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Hamdan AL, Hosri J, Daou CAZ, Yammine Y, Ghzayel L, Nawfal N, Sataloff RT. Office-Based Blue Laser Therapy vs Thulium Laser Therapy for Reinke's Edema. J Voice 2024:S0892-1997(24)00215-7. [PMID: 39127535 DOI: 10.1016/j.jvoice.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To compare the treatment outcomes of patients with Reinke's edema (RE) who were treated in-office using the blue laser vs those treated in-office using the thulium laser. STUDY DESIGN Retrospective case-control study. METHODS The medical records and video recordings of patients who underwent office-based thulium laser therapy for RE between November 2018 and July 2019, and office-based blue laser therapy for RE between November 2023 and March 2024 in a tertiary referral center were reviewed. The primary outcome measures used in this study were the Voice Handicap Index-10 (VHI-10) score and disease regression based on the laryngeal examination performed before and after therapy. RESULTS Twenty-two patients were included in this study. They were divided into 2 subgroups, 12 patients with 22 lesions who underwent office-based thulium therapy and 10 patients with 17 lesions who underwent office-based blue laser therapy. There was no significant difference in the decrease in the mean VHI-10 score following surgery between those treated with the thulium laser vs those treated with the blue laser (10.5 ± 13.15 vs 8.2 ± 5.98, P = 0.657). Nine out of 22 lesions (40.9%) treated with thulium laser regressed completely compared to 9 out of 17 lesions (52.9%) treated with a blue laser. The difference in disease regression between the two subgroups was not statistically significant (P = 0.455). CONCLUSIONS Blue laser and thulium laser can be used interchangeably in-office for the treatment of RE with no significant difference in patient self-perceived improvement in voice quality and disease regression. A larger study using objective measures is warranted.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Jad Hosri
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christophe Abi Zeid Daou
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yara Yammine
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lana Ghzayel
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nader Nawfal
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Robert T Sataloff
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Bhat AM, Marrero-Gonzalez AR, Nguyen SA, Scharner M, Meenan K, Sataloff RT. Photoangiolytic Lasers for Treatment of Benign Laryngeal Lesions: A Systematic Review and Meta-Analysis. Laryngoscope 2024. [PMID: 39119758 DOI: 10.1002/lary.31658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/24/2024] [Accepted: 07/09/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES To compare the efficacy of the 445-nm blue laser to the 585-nm pulsed dye laser (PDL) and 532-nm potassium-titanyl-phosphate (KTP) laser in the treatment of benign laryngeal lesions. DATA SOURCES Cochrane Library, PubMed, Scopus, and CINAHL. REVIEW METHODS Following PRISMA guidelines, databases were searched from inception through January 29, 2024, for studies reporting the use of photoangiolytic lasers for treatment of benign laryngeal lesions, including the 585-nm PDL, 532-nm KTP laser, and 445-nm blue laser. Outcome measures included lesion resolution (%), mean differences (Δ) in Voice Handicap Index (VHI-10), and summed dysphonia grade, roughness, and breathiness (GRB) scale. RESULTS A total of 45 studies were included for meta-analysis, consisting of 348 patients treated with PDL, 550 patients with KTP laser, and 338 patients with blue laser. Treatment with blue laser resulted in the greatest lesion resolution (94.0%; 95% confidence interval [CI]: 90.2%-96.7%), followed by KTP laser (90.4%; 95% CI: 84.1%-95.2%), and PDL (86.9%; 95% CI: 62.9%-99.2%). VHI-10 improved significantly in patients following treatment with blue laser (Δ13.3; 95% CI: 10.7-16.0; p < 0.0001), KTP laser (Δ10.3; 95% CI: 7.4-13.3; p < 0.0001), and PDL (Δ7.4; 95% CI: 4.8-10.1; p < 0.0001). GRB improved significantly in patients following treatment with blue laser (Δ4.1; 95% CI: 2.9-5.2; p < 0.0001), KTP laser (Δ3.0; 95% CI: 2.0-4.0; p < 0.0001), and PDL (Δ2.5; 95% CI: 0.8-4.2; p = 0.005). CONCLUSIONS Photoangiolytic lasers are effective in treating benign laryngeal lesions. Blue lasers are promising for laryngeal laser surgery. Laryngoscope, 2024.
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Affiliation(s)
- Akash M Bhat
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Alejandro R Marrero-Gonzalez
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Megan Scharner
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Kirsten Meenan
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
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Tam AKY, Leung NMW, Lee SKJ, Wei Y, Hu Y, Chan JYK, Law T. Randomized Controlled Trial of Awake Transnasal Laser-Assisted Surgery for Benign Laryngeal Lesions. Laryngoscope 2024; 134:3732-3740. [PMID: 38727019 DOI: 10.1002/lary.31481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/23/2024] [Accepted: 04/15/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To compare functional and cost-effectiveness of awake transnasal laser assisted-surgery versus microlaryngeal surgery for benign laryngeal lesions. METHODS This was a prospective non-inferiority randomized controlled trial conducted from May 2021 to December 2022 at two tertiary referral hospitals in Hong Kong. Patients were block-randomized to receive either awake transnasal laser-assisted surgery or microlaryngeal surgery, with post-operative follow-up in a multidisciplinary voice clinic for 1-year. Primary outcome was Voice Handicap Index (VHI-30). Secondary outcomes included operation time, complications, length of stay, peri-operative discomfort, recurrence, and medical costs. RESULTS Sixty-one patients were randomized to either awake transnasal laser-assisted surgery (n = 30) and microlaryngeal surgery (n = 31). Both groups had comparable demographics and laryngeal pathologies. Both groups showed significant improvement of VHI-30 score over time and had comparable post-operative VHI-30. Awake transnasal laser-assisted surgery group had a significantly shorter length of stay (0.5 vs. 1 day) and less throat discomfort (2 vs. 4) compared to microlaryngeal surgery group. Intraoperative complications were more common in microlaryngeal surgery group (14.3% vs. 0%). Otherwise, both groups had similar operative time and recurrence rate. Cost-analysis showed a significantly lower hospital cost for awake transnasal laser-assisted surgery (USD 3090) compared to microlaryngeal surgery group (USD 5120). CONCLUSION Awake transnasal laser-assisted surgery was safe, functionally non-inferior, as measured by VHI-30, to microlaryngeal surgery in managing benign laryngeal lesions, while superior to microlaryngeal surgery in peri-operative discomfort and medical costs. LEVEL OF EVIDENCE 2 Laryngoscope, 134:3732-3740, 2024.
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Affiliation(s)
- Aurora Ka Yue Tam
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Natalie Moon Wah Leung
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shui Kwong John Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yifeng Wei
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- The Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yunyi Hu
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- The Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason Ying Kuen Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas Law
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- The Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR, China
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Adly AS, Adly MS, Cuisinier F, Egea JC, Panayotov I, Adly AS, Malthiery E. Laser-Induced Blood Coagulation for Surgical Application: A Scoping Review. Semin Thromb Hemost 2024; 50:236-252. [PMID: 37611623 DOI: 10.1055/s-0043-1772573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
There is a lack of evidence-based reviews on the effects of laser irradiation on blood coagulation in the literature, despite a large number of clinical trials. We therefore evaluated the available evidence on laser irradiation parameters used in coagulation of blood to optimize physical parameters. We performed a literature search for recent scientific studies indexed between 2017 and 2023 using the databases of PubMed and ScienceDirect. Articles were selected based on defined inclusion and exclusion criteria, and 78 publications in total were eventually included in this scoping review. The following were found to produce significant benefits in blood coagulation for surgical application: (1) dentistry and oral surgeries: 980 nm, 27 s, 2 W, 1502.7 W/cm2, 26.5 J, 622 J/cm2, 400 μm; (2) urogenital disorders: 532 nm, 4 s, 40 W, 10600 W/cm2, 1.3 J, 424 J/cm2, 600 μm; (3) ophthalmic disorders: 810 nm, 1 s, 1 W, 3540 W/cm2, 0.75 J, 1326 J/cm2, 100 μm; (4) embryological surgeries: 1064 nm, 10 s, 25 W, 35400 W/cm2, 262.5 J, 371000 J/cm2, 332.5 μm; (5) dermatological disorders: 1064 nm, 20 W, 2440 W/cm2, 0.1 J, 24 J/cm2, 670 μm; (6) gastrointestinal disorders: 532 nm, 3 s, 20 W, 1051 W/cm2, 120 J, 26500 J/cm2, 760 μm; (7) neurological surgeries: 2.5 s, 1.5 W, 1035 W/cm2, 2 J, 1584 J/cm2, 385 μm; (8) pulmonary disorders: 1320 nm, 5s, 35 W, 12450 W/cm2, 250 J, 65000 J/cm2, 700 μm (9) cardiovascular disorders: 1064 nm, 16.5 s, 5 W, 1980.5 W/cm2, 900 J, 760 J/cm2, 400 μm. In conclusion, our scoping review identifies that combining data from all clinically heterogeneous studies suggests that laser irradiation reflects an effective method for inducing blood coagulation in several medical fields.
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Affiliation(s)
| | - Mahmoud Sedky Adly
- LBN, Univ Montpellier, Montpellier, France
- Royal College of Surgeons of Edinburgh, Scotland, United Kingdom
| | - Frederic Cuisinier
- LBN, Univ Montpellier, Montpellier, France
- CSERD, CHU Montpellier, Montpellier, France
- UFR Odontologie, Univ. Montpellier, Montpellier, France
| | - Jean-Christophe Egea
- LBN, Univ Montpellier, Montpellier, France
- CSERD, CHU Montpellier, Montpellier, France
- UFR Odontologie, Univ. Montpellier, Montpellier, France
| | - Ivan Panayotov
- LBN, Univ Montpellier, Montpellier, France
- CSERD, CHU Montpellier, Montpellier, France
- UFR Odontologie, Univ. Montpellier, Montpellier, France
| | | | - Eve Malthiery
- LBN, Univ Montpellier, Montpellier, France
- CSERD, CHU Montpellier, Montpellier, France
- UFR Odontologie, Univ. Montpellier, Montpellier, France
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Lin S, Lin Q, Huang X, Yu Q, Wang D. Surgical management of broad-based sessile vocal cord polyps: Transnasal vocal fold polypectomy versus microlaryngoscopic surgery: Our experience in 159 cases. Clin Otolaryngol 2023; 48:902-908. [PMID: 37532258 DOI: 10.1111/coa.14090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/07/2023] [Accepted: 07/15/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES In this study, we retrospectively reviewed and compared the treatment outcomes and complications of office transnasal vocal fold polypectomy (TVFP) with those of microplarygoscopic surgery (MLS) for different clinical and histopathological features of broad-based sessile vocal fold polyps. METHODS We retrospectively reviewed the records of 159 consecutive patients with broad-based sessile vocal fold polyps treated by TVFP or MLS. The differences in efficacy and complication between these two surgical techniques were compared according to the different types of vocal fold polyps. RESULTS Satisfactory outcomes of both TVFP and MLS treatments were reported in patients with oedematous, gelatinous and vascular types of vocal fold polyps (p > .05). The efficacy of TVFP was slightly worse than MLS in fibrous polyps group (p < .05). The TVFP-treated patients did not exhibit obvious complications, whereas several MLS-treated patients had suffered different complications. CONCLUSION The therapeutic effects of both TVFP and MLS on the treatment of broad-based sessile vocal cord polyps are related to their clinical characteristics and histological types. Satisfactory outcomes are achieved in oedematous, gelatinous, and vascular types of polyps after either surgical procedure. TVFP has fewer surgical complications than MLS which can be a preferred option for the treatment of broad-based sessile vocal cord polyps at outpatient setting. TVFP also can be an alternative surgery option for patients who could not tolerate general anaesthesia or laryngeal suspension. In contrast, MLS has proven to be a particularly advantageous treatment in patients who have fibrous type of polyps.
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Affiliation(s)
- Shuchun Lin
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qin Lin
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaoting Huang
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qian Yu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Desheng Wang
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fuzhou, China
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White AC, Awad R, Carding P. Pre and Post-operative Voice Therapy Intervention for Benign Vocal Fold Lesions: A Systematic Review. J Voice 2023; 37:857-874. [PMID: 34272141 DOI: 10.1016/j.jvoice.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/01/2021] [Accepted: 06/06/2021] [Indexed: 01/16/2023]
Abstract
Benign vocal fold lesions cause dysphonia by preventing vocal fold closure, causing irregular vibration and increasing compensatory muscle tension. Voice therapy delivered in addition to phonosurgery may improve voice and quality of life outcomes but the evidence base is lacking and what constitutes voice therapy for this population is not defined. The purpose of this systematic review is to critically evaluate the evidence for pre and post-operative voice therapy to inform the development of an evidence based intervention. STUDY DESIGN Systematic Review. METHODS Electronic databases were searched using key terms including dysphonia, phonosurgery, voice therapy and outcomes. Eligible articles were extracted and reviewed by the authors for risk of bias and for information regarding the content, timing and intensity of any pre and post-operative voice therapy intervention. RESULTS Of the 432 articles identified, 35 met the inclusion criteria and were included in the review. 5 were RCTs, 2 were individual cohort studies, 1 was a case control study and 26 were case series. There was considerable heterogeneity in participant characteristics. Information was frequently lacking regarding the content timing and intensity of the reported voice therapy intervention, and where present, interventions were highly variable. CONCLUSION Reporting in relevant literature is limited in all aspects of content, timing and intensity of intervention. Further intervention development work is required to develop a robust voice therapy treatment intervention for this population, before effectiveness work can commence.
