 mL saline. A 1.5-in, 25G or 27G needle will be used.

Outcome Instruments The treatment progress/outcome will be based on questionnaires (modified version of McGill-Melzack Pain Questionnaire, Numeric Pain Scale, Brief Pain Inventory, Vocal Tract Discomfort scale and Voice Handicap Index-10) and the clinician's auditory-perceptual and acoustic analysis of voice. The data will be taken during the initial evaluation, at each treatment session, and post-treatment.

• Study Type: Interventional
• Phase: Phase 4

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Patients who report pain associated with voicing and are diagnosed with odynophonia

Exclusion Criteria:

• • Vocal fold mobility or tissue abnormality

  • history of jaw surgery/TMJ
  • history of neck surgery or trauma
  • Uncontrolled reflux. (patient's scoring on Reflux Symptom Index(RSI) is 13 or higher: Normative data suggests that a RSI of greater than or equal to 13 is clinically significant.)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: The experimental group; At each clinic visit for a subject's injection, the study coordinator will inform the clinic nurse of the group assignment, and the nurse will draw up the corresponding 2 mL injectate (either the bupivacaine/triamcinolone mixture) and wrap the syringe in foil. The syringe will then be provided to the physician for the injection.	Drug: Bupivacain; FDA approved drug; Other Names: Kenalog-40
Placebo Comparator: The control group; At each clinic visit for a subject's injection, the study coordinator will inform the clinic nurse of the group assignment, and the nurse will draw up the corresponding 2 mL saline and wrap the syringe in foil. The syringe will then be provided to the physician for the injection.	Other: Normal Saline; FDA approved

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in pain on the McGill Pain Questionnaire	The McGill Pain Questionnaire (MPQ) is a valid and reliable measure of pain. The MPQ captures pain intensity on a 0 to 10 scale where 0 indicating no pain and 10 indicating severe pain	Baseline, Visit 2 (approximately 1 week)

Collaborators and Investigators

• Sponsor: University of Texas Southwestern Medical Center

Study record dates

Study Major Dates

• Study Start (Anticipated): July 1, 2023
• Primary Completion (Anticipated): December 31, 2024
• Study Completion (Anticipated): December 31, 2027

Study Registration Dates

• First Submitted: December 8, 2021
• First Submitted That Met QC Criteria: December 30, 2021
• First Posted (Actual): January 5, 2022

Study Record Updates

• Last Update Posted (Actual): July 28, 2022
• Last Update Submitted That Met QC Criteria: July 25, 2022
• Last Verified: July 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Physiological Effects of Drugs; Central Nervous System Depressants; Peripheral Nervous System Agents; Sensory System Agents; Anesthetics; Anti-Inflammatory Agents; Immunosuppressive Agents; Immunologic Factors; Glucocorticoids; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Anesthetics, Local; Triamcinolone Acetonide; Bupivacaine
• Other Study ID Numbers: STU-2020-0443

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes