Effect of the 532nm pulsed KTP laser in the treatment of Reinke's edema

Voice outcomes in high-grade Reinke's edema: Comparing microflap excision and microdebrider surgery

Objectives

Patients presenting with hoarseness and diagnosed with high-grade Reinke's edema (RE) will often require surgical intervention for polypoid changes of the true vocal folds. We compared patient outcomes in patients who had microflap or microdebrider excision surgeries.

Methods

Patients with the diagnosis of grade II or grade III RE based on laryngoscopy or videostroboscopy who failed conservative management underwent surgery using the standard excision practice of the primary surgeon. Voice outcomes were compared using VHI-30 (Voice Handicap Index), V-RQOL (Voice-Related Quality of Life), and MPT (maximum phonation time) preoperatively and at 1-month and 6-months postoperatively.

Results

Of the 115 patients included, there were 46 RE grade II patients and 69 RE grade III patients with 52 patient undergoing microflap surgery and 63 patients undergoing microdebrider surgery. Both procedures resulted in significant improvement in VHI-30, V-RQOL, and MPT at 1-month and 6-months postoperatively. The microdebrider group had better 6-month VHI scores (40.84) than the microflap group (44.54) (CI -7.27 to -0.12). The microdebrider group also had better 6-month V-RQOL measures (62.56) than the microflap group (57.79) (CI 0.38-9.16).

Conclusion

Both microflap excision and microdebrider excision for high-grade RE lesions resulted in significant improvement in VHI-30, V-RQOL, and MPT at 1-month and 6-months postoperatively with the microdebrider excision group scoring statistically significantly better at 6 months in comparison to the microflap group. Overall, the results support the use of both surgical modalities for treating high-grade RE patients.

Level of evidence

3.

Reinke's Edema: Cold Steel Versus Radiofrequency Coblation

OBJECTIVE

This study compared the effects of radiofrequency (RF) coblation and cold steel (CS) surgery for the treatment of Reinke's edema (RE).

METHODS

A retrospective analysis was conducted on 61 patients with RE, with 33 (54.1%) in the CS surgery group and 28 (45.9%) in the RF coblation group. The primary endpoints were the bilateral operation time and dyspnea severity, assessed preoperatively and at 1 and 3 months postoperatively. Secondary endpoints included subjective and objective vocal assessments, laryngovideostroboscopy (LVS) images, and Voice Handicap Index-10 (VHI-10) scores obtained before and at 1 and 3 months postoperatively.

RESULTS

The average bilateral operation time was significantly shorter in the RF coblation group (24.2 ± 3.9 min) compared to the CS group (38.4 ± 5.2 min) (P = .041). All patients experienced a decrease in their Dyspnea Severity Index (DSI) scores postoperatively, with no significant differences observed between the two groups at any time point. However, improvements in the grade of hoarseness, roughness, and asthenia were significantly greater in the RF coblation group than in the CS group (P < .001). There were no statistically significant differences in breathiness and strain between the two groups. The average VHI-10 score significantly decreased from preoperative values in both groups (P < .001), with no significant differences observed between the two groups at any time point.

CONCLUSIONS

The RF coblation procedure is a reliable and safe method for RE surgery, offering an effective treatment choice for RE.

Office-based blue laser therapy for dyspnea in patients with type 3 Reinke's edema

PURPOSE

To investigate the effectiveness of in-office blue laser therapy on dyspnea in patients with type 3 Reinke's edema.

METHODS

The medical records and video-recordings of patients with Reinke's edema type 3 who had undergone office-based blue laser therapy between March 2022 and January 2023 were reviewed. The primary outcome measures assessed before and after surgery were dyspnea severity, risk of obstructive sleep apnea (OSA), and disease regression. The severity of dyspnea was measured using the Dyspnea Severity Index (DSI), the risk of OSA was assessed using the STOP-BANG questionnaire, and disease regression was assessed by reviewing the laryngeal examination before and after surgery. The Voice Handicap Index-10 (VHI-10) was used as a secondary outcome measure.

RESULT

A total of 10 patients were included. The mean age of the study population was 58.9 ± 4.2 years. The male-to-female ratio was 2:3. In total, 20 vocal fold lesions were treated among which 18 were reviewed. Eight lesions regressed completely and 10 partially. There was a statistically significant drop in the mean score of DSI after surgery (16.1 ± 10.2 pre-operatively vs 2.3 ± 2.3 post-operatively, p-value < 0.001). The mean STOP-BANG score decreased from 4.8 ± 1.47 to 3.1 ± 1.28 (p-value = 0.001). There was also a significant improvement in VHI-10 score (22.7 ± 7.0 vs 4.4 ± 5.6, p-value < 0.001).

CONCLUSION

Office-based blue laser therapy offers a safe and effective treatment for shortness of breath in patients with type 3 Reinke's edema.

Office-based Laser Therapy in Reinke's Edema: A Systematic Review and Meta-analysis

OBJECTIVE

To analyze voice outcomes and lesion regression in patients with Reinke's edema treated in the office with lasers.

STUDY DESIGN

Systematic review and meta-analysis METHODS: The search was performed in the Medline, Embase, Medline, Cochrane, and Google Scholar databases using the PRISMA 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 Reinke's edema measured through voice-handicap index, 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

The initial search identified 650 articles, 6 of which met the inclusion criteria and were analyzed. The total number of participants was 58. Meta-analysis showed significant improvement in VHI-10 scores after in-office laser therapy (95% CI, [-1.46; -0.75]). It also showed significant improvement in jitter, significant increase in fundamental frequency (95% CI, [0.52; 1.71]) and significant decrease in lesion size (95% CI, [-2.03; -0.35]).

CONCLUSION

Office-based laser therapy is a reliable alternative to the traditional phono-microsurgery performed in the operating room. Patients show significant improvement in voice outcomes and laryngeal examination.

Unsedated Office-Based Blue Laser Therapy in Female Patients With Reinke's Edema: A Retrospective Review of 8 Cases

OBJECTIVES

To report on the outcomes of unsedated blue laser therapy in female patients with Reinke's edema.

STUDY DESIGN

Retrospective chart review.

METHODS

A retrospective chart review of female patients undergoing unsedated office-based blue laser treatment of Reinke's edema between February 2020 and March 2022 at the Hamdan Voice and Swallowing Unit at the American University of Beirut Medical Center in Beirut, was conducted. Patients were assessed before and after the procedure with a follow-up interval of 3-6 weeks. Demographic data included age, history of smoking and grade of Reinke's edema. Voice outcome measures included the Voice Handicap Index-10 questionnaire, perceptual evaluation (GRBAS scale), acoustic analysis and maximum phonation time. Vocal fold lesions were evaluated using indirect laryngeal endoscopy.

RESULTS

A total of eight patients were reviewed. The mean age was 59.63 ± 7.98 years. One patient was lost to follow-up. We report on a total of 10 Reinke's edema lesions treated with the blue laser. There was a significant decrease in the mean VHI-10 score (14.86 ± 5.84-6.71 ± 7.32; P < 0.01) as well as in the means of three perceptual evaluation parameters (G, R, B; P < 0.05). There was also a nonstatistically significant increase in the mean fundamental frequency and habitual pitch. Laryngeal examination showed complete regression in 50% of the lesions, and partial regression in the remaining 50%.

CONCLUSIONS

Office-based blue laser treatment of Reinke's edema under local anesthesia can be considered an effective treatment modality as evidenced by improvement in post-procedure voice outcome measures.

Phonosurgery of Reinke's edema with microdebrider

PURPOSE

To present our experience with a new microsurgical approach for treatment of the Reinke's edema in suspension laryngoscopy-microdebridement. After a short review of existing literature we introduce speech therapy before and after the surgery into the protocol.

METHODS

 The authors compare the phonatory outcome, laryngostroboscopical results and subjective improvement of the voice of 30 patients with Reinke's edema that were operated with either microdebridement or cold steel surgery techniques. "Sandwich" speech therapy strategy was applied for the vocal rehabilitation before and after surgery in both patient groups.

RESULTS

After the microdebridement and the speech therapy the mucosal wave was regular, symmetric and periodic in all patients. No signs of abnormal scar tissue or anterior adhesions were observed. Significant improvement of vocal parameters was found after the surgery in both groups of patients: operated with the microdebridement technique and the cold steel technique. The subjective voice evaluated by Voice Handicap Index (VHI-10) was improved for both patient groups in a homogenous way.

CONCLUSIONS

Based on the similarity of the vocal outcome in the two groups, microdebridement of the vocal folds is an excellent method for removing the edema of the Reinke's space. Careful suction at a low voltage protects the lamina propria during the microdebridement. The authors discuss the indication to this innovating procedure in patients with difficult laryngeal exposure and small operating field.

Reinke's edema management and voice outcomes

Objectives

Reinke's edema is a chronic disease of the respiratory tract that occurs in adults with a history of chronic smoke exposure. Also known as polypoid corditis, polypoid laryngitis, and polypoid degeneration of the vocal fold, it is strongly associated with smoking, frequently with vocal misuse/abuse, and occasionally with laryngopharyngeal reflux. Reinke's edema remains a cause of chronic dysphonia that is difficult to manage. This review provides perspectives on current and future management of Reinke's edema.

Results

Reinke's edema impacts <1% of the population. The excessive mass is seen in polypoid degeneration results in a loss of pitch control and a rough voice. Women are more likely to present for treatment as the characteristic lowering of vocal pitch is more noticeable in women than men. Multiple grading systems have been proposed within the literature. The current standard of care is surgical excision, after smoking cessation. The microflap technique remains the approach of choice for bulky lesions. Surgical management of Reinke's edema has evolved with the introduction of various lasers into otolaryngologic practice; some which can now be used in the office setting. While many management approaches have been described within the literature, there is a little direct comparison and no obvious superior method of Reinke's edema management.

Conclusion

To date, the biology of Reinke's edema is not well understood. Additional research is needed further elucidate the role of uncontrolled reflux in the development and recurrence of Reinke's edema.

Use of 532 nm Potassium Titanyl Phosphate Laser on Vocal Fold Scars Under Topical Anesthesia: A Pilot Study

OBJECTIVE

This pilot study aims to evaluate the efficacy of 532 nm potassium titanyl phosphate (KTP) laser under topical anesthesia in patients with vocal fold scars.

METHODS

A series of 18 patients with vocal fold scars of varying degrees were treated. The KTP laser was used under local anesthesia in the outpatient clinic. It was set to deliver 6 W of power using a continuous output mode. Close-to-contact mode was used for laser irradiation, and contact mode was used for ablation and excision of the lesions. Some of the patients received laser scar ablation on both vocal folds; the scarred vocal fold on one side and the hypertrophic vocal fold on the other. Parameters include glottic closure, amplitude, and mucosal wave pattern were measured using laryngeal stroboscopic examination. Aerodynamic and voice evaluations were carried out using maximum phonation time (MPT), jitter, shimmer, Voice Handicap Index questionnaire (VHI-30), and GRBAS scale.

RESULTS

In total, 21 surgeries were performed on 18 patients. Glottic closure, amplitude, and mucosal wave pattern showed improvement 2 months postoperatively (P < .05). There was significant improvement in the postoperative scores for VHI-30, VHI-emotional sub-scale, VHI-physical sub-scale, and GRBAS (P < .05). There was no significant difference in the MPT and VHI-functional sub-scale before and after the operation (P > .05). Re-adhesion of the anterior commissure was observed in 2 patients with Type III scars.

CONCLUSION

The 532 nm KTP laser is an effective tool for the treatment of vocal fold scars. Further research is required to determine if serial laser applications could improve outcomes for this challenging condition.

LEVEL OF EVIDENCE

Level IV.

Unsedated Office-Based Thulium Laser Therapy in Patients With Reinke's Edema

OBJECTIVE

To report the outcome of unsedated office based Thulium laser therapy for Reinke's edema.

MATERIALS AND METHODS

A retrospective chart review of patients operated between March 2017 and November 2018 was conducted. Twelve patients were included, two of whom had two procedures performed. Demographic data included age, gender, smoking status, and grade of Reinke's edema. Outcome measures included Voice Handicap Index-10 (VHI), perceptual evaluation, extent of disease regression, acoustic analysis, and maximal phonation time.

RESULTS

Twelve patients were enrolled in this study, one of whom was lost for follow-up. There were eight females and three males. The mean age was 51.27 ± 9.12 years. Endoscopic evaluation 6-12 weeks after surgery revealed complete and partial regression of disease in three and eight patients, respectively. There was a significant improvement in the mean score of VHI-10 (15.00 ± 9.45 vs 3.07 ± 3.81) and the mean score of GRABS parameters following surgery (P < 0.05). The mean habitual pitch increased from 125.11 ± 28.48 Hz to 155.86 ± 55.14 Hz (P = 0.070). There was improvement in the mean jitter and shimmer but none reached a statistical significance. There was no significant change in the mean Maximum phonation time (MPT) scores before and after surgery.

CONCLUSION

Unsedated office-based Thulium laser therapy can be considered as an alternative therapy to patients with Reinke's edema who are not willing to undergo conventional microlaryngeal surgery.

The Use of 532-Nanometer-Pulsed Potassium-Titanyl-Phosphate (KTP) Laser in Laryngology: A Systematic Review of Current Indications, Safety, and Voice Outcomes

OBJECTIVE

To investigate the indications, efficacy, safety, and outcomes of potassium-titanyl-phosphate (KTP) laser procedures for treatment of laryngeal disease.

METHODS

PubMed, Cochrane Library, and Scopus were searched for studies providing information about the indications, efficacy, and safety of both in-office and operative suspension microlaryngoscopy KTP laser procedure in treatment of laryngeal disease. Diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.

RESULTS

Of the initial screened 140 papers, 17 met our inclusion criteria. Six papers involved KTP laser procedures for benign and malignant vocal fold lesions in suspension microlaryngoscopy only, 10 papers focused on only in-office KTP laser procedures for benign vocal fold lesions, and 1 paper included both in-office and suspension microlaryngoscopy procedures. The following lesions may be considered as indications for KTP laser procedures: Reinke's edema, sulcus vocalis, vocal fold hemorrhage, polyp, granuloma, cyst, scar, papillomatosis, dysplasia, leukoplakia, and early vocal fold malignancies. Irrespective of the types of procedure (in-office vs suspension microlaryngoscopy), the KTP laser is associated with a low complication rate and overall good vocal fold vibration recovery. There is an important heterogeneity among studies concerning laser settings, indications, and outcomes used for the assessment of treatment effectiveness. There are no controlled studies directly comparing KTP laser with other lasers (ie, carbon dioxide laser).

CONCLUSION

The use of KTP laser procedures for treatment of laryngeal disease has increased over the past decade, especially for office-based management of vocal fold lesions. Future controlled studies are needed to compare the safety and outcomes of the KTP laser to other techniques.

Surgical and Nonsurgical Lines of Treatment of Reinke's Edema: A Systematic Literature Review

OBJECTIVES

The aim of this study was to carry out a systematic review of different surgical and nonsurgical lines of treatment of Reinke's edema to identify the effectiveness and the guidelines described to use each of them.

METHODS

We searched PubMed and Coherence for randomized controlled trials and case reports studies did on adult humans aged from 18 to 80 years, from January 1997 to December 2018. We included studies that treated patients with Reinke's edema by one and/or combinations of the following interventions: cold steel microlaryngeal phonosurgery, microdebrider, CO₂ laser, photoangiolytic laser, voice therapy, Steroid and Hyaluronidase injection. We selected studies that assessed patients pre- and post-treatment by at least one of the following measures: subjective assessment of the patient's voice by the voice handicap index, perceptual analysis of the voice by GRBAS scale, video laryngeoscopic examination of the VFs and the lesion, aerodynamic measures, and acoustic analysis of the voice by the computerized speech lab. We assessed quality of the included studies with the Cochrane risk of bias assessment Tool.

RESULTS

After removal of duplicates, research yielded 262 studies. Of 217 abstracts and titles, 36 full-text articles were read, and one study was added through hand search, resulting in 10 included studies.

CONCLUSIONS

Most of literature analyzed were deficient to address the effectiveness of any of the six lines included in this study. This is mainly due to the small number of the included articles and the small sample size in most of these studies. We found only 10 articles that reported the effectiveness based on comparing the results of before and after treatment. In addition, the variability of outcome measures used and the lack of the comprehensive assessment of the patient's voice, vocal image in most of the included studies made it hard to us to compare the results of any of the included studies. More researches with larger sample size and accurate randomization are needed for further accurate assessment of the effectiveness of the surgical and nonsurgical lines of treatment of Reinke's edema. The future researches should take in their consideration the use of an agreed comprehensive assessment protocol for assessing and comparing the outcome measures before and after treatment.

Two-handed tying technique in vocal fold mucosa microsuture for the treatment of Reinke's edema

BACKGROUND

Removal of Reinke's edema may result in moderate to large-sized mucosal defect on the vocal fold, which heals by secondary intention. Microsuturing this defect may lead to primary wound healing with fastened recovery and less scar, but costs extra time and effort. Exploring methods that can shorten microsuture time is helpful for the wider application of this technology.

STUDY DESIGN

Retrospective.

METHODS

57 patients with Reinke's edema, who were admitted from November 2010 to June 2018, were enrolled as research subjects for the retrospective analysis. 27 patients were the knot pusher group (from November 2010 to March 2015), and 30 patients were the two-handed tying group (from April 2015 to June 2018). Evaluation indicators include the number of knots, the average time for suturing and tying the knot for each patient, and the occurrence of complications, subjective and objective voice assessments.

RESULTS

All patients underwent successful operation. The average time for making knots in the knot pusher group and two-handed tying group was 668.40 ± 173.73 s and 328.73 ± 121.0 s, respectively, and there was a statistically significant difference between the two groups (p < 0.001). No significant difference was noted in the mucosal avulsion, overall incidence of complications between the groups, and no significant difference was found between the two groups in terms of the preoperative and 3-month postoperative subjective and objective indicators.

CONCLUSION

Microsuturing of Reinke's edema microflaps using the two-handed tying technique can achieve the similar effect with the knot pusher method, and save operation time while the surgeon is well trained.

LEVEL OF EVIDENCE

4.

Reinke's Edema

Reinke's edema (RE) is the polypoid degeneration of one or both vocal folds within Reinke's space. The viscoelastic properties of the mucosal folds are characteristically altered by the expansion of the subepithelial space. Most frequently, patients present with dysphonia, with women being more affected than men. The primary risk factor is tobacco use. Voice overuse and laryngopharyngeal reflux are also considered to be contributory. Although RE shares the same primary risk factor as malignancy, the risk of malignancy is low, and dysplasia is found only in 0% to 3% of cases. Treatment is focused on decrease of risk factors, such as implementation of smoking cessation, voice therapy, and reflux control. Surgical techniques aim to decrease redundant polypoid mucosa in order to improve voice and restore the glottic airway. Recurrence of RE is high.

Office-Based 532-Nanometer Pulsed Potassium-Titanyl-Phosphate Laser Procedures in Laryngology

With fiber-based lasers that may be passed via the working channel of a flexible laryngoscope, in-office laser laryngeal surgery has become possible. The potassium-titanyl-phosphate laser has several features that make it ideal for laryngeal surgery, and it is now the laser of choice for in-office management of a variety of laryngeal lesions. Its applications have expanded significantly since its introduction, with reports of new indications continuing to appear in the literature. This article provides a comprehensive review of the indications and technical details of in-office potassium-titanyl-phosphate laser laryngeal surgery, and a summary of the existing literature regarding outcomes of these procedures.

Pathogenic Role of Reinke's Edema in Snoring and Obstructive Sleep Apnea

OBJECTIVE

To investigate the association between vocal fold Reinke's edema, snoring, and obstructive sleep apnea.

DESIGN/METHODS

Twenty-five patients diagnosed with Reinke's edema and 25 patients with normal laryngeal examination, matched according to age, gender, and body mass index were recruited for this prospective study. Demographic data included age, gender, and body mass index. All patients filled the Berlin Questionnaire, STOP-BANG Sleep Apnea Questionnaire, and the Epworth Sleepiness Questionnaire.

RESULTS

Out of 25 patients with Reinke's edema, 36% had Obstructive Sleep Apnea (OSA) as evidenced by having two or more positive categories in the Berlin Questionnaire. In the control group, only 4% had OSA.The difference between the two groups was statistically significant (P value = 0.005). With respect to Epworth Sleepiness Scale and the STOP-BANG Sleep Apnea Questionnaire (P value > 0.05), there was no statistically significant difference between the two groups.

CONCLUSIONS

This investigation revealed higher prevalence of snoring and obstructive sleep apnea in patients with Reinke's edema as evidenced by the Berlin Questionnaire. The caring physician should be alert to symptoms of airway obstruction for possible early intervention.

In-Office Endoscopic Laryngeal Laser Procedures: A Patient Safety Initiative

Objective

To review complications of in-office endoscopic laryngeal laser procedures after implementation of standardized safety protocol.

Methods

A retrospective review was conducted of the first 2 years of in-office laser procedures at St Michaels Hospital after the introduction of a standardized safety protocol. The protocol included patient screening, procedure checklist with standardized reporting of processes, medications, and complications. Primary outcomes measured were complication rates of in-office laryngeal laser procedures. Secondary outcomes included hemodynamic changes, local anesthetic dose, laser settings, total laser/procedure time, and incidence of sedation.

Results

A total of 145 in-office KTP procedures performed on 65 patients were reviewed. In 98% of cases, the safety protocol was fully implemented. The overall complication rate was 4.8%. No major complications were encountered. Minor complications included vasovagal episodes and patient intolerance. The rate of patient intolerance resulting early termination of anticipated procedure was 13.1%. Total local anesthetic dose averaged 172.9 mg lidocaine per procedure. The mean amount of laser energy dispersed was 261.2 J, with mean total procedure time of 48.3 minutes. Sixteen percent of patients had preprocedure sedation. Vital signs were found to vary modestly. Systolic blood pressure was lower postprocedure in 13.8% and symptomatic in 4.1%.

Discussion

The review of our standardized safety protocol has revealed that in-office laser treatment for laryngeal pathology has extremely low complication rates with safe patient outcomes.

Implications for Practice

The trend of shifting procedures out of the operating room into the office/clinic setting requires new processes designed to promote patient safety.

In-office laryngeal procedures (IOLP) in Canada: current safety practices and procedural care

BACKGROUND

The advent of chip tip technology combined with advanced endoscopy has revolutionized the field of laryngology in the past decade. Procedures such as transnasal esophagoscopy, site-specific steroid injections, injection laryngoplasty and laryngeal laser treatment can now be performed in the office setting under local anaesthesia. Although In-Office Laryngeal Procedures (IOLPs) have become standard-of-care in many American and several Canadian centers, there are no guidelines regulating the practice of these procedures. The goal of this report was to evaluate the current method of IOLP delivery in Canada.

METHODS

An electronic survey was dispersed to 22 practicing Canadian laryngologists to assess safety and procedural care measures undertaken when performing IOLP. The survey consisted of 37 questions divided into 6 categories; 1) Demographic data 2) Facilities 3) Staff/personnel 4) Patient screening/monitoring 5) Procedure and emergency equipment 6) Reporting of adverse events.

RESULTS

Data was collected for 16/22 laryngologists (72.7% response rate). Only 1 respondent did not perform IOLP. All performed injection augmentation laryngoplasty. Most performed laryngeal biopsies, intramuscular injection and/or electromyography guided injection for the treatment of spasmodic dysphonia and glottic/subglottic steroid injections. Only 4 respondents performed in-office KTP laser. Significant variation was found in procedural processes including intra procedural monitoring, anticoagulation screening, access to emergency equipment and documentation.

CONCLUSION

Our survey demonstrates that the delivery of IOLP in Canada varies considerably. The construct of IOLP practice guidelines based on the evidence with consistent documentation would promote safe, efficient and quality care for patient with voice disorders.

Feasibility and Associated Limitations of Office-Based Laryngeal Surgery Using Carbon Dioxide Lasers

Importance

There are few reports evaluating awake, office-based carbon dioxide (CO2) laser surgery for laryngeal lesions. To date, this study was the largest reported case series of office-based laryngeal surgery by fiber delivery CO2 laser. Office-based laryngeal surgical procedures have become increasingly popular. Technical problems and treatment outcomes associated with the use of a CO2 laser for office-based laryngeal surgery have yet to be fully addressed.

Objectives

To discuss a single institution's clinical experience with office-based CO2 laser laryngeal surgery and the feasibility and limitations associated with this procedure.

Design, Setting, and Participants

This retrospective study evaluated 49 laryngeal surgical procedures performed using a CO2 laser in 40 consecutive adult patients at a single institution in Taiwan from July 1, 2014, through September 30, 2015. Laryngeal lesions treated included vocal fold leukoplakia (n = 13), benign vocal fold lesions (n = 10), Reinke edema (n = 4), recurrent respiratory papillomatosis (n = 6), and lesions outside the vocal folds (n = 7).

Interventions

Office-based laryngeal surgery performed using a CO2 laser under topical anesthesia.

Main Outcomes and Measures

Videolaryngoscopy was performed on all patients at each follow-up point. Among patients with benign vocal lesions and Reinke edema, videolaryngostroboscopy, voice laboratory measurements, perceptual measurements of vocal quality, and subjective evaluations were conducted before and after surgery.

Results

Among the 40 patients included in this study (28 men [70%] and 12 women [30%]; median [range] age, 56 [29-83] years), median follow-up time was 6.5 months (range, 1-21 months). Among the 49 procedures, 2 (4%) could not be tolerated by patients owing to severe gag reflex and laryngeal hypersensitivity, 6 (12%) could not completely evaporate lesions owing to an inadequate surgical field or laryngeal instability, and 1 (2%) led to a complication (ie, mild vocal fold wound stiffness). In addition, 2 patients with premalignant vocal fold leukoplakia showed lesion recurrence in the subglottic area. Among patients with benign vocal lesions and Reinke edema, postoperative phonatory function showed large improvements in jitter (effect size, 0.61; median difference, -0.98%; 95% CI, -1.57% to -0.11%), noise to harmonic ratio (effect size, 0.63; median difference, -0.02; 95% CI, -0.07 to -0.01), maximal phonation time (effect size, 0.61; median difference, 3.6 seconds; 95% CI, 1.9 to 8.8 seconds), and Voice Handicap Index-10 score (effect size, 0.60; median difference, -7; 95% CI, -12 to -2).

Conclusions and Relevance

Office-based laryngeal surgery performed using a CO2 laser was shown to be a feasible treatment option for various types of vocal lesions. However, patients should not undergo this procedure if they have multiple bulky lesions or lesions involving the subglottic area, the laryngeal ventricle, or (in cases of inadequate laryngeal stability) the free edge of a vocal fold.

Office-based 532-Nanometer pulsed potassium-titanyl-phosphate laser for marsupialization of laryngeal and vallecular mucoceles

OBJECTIVES/HYPOTHESIS

Many laryngopharyngeal disorders are effectively managed in the office. Herein, an in-office method utilizing the 532-nm potassium-titanyl-phosphate (KTP) laser for the treatment of benign laryngeal and vallecular mucoceles is described.

STUDY DESIGN

Retrospective case review.

METHODS

A review was performed of patients who had their vallecular or laryngeal mucoceles marsupialized in the office using KTP laser.

RESULTS

Outcomes included long-term follow-up laryngoscopy for evidence of recurrence, significant intraprocedural complications, tolerance of the procedure, final pathology of the specimen, and resolution of symptoms.

CONCLUSIONS

In-office KTP marsupialization of laryngeal and vallecular mucoceles is effective and well tolerated, with no episodes of recurrence to date.

LEVEL OF EVIDENCE

4. Laryngoscope, 127:1116-1118, 2017.

Office-Based Photoangiolytic Laser Treatment of Reinke’s Edema

Objective

To evaluate the safety, tolerability, and voice outcomes of office-based photoangiolytic laser treatment of Reinke’s edema.

Study Design

Case series with chart review.

Setting

Academic medical center.

Subjects and Methods

We performed a retrospective analysis of patients undergoing office-based laser treatment of endoscopy-proven Reinke’s edema. Safety and tolerability were evaluated by reviewing complications. Voice outcomes were analyzed by comparing pre- and postprocedural acoustic, aerodynamic, and Voice Handicap Index measurements. Complete data sets were not available for all subjects; sample size for each parameter is reported with the corresponding result.

Results

Nineteen patients met inclusion criteria. There were no minor or major complications. Five procedures were truncated due to patient intolerance. Phonatory frequency range increased (n = 12, P = .003), while percent jitter decreased (n = 12, P = .004). Phonation threshold pressure decreased after treatment (n = 4, P = .049). Voice Handicap Index also decreased (n = 14, P < .001).

Conclusion

This study represents the largest series of patients undergoing office-based photoangiolytic laser treatment specifically for Reinke’s edema. Our data suggest that this is a safe and effective modality to treat dysphonia associated with Reinke’s edema, although patient intolerance of the procedure may represent a barrier.

Comparison of treatment outcomes of transnasal vocal fold polypectomy versus microlaryngoscopic surgery

OBJECTIVES/HYPOTHESIS

Office-based procedures have been proposed for the treatment of vocal polyps, including indirect laryngoscopic surgery and angiolytic laser photocoagulation. Our previous report documented good treatment outcomes by combining the two aforementioned procedures. This study was intended to further compare the treatment outcomes of office transnasal vocal fold polypectomy (VFP) with those of microlaryngoscopic surgery (MLS).

STUDY DESIGN

A matched cohort study.

METHODS

This study retrospectively enrolled 50 age-, gender-, and size-matched patients with vocal polyps treated by VFP or MLS at a tertiary teaching hospital from January 2012 to October 2013. Treatment outcomes were evaluated before, 2 weeks, and 6 weeks after the procedures via perceptual rating of voice quality, acoustic measurement of the speech signal, 10-item voice-handicap index, maximal phonation time, subjective rating of voice quality, and videolaryngostroboscopic evaluation.

RESULTS

Both VFP and MLS resulted in significant clinical improvements 2 and 6 weeks postoperatively. Study results exhibited similar objective outcomes between VFP and MLS, whereas patients who received VFP reported higher subjective voice quality than those receiving MLS 2 weeks postoperatively. Six weeks after the procedures, the objective and subjective treatment outcomes were not significantly different between the two treatment groups.

CONCLUSION

This study shows that transnasal VFP may be used as an effective alternative treatment for small vocal polyps. Patients who received office VFP experienced rapid symptomatic relief with a higher degree of subjective effectiveness than MLS 2 weeks postoperatively, whereas the overall treatment outcomes showed a comparable level of effectiveness for both modalities.

LEVEL OF EVIDENCE

3B.

Analysis of Potassium Titanyl Phosphate Laser Settings and Voice Outcomes in the Treatment of Reinke’s Edema

Objective:

Despite increased clinical utility of the 532-nm potassium titanyl phosphate (KTP) laser, no studies have examined outcomes for Reinke’s edema (RE) as a function of laser parameters and initial treatment effects. Variability in delivery parameters, fiber-to-tissue distance, and immediate end-tissue effects limits universal application of existing study outcomes. We examine voice outcomes using standardized treatment classification, providing justification for laser parameter selection and immediate tissue effect in clinical use.

Methods:

Retrospective review of 9 patients who underwent KTP laser treatment for RE. Demographics, RE severity, laser settings, total laser energy, and immediate tissue effects were correlated with quantified voice outcomes.

Results:

An average of 157 joules (6-640 J) was delivered over a 0.369-second exposure time (0.1-0.9 seconds). Immediate tissue effects varied from nonablative treatment (type I and type II) to ablation without tissue removal (type III). Overall, Voice Handicap Index-10 (VHI-10) decreased by 8.23; improvement was most pronounced with type II treatments (delta VHI-10 = 12). No complications were encountered.

Conclusion:

Potassium titanyl phosphate laser can be safely and effectively used to improve voice in RE patients regardless of severity. This is the first study to provide detailed information on laser settings, energy delivery, and treatment effect in RE management; these results may guide clinical use of this modality, especially for novice laser surgeons.