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Affiliation(s)
- Anna C White
- Division of Rehabilitation, Wellbeing and Ageing, University of Nottingham, Nottingham NG7 2UH; Nottingham University Hospitals NHS Trust, Nottingham, NG72UH.
| | - Rehab Awad
- Lewisham and Greenwich NHS Trust, University Hospital Lewisham Hospital, Lewisham High Street, London, SE13 6LH; Kasr Alaini Hospital, Cairo University, Al-Saray Street, El Manial, Cairo, 11956, Egypt
| | - Paul Carding
- Health & Life Sciences, Oxford Institute of Nursing, Midwifery & Allied Health Research, Jack Straws Lane, Oxford, OX3 0FL, England
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Kenny HL, Friedman L, Blake Simpson C, McGarey PO. Vocal Fold Polyps: A Scoping Review. J Voice 2023:S0892-1997(23)00180-7. [PMID: 37433709 DOI: 10.1016/j.jvoice.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE This review aims to summarize the current understanding of vocal fold polyp etiology, pathophysiology, and prognosis, as well as recent developments in management. STUDY DESIGN Scoping literature review. REVIEW METHODS OVID Medline, PubMed, Google Scholar, Conference Papers Index, and Cochrane Library were searched for publications within the last 5 years using terms including "vocal," "cord," "fold," and "polyp." All abstracts were screened. Relevant studies pertaining to the etiology, pathophysiology, diagnosis, management, and prognosis of vocal fold polyps (VFPs) were included for review. RESULTS Eight-hundred and sixty-five citations resulted from database review. Seven-hundred and thirty citations remained after the exclusion of duplicates. One hundred and ninety-three papers underwent abstract review, with 73 citations undergoing full-text review. Fifty-nine papers were included in the review. CONCLUSIONS VFPs are one of the most common subtypes of benign vocal fold lesions. Phonotrauma contributes significantly to the development of these lesions, with laryngopharyngeal reflux and smoking also contributing. Correct diagnosis relies on a careful history, stroboscopy, response to voice therapy, and, in some cases, intraoperative findings. Phonosurgery is a definitive means of treatment, though more recently, in-office procedures have demonstrated efficacy and are potentially less costly and less invasive treatment options. Treatment modalities can be tailored based on the type and size of the lesion, the patient's vocal needs, medical comorbidities, and initial response to voice therapy. Voice specialists can anticipate greater emphasis placed on minimally invasive office-based procedures for the management of vocal pathology.
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Affiliation(s)
- Hannah L Kenny
- University of Virginia School of Medicine, Charlottesville, Virginia; Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Lisa Friedman
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
| | - C Blake Simpson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, Alabama
| | - Patrick O McGarey
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia.
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Barsties V Latoszek B, Watts CR, Hetjens S, Neumann K. The Efficacy of Different Voice Treatments for Vocal Fold Polyps: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12103451. [PMID: 37240557 DOI: 10.3390/jcm12103451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Vocal fold polyps (VFP) are a common cause of voice disorders and laryngeal discomfort. They are usually treated by behavioral voice therapy (VT) or phonosurgery, or a combination (CT) of both. However, the superiority of either of these treatments has not been clearly established. METHODS Three databases were searched from inception to October 2022 and a manual search was performed. All clinical trials of VFP treatment were included that reported at least auditory-perceptual judgment, aerodynamics, acoustics, and the patient-perceived handicap. RESULTS We identified 31 eligible studies (VT: n = 47-194; phonosurgery: n = 404-1039; CT: n = 237-350). All treatment approaches were highly effective, with large effect sizes (d > 0.8) and significant improvements in almost all voice parameters (p-values < 0.05). Phonosurgery reduced roughness and NHR, and the emotional and functional subscales of the VHI-30 were the most compared to behavioral voice therapy and combined treatment (p-values < 0.001). Combined treatment improved hoarseness, jitter, shimmer, MPT, and the physical subscale of the VHI-30 more than phonosurgery and behavioral voice therapy (p-values < 0.001). CONCLUSIONS All three treatment approaches were effective in eliminating vocal fold polyps or their negative sequelae, with phonosurgery and combined treatment providing the greatest improvement. These results may inform future treatment decisions for patients with vocal fold polyps.
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Affiliation(s)
- Ben Barsties V Latoszek
- Speech-Language Pathology, SRH University of Applied Health Sciences, 40210 Düsseldorf, Germany
| | - Christopher R Watts
- Harris College of Nursing & Health Sciences, Texas Christian University, Fort Worth, TX 76109, USA
| | - Svetlana Hetjens
- Department for Medical Statistics and Biomathematics, Medical Faculty Mannheim, University of Heidelberg, 68165 Mannheim, Germany
| | - Katrin Neumann
- Department of Phoniatrics and Pediatric Audiology, University Hospital Münster, University of Münster, 48149 Münster, Germany
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Abi Zeid Daou C, Ghanem A, Hosri J, Abou Raji Feghali P, Hamdan AL. Office-Based Laser Therapy in Vocal Fold Polyps: A Systematic Review and Meta-Analysis. J Voice 2023:S0892-1997(23)00095-4. [PMID: 37003865 DOI: 10.1016/j.jvoice.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES To analyze voice outcomes and lesion regression in patients with vocal fold polyps treated in-office using lasers. STUDY DESIGN Systematic review and meta-analysis. METHODS The search was performed in the Medline, Embase, and Cochrane databases using the preferred reporting items for systematic review and meta-analyses framework. There were no limitations to the year of publication and the search included studies looking at voice outcomes and lesion evolution of in-office laser treatment for vocal fold polyps measured through voice-handicap index, GRB, acoustic analysis or aerodynamics measures. Risk of bias was assessed using Cochrane's ROBINS-I tool for observational studies. Data analysis was performed SPSS software with a significance level of 5%. RESULTS We identified 167 articles, 10 of which met the inclusion criteria and were analyzed. The total number of participants was 242. Meta-analysis showed significant improvement in voice handicap index-10 scores (95% CI, [0.86; 1.45]) and decrease in GRB score (95% CI, [1.09; 4.13]) after in-office laser therapy. It also showed significant improvement in percent shimmer (95% CI, [0.26; 1.01]), and significant increase in maximum phonation time (95% CI, [-0.92; -0.18]). CONCLUSIONS Laser therapy an outpatient office setting is a reliable alternative to classical phono-microsurgery. Results show Office-based laser therapy of vocal fold polyps results in a significant improvement in subjective voice outcomes measures. This subjective improvement in voice quality is associated with partial or complete disease regression on laryngeal examination and an increase in maximum phonation time. Ovlaryngeal examination in patients with polyps treated with in-office laser.
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Affiliation(s)
- Christophe Abi Zeid Daou
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Anthony Ghanem
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon.
| | - Jad Hosri
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Patrick Abou Raji Feghali
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Abdul-Latif Hamdan
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon.
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Englert M, Barsties v. Latoszek B, Maryn Y, Behlau M. Validation of the Acoustic Voice Quality Index, Version 03.01, to the Brazilian Portuguese Language. J Voice 2021; 35:160.e15-160.e21. [DOI: 10.1016/j.jvoice.2019.07.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
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Hung WC, Lo WC, Fang KM, Cheng PW, Wang CT. Longitudinal Voice Outcomes Following Serial Potassium Titanyl Phosphate Laser Procedures for Recurrent Respiratory Papillomatosis. Ann Otol Rhinol Laryngol 2020; 130:363-369. [PMID: 32847376 DOI: 10.1177/0003489420950374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Repeated surgical interventions are usually required to control recurrent respiratory papillomatosis (RRP), but at considerable risk of worsened postoperative voice quality. Potassium titanyl phosphate (KTP) laser has been reported to effectively manage RRP; however, voice quality after repeated procedures has not been investigated. METHODS This study recruited 16 patients with RRP treated using KTP laser between 2013 and 2019. KTP laser procedures were performed under general anesthesia via direct suspension laryngoscope or under local anesthesia via flexible endoscope, depending on the need for pathological proof, patient tolerance, and lesion size and location. Disease control was investigated by videolaryngostroboscopy. Voice outcome was evaluated using a 10-item voice handicap index (VHI-10), acoustic and perceptual analyzes. RESULTS We reviewed the medical records of 11 male and 5 female patients with RRP (age range: 23-73 years). Five patients received KTP laser once, six patients received it 2 to 5 times, and five patients received 6 to 15 procedures. Median VHI-10 decreased from 28.3 to 12.0 points after the initial procedure and were maintained at 10.1 to 11.0 points following subsequent procedures (P < .01, generalized estimating equation). Acoustic and perceptual analysis of voice quality also revealed significant improvements (P < .01), which remained stable even after 6 to 10 KTP laser procedures. Minor adverse events included slight fibrotic change of vocal folds and glottic web, but these did not significantly alter postoperative voice quality. CONCLUSION This longitudinal follow-up study revealed that serial KTP laser procedures can effectively control RRP while preserving phonatory function and maintaining adequate voice quality. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Wei-Chen Hung
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei
| | - Wu-Chia Lo
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei
| | - Kai-Min Fang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei
| | - Po-Wen Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei.,Department of Special Education, University of Taipei, Taipei.,Department of Otolaryngology, National Taiwan University College of Medicine, Taipei.,Department of Electrical Engineering, Yuan Ze University, Taoyuan.,Department of Otolaryngology Head and Neck Surgery, National Taiwan University Hospital, Taipei
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Ma J, Fang R, Zhen R, Mao W, Wu X, He P, Wei C. A 532-nm KTP Laser for Vocal Fold Polyps: Efficacy and Relative Factors. EAR, NOSE & THROAT JOURNAL 2020; 100:87S-93S. [PMID: 32776834 DOI: 10.1177/0145561320946153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We retrospectively analyzed the laryngoscopy results and voice outcomes of patients with vocal polyps who received potassium titanyl phosphate (KTP) laser treatments in a clinician's office, in order to establish the effectiveness and relative factors affecting the efficacy of this treatment. MATERIAL AND METHODS We enrolled 25 patients with vocal polyps who had undergone KTP laser treatment in the Department of Otorhinolaryngology at our hospital between July 2017 and November 2019. Pre- and postoperative evaluations were measured using laryngovideostroboscopy (LVS), the Voice Handicap Index questionnaire (VHI-30), the GRBAS scale (G hoarseness, R roughness, B breathiness, A asthenia, S strain), and objective acoustic parameters. The reduction rate of lesions was calculated and relative factors affecting efficacy (size, side, location, the position of lesions, type, gender, and occupation) were tested. RESULTS Areas of lesions decreased from 101.95 ± 70.16 before surgery to 30.49 ± 35.80 after surgery (Z = 5.234, P < .001). The LVS data showed that the postoperative proportions of normal to mild conditions were the same or higher than the preoperative data in 3 instances: glottal closure (100% vs 100%), amplitude (90.91% vs 63.64%), and mucosal wave (81.82% vs 54.55%). A significant improvement was observed in VHI-30 scores, GRBAS scores, and acoustic parameters (P < .05). The size of lesions had an effect on the GRBAS scores (P < .001) but not on VHI-30 scores and objective acoustic parameters (P > .05). Other factors we tested did not affect voice outcomes. CONCLUSION Potassium titanyl phosphate laser treatment can effectively reduce the lesion area of vocal polyps and improve the voice quality. The presence of small lesions seems to predict good subjective assessments of voice quality, but it remains to be seen whether this correlates with true voice quality.
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Affiliation(s)
- Jingru Ma
- Department of Otolaryngology-Head and Neck Surgery, 159395Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Rui Fang
- Department of Otolaryngology-Head and Neck Surgery, 159395Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Ruiqing Zhen
- Department of Otolaryngology-Head and Neck Surgery, 159395Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Wenjing Mao
- Department of Otolaryngology-Head and Neck Surgery, 159395Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Xiufa Wu
- Department of Otolaryngology-Head and Neck Surgery, 159395Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Peijie He
- Department of Otolaryngology-Head and Neck Surgery, 159395Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Chunsheng Wei
- Department of Otolaryngology-Head and Neck Surgery, 159395Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
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