Microdissection or microspot CO2 laser for limited vocal fold benign lesions: a prospective randomized trial

A Retrospective Study of Glottic Cyst Histopathology and Its Clinical Presentation

To understand the frequency and clinical presentation of the four types of vocal-fold cyst described by the Koren classification. Glottic cysts operated in a 1-year period were grouped retrospectively into Koren A, B, C and D (KA, KB, KC, KD). The age and sex of the patient, cyst location, laterality, associated lesions, profession, daily water consumption, duration of symptoms prior to surgery and postoperative healing time were noted. Of 30 cysts, 14 KA, 10 KB, 4 KC and 2 KD were identified. Average age of symptoms in KA to KD was 45, 52, 40 and 37 years. KC and KD were found only in females unlike the male predominance of KA and KB. Striking zone was the location of 28/30 cysts with a focal pit in 1 KC and mucosal bridge in 1 KD. There was no significance to laterality or profession. Average daily water consumption was 1.8, 1.75, 2 and 2 L in KA to KD. Average duration of symptoms up-till surgery for KA to KD was 2.6 years, 1.4 years, 2.9 years and 1 month. Post-operative healing time for KA to KD was 6.6, 7.4, 11.7 and 10 weeks. KA was the commonest cyst excised followed by KB, KC and KD. The KD patients were earliest and youngest to present. All KC and KD cysts were found in females unlike the male predominance of KA and KB. As majority of the cysts were found on the striking zone, phonotrauma may be one of the etiologies for all four cysts.

Prospective Outcomes of Microlaryngoscopy Versus Office Laser Photoangiolysis for Vocal Fold Polyps

OBJECTIVE(S)

The objective of this study is to compare treatment outcomes for vocal fold polyps (VFPs) between operating room microlaryngoscopy and office-based photoangiolysis with the potassium titanyl phosphate (KTP) laser.

METHODS

Prospective nonrandomized cohort study of patients with VFPs undergoing microlaryngoscopy ("OR group") or KTP laser photoangiolysis ("KTP group"). Voice outcomes (patient-reported outcome measures [Voice Handicap Index-10 (VHI-10) and Singing VHI-10 (SVHI-10)], auditory-perceptual measures [Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)], videostroboscopic characteristics [Voice-Vibratory Assessment of Laryngeal Imaging (VALI)], and acoustic and aerodynamic measures) were performed at baseline and regular intervals after intervention.

RESULTS

Forty-four subjects (17 OR group, 27 KTP group) with VFPs were enrolled. Mean VHI-10 significantly improved from baseline to each follow-up interval in both groups, except for the 1-2-week interval in the OR group. Mean SVHI-10 improved for both groups at some intervals. Growth curve models and time-to-event analyses for patient-reported outcomes did not differ between groups. There were significant improvements in all categories of auditory-perceptual voice quality and some categories of videostroboscopic characteristics in both groups. No significant trends were identified in acoustic and aerodynamic measures. Improvements in most outcomes did not significantly differ between groups or based on polyp size. There were no major complications.

CONCLUSIONS

Significant improvements in patient-reported voice outcomes measures, auditory-perceptual voice evaluation, and videostroboscopic characteristics occur following surgical treatment of vocal fold polyps with either microlaryngoscopy or office-based KTP laser. Long-term voice outcomes do not significantly differ between treatment modalities.

LEVEL OF EVIDENCE

Level 3 Laryngoscope, 2024.

Hemorrhagic Pseudocyst (Polyst) and True Hemorrhagic Cyst of the Vocal Fold

OBJECTIVES

Though hemorrhagic vocal fold polyps are a common entity, hemorrhagic vocal fold cysts have not been previously described. In our study, we have evaluated patients who were diagnosed on stroboscopy with "hemorrhagic" cysts.

METHODS

This 18-month retrospective study has received institutional ethics clearance. Using the database of our voice clinic, 14 patients diagnosed with hemorrhagic cysts by stroboscopy were reviewed. Age, sex, chief complaints, symptom duration, videostroboscopy findings, surgical details, and histopathology were noted.

RESULTS

Out of a total 14 patients, 12 were males with a mean age of presentation of 41 years. The duration of hoarseness ranged from 2-24 months. Videostroboscopy revealed a markedly decreased amplitude of the mucosal waves over a well-delineated ovoid or spheroid hemorrhagic lesion, which seemed tethered down by overlying vocal fold epithelium. All patients had operative findings of a well-encapsulated hemorrhagic lesion in the superficial lamina propria with anterior and posterior fibrotic bands. Histopathology of 13 patients was similar and revealed a hemorrhagic polypoidal lesion. A pseudo-capsule could be identified occasionally. These lesions seemed to be hemorrhagic pseudocysts, named "polyst" by us. In one male patient, the histopathology revealed a true vocal fold cyst (type C Koren) with hemorrhage.

CONCLUSIONS

A hemorrhagic pseudocyst (polyst) of the vocal fold has stroboscopic and surgical findings resembling a true vocal fold cyst with hemorrhage; however, histologically it resembles a hemorrhagic polyp. A true hemorrhagic cyst however is typically a type C Koren cyst with hemorrhage. Both these entities have not been previously described.

Congenital laryngo-tracheo-esophageal clefts: updates from a quaternary care pediatric airway unit

PURPOSE

To review the operative techniques, outcomes, and complications following surgery in pediatric patients with laryngo-tracheo-esophageal clefts (LTEC). We describe a new combined approach to treat long LTECs.

METHODS

Twenty-five patients underwent surgical repair for LTEC from March 2012 to July 2022 at our hospital. Every patient underwent a diagnostic endoscopy under general anesthesia and spontaneous ventilation to assess the LTEC and synchronous aero-digestive comorbidities/malformations. All patients underwent at least one surveillance endoscopy after the repair at our institution.

RESULTS

The patients had multiple other malformations, specifically gastro-intestinal, synchronous airway, and cardiac. The cleft distribution according to the modified Benjamin and Inglis classification was type I (n = 5, 20%), type II (n = 6, 24%), type IIIa (n = 8, 32%), type IIIb (n = 4, 16%), and type IVa (n = 2, 8%). The median follow-up was 44.6 months. Five patients (20%) had undergone previous cleft corrective surgery(s). Seven patients (28%) had partial to complete breakdown of the repair, needing additional intervention(s), and two required a combined-open plus endoscopic repair. Preoperatively, most patients (n = 18, 72%) needed a feeding assistance. At latest follow-up, feeding assistance was weaned off in 13 out of 18 patients, which was a 72% improvement. Ten patients (40%) needed ventilation assistance before the surgery. Post-operatively, ventilatory assistance was weaned off in 6 patients, meaning a 60% improvement.

CONCLUSION

LTEC are rare malformations, and their management needs precise diagnosis, appropriate surgical planning, and execution, and dedicated post-operative care. Primary and revision repair of long clefts with tracheal extension may require a combined approach.

Analysis of the clinical efficacy and voice outcomes of CO2 laser resection versus laryngeal microsurgery for vocal cord polyps

OBJECTIVE

To compare CO2 laser resection and laryngeal microsurgery for vocal cord polyps and provide evidence for the optimal surgical method.

METHODS

This was a retrospective cohort study that included 74 patients with vocal cord polyps who underwent either CO2 laser resection or laryngeal microsurgery in our hospital from August 2018 to December 2021. According to their preference, 77 patients were divided into two groups: a CO2 laser resection group (n = 35) and a laryngeal microsurgery group (n = 39). Patients were evaluated two days before surgery, and follow-ups were conducted one, two and four weeks after surgery. The voice handicap index (VHI-10) score, voice acoustic analysis results and electronic laryngoscopy results were collected for each patient, and the differences between the two groups were evaluated.

RESULTS

The basic demographic characteristics of the 74 patients were comparable, and all patients completed postoperative follow-up observations. A total of 30 (85.71%) patients in the CO2 laser resection group and 22 (56.41%) patients in the laryngeal microsurgery group were healed. The total effectiveness rate of the CO2 laser resection group (94.29%) was significantly higher than that of the laryngeal microsurgery group (82.05%), and the difference between the two groups was statistically significant (p = .037). Both surgical methods had a positive effect on reducing VHI-10 scores with the effect of CO2 laser resection being more obvious. The difference between the two groups in this regard was statistically significant (p < .001). The effects of each surgical method on the average fundamental frequency perturbation (jitter), amplitude perturbation (shimmer), maximum phonation time and dysphonia severity index were not statistically significant (p > .05).

CONCLUSION

CO2 laser resection and laryngeal microsurgery have similar effects on voice quality, but CO2 laser resection has higher clinical efficacy.

Minimizing Thermal Damage During Thulium Laser-Assisted Partial Arytenoidectomy: Pulsed Versus Continuous Cutting in an Ex-Vivo Calf Model

OBJECTIVES

The 2 µm-wavelength thulium laser is an effective cutter during partial arytenoidectomy, but thermal trauma can damage adjacent laryngeal tissue. Pulsing laser energy may reduce trauma when compared to continuous-wave cutting. This study measured temperature changes, thermal trauma, and time to complete partial arytenoidectomy, with and without pulsing, in an ex-vivo calf model.

METHODS

Tissue temperature and time to complete a trans-cartilaginous cut were measured during partial arytenoidectomy on ex-vivo calf vocal folds (N = 24) using a thulium laser in continuous-wave (CW, N = 12) and pulsed-wave (PW, N = 12) modes. Energy was 5 W for CW and PW cuts; pulse-widths were 250, 500, and 750 ms. Thermal damage was analyzed histologically by measuring the depth of lactate dehydrogenase (LDH) inactivation perpendicular to the laser-cut edge at the vocal process. Paired t-tests compared CW and PW modes.

RESULTS

Change in temperature was lower using CW (6.5°C) compared to PW modes (250 ms = 18°; 500 ms = 16°; 750 = 19°; P < .05). Trans-cartilaginous cuts were completed faster using CW (37 seconds) compared to PW (250 ms = 136 seconds; 500 ms = 61 seconds; 750 = 44 seconds; P < .05), and both modes delivered the same total Joules. The average depth of LDH depletion (thermal damage) was similar for all cuts.

CONCLUSIONS

1. Thulium laser cuts in continuous-mode unexpectedly produced less tissue heating yet created similar thermal damage than pulsed-mode cuts during simulated partial arytenoidectomy. 2. Trans-cartilaginous cuts were completed significantly faster in continuous-mode as compared to pulsed-mode cutting. 3. Pulsing the thulium laser does not minimize thermal damage compared to continuous wave cutting during thulium laser-assisted partial arytenoidectomy.

Vocal Fold Polyps: A Scoping Review

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.

Blue light laser recontouring for pediatric benign fibrovascular vocal fold lesions

INTRODUCTION

Up to 40% of children with hoarseness due to benign fibrovascular vocal fold lesions do not respond to voice therapy and could benefit from further intervention to improve their communication abilities. Currently there are limited surgical options for children too young to comply with post-operative voice rest. We have begun using the 445 nm laser to recontour benign fibrovascular vocal fold lesions without post-operative voice rest in young children with hoarseness due to vocal fold nodules that is unresponsive to voice therapy. This report presents pilot data on the effect of this treatment on pediatric voice-related quality of life.

METHODS

Pediatric patients with benign fibrovascular lesions and severe subjective dysphonia (per parents or teachers) were given the option of undergoing surgery or continuing voice therapy. Those that opted for surgery underwent 445 nm laser recontouring of their vocal folds. They were discharged home the same day with no voice rest required. Pre- and post-demographic, acoustic measures, auditory perceptual assessments, and validated patient quality of life measures were collected.

