Longstanding recurrent laryngeal papillomatosis: impact on voice quality

Voice Outcomes Following Multiple Surgeries for Recurrent Respiratory Papillomatosis

OBJECTIVES

Recurrent Respiratory Papillomatosis (RRP) is a rare disease caused by the human papilloma virus that presents as warty, exophytic growths in the upper airway. RRP in the larynx can lead to severe airway obstruction and voice changes. It is clinically known that patients with RRP frequently experience dysphonia. The purpose of this study was to assess the impact of multiple surgical treatments on RRP patients' voice outcomes, and to determine whether a higher number of repeated surgeries lead to decreased voice quality.

METHODS

A retrospective cohort study was conducted of adult RRP patients (n = 23) who underwent multiple surgeries. Group 1 included patients (n = 11) who had <5 surgeries (range 2-4 surgeries) and Group 2 included patients (n = 12) who had ≥5 surgeries (range 5-50+ surgeries). Voice recordings were selected from the following clinic visits: initial office visit (initial presurgery), first postsurgery, and the last clinic encounter(s) with no immediate planned surgery. Blinded auditory-perceptual ratings along with cepstral and spectral acoustic measures assessed voice severity.

RESULTS

There was significant improvement from the initial presurgery visit compared to each postoperative visit over time for all voice outcome measures for both Group 1 and Group 2. The results of the study indicated that the number of surgeries did not significantly affect mean postoperative voice outcomes, and there were no significant differences between patient groups for voice quality over time.

CONCLUSIONS

The results of this study suggest that RRP patients' voice quality may not suffer cumulative negative effects when using modern tissue-sparing surgical techniques.

Multidimensional vocal assessment after laser treatment for recurrent respiratory papillomatosis

OBJECTIVES/HYPOTHESIS

Recurrent respiratory papillomatosis (RRP) is a benign epithelial tumor that exhibits a high frequency of recurrence. This study assesses the vocal function after laser treatment for RRP, particularly in relation to the frequency of surgery.

STUDY DESIGN

Retrospective study.

METHODS

Thirty RRP patients who underwent laser surgery that controlled the tumor were included. Preoperative and postoperative Grade, Roughness, Breathiness, Asthenia, and Strain Scale, videostroboscopic findings, aerodynamic and acoustic parameters, and self-assessment questionnaires were measured and compared with an age- and sex-matched control group. Subsequently, to evaluate the association between postoperative voice quality and the number of surgeries, the patients were divided into three groups (group 1: single surgery, group 2: 2-5 surgeries, group3: >6 surgeries), and comparative multidimensional vocal assessments were performed.

RESULTS

The mean number of surgeries was 3.4 (range, 1-8). Although all patients exhibited poorer vocal function than the control group preoperatively, they showed improvement in postoperative subjective and objective parameters. However, four patients who underwent one surgery with relatively aggressive ablation exhibited vocal cord scarring and deteriorated objective parameters. All remaining patients showed voice quality that was on par with the control group. Subgroup analysis proved no association between post-therapeutic voice quality and the patient characteristics, including preoperative staging and the number of surgical treatments performed.

CONCLUSIONS

RRP patients can achieve a close to normal voice with high satisfaction even after recurrent surgical treatment when ablation of a subepithelial lesion using sufficient laser energy is adequate.

LEVEL OF EVIDENCE

3b Laryngoscope, 127:679-684, 2017.

Anatomic Derkay Score Is Associated with Voice Handicap in Laryngeal Papillomatosis in Adults

OBJECTIVE

The Derkay staging system quantifies recurrent respiratory papillomatosis (RRP) severity based on involvement of laryngeal structures. Despite its broad use in the laryngology literature, the association between Derkay score and voice-related quality of life has not previously been studied. It is hypothesized that Derkay score positively correlates with the Voice Handicap Index-10 (VHI-10).

STUDY DESIGN

Case series with chart review.

SETTING

Tertiary medical center.

SUBJECTS AND METHODS

Forty-six adult RRP patients treated from 2007 to 2013 at a tertiary medical center were included. Anatomic Derkay scores at the time of each RRP procedure were calculated. VHI-10 scores obtained within 30 days preceding the procedures were used to assess for correlation between Derkay staging system and VHI-10.

RESULTS

Ninety-three procedures performed on 46 patients met inclusion criteria. Mean Derkay score was 11.9 (range, 2-28), and mean VHI-10 was 18.0 (range, 0-40). There was a significant positive correlation between Derkay score and VHI-10 (Spearman coefficient r = 0.42, P < .0001).

CONCLUSION

The anatomic burden of RRP as assessed by Derkay staging system is positively correlated with voice-related quality of life as quantified by the VHI-10.