RESULTS

Four patients (ages 3-8y, all male) were selected for surgery. The mean pre- and post-op PVRQOL scores were 59.4 (range: 22.5-80) and 98.1 (range: 97.5-100), respectively (low scores suggest lower voice-related QOL), and a mean change of 38.8 (previously established minimum clinically important difference: 12). Pre- and post-acoustic and aerodynamic measures similarly reflected this improvement.

CONCLUSION

This pilot case series addresses a commonly seen population (children with benign fibrovascular lesions and significant dysphonia despite voice therapy) where the best practice for timing and types of surgical intervention is unclear. Photoangiolytic lasers (including the 445 nm laser) are gaining popularity for the treatment of benign laryngeal pathologies, and their use may expand treatment possibilities for children with severe dysphonia due to benign vocal fold lesions that do not respond to voice therapy. Further longitudinal investigations are necessary to confirm the safety and efficacy.

Treatment of Vocal Fold Nodules: Transnasal Steroid Injection Versus Microlaryngoscopic Phonomicrosurgery

OBJECTIVES

Vocal fold nodules (VFNs) are bilateral, mid-membranous, swellings of the vocal folds. Intralesional steroid injection was successfully tried in the management of benign vocal fold lesions including nodules. The aim of the present study was to compare treatment outcomes of vocal fold steroid injection (VFSI) and surgery in patients with VFNs in terms of lesion regression, subjective, and objective voice parameters.

STUDY DESIGN

Nonrandomized controlled clinical trial.

METHODS

This bicenter interventional study was conducted on 32 patients with VFNs, in the age range of 16-63 years. Sixteen patients underwent transnasal VFSI under local anesthesia (the injection group), and 16 underwent surgical excision of the nodules under general anesthesia (the surgery group). Prior to intervention and at the follow-up visit, participants were subjected to videolaryngoscopic examination with evaluation of nodules' sizes as well as subjective voice assessment by auditory perceptual assessment (APA) of voice and the international nine-item Voice Handicap Index (VHI-9i). Objective voice assessments including the measurements of cepstral peak prominence, jitter, shimmer, harmonic to noise ratio, and maximum phonation time were also administered.

RESULTS

The size of vocal fold nodules was significantly decreased postintervention in both studied groups. There was a decrease in the VHI-9i score, a decrease in the values of jitter and shimmer, together with an increase in the values of cepstral peak prominence and maximum phonation time after interventions indicating improvement of subjective and objective voice outcomes in both groups.

CONCLUSION

Office-based transnasal VFSI is a safe and tolerable therapy option for VFNs. Voice outcomes of VFSI were comparable to surgery, hereby VFSI can be considered a promising therapy for VFNs and could be used as an alternative to surgery in selected cases.

Comparative Results of Vocal Fold Injury According to the Fiber-Based Laser in a Rabbit Vocal Fold Model

OBJECTIVES

We assessed the safety of flexible fiber-based lasers including the potassium-titanyl-phosphate (KTP), CO2, and Holmium lasers using a rabbit vocal fold model and provided the safety evidence of laser before human clinical trial.

METHODS

In all, 120 male New Zealand white rabbits were used. Each laser was used to induce acute and chronic vocal fold injuries in 40 rabbits. The same laser energy with the same intensity and frequency were used in all cases, and we evaluated outcomes via surface scanning electron microscopy (SEM) and histological examination 1 day after injury. Histological and high-speed vocal fold vibration examinations were evaluated 1 month after injury. Surface injury roughness grading was done via SEM, and the Acute injury ratio and lamina propria (LP) ratio were also calculated. The dynamic glottal gap was measured through functional analyses based on recordings from a high-speed digital camera.

RESULTS

The Holmium laser caused significantly more vocal fold damage than did the KTP and CO2 lasers as revealed by SEM and evaluation of acute and chronic injuries. Functional analysis with high-speed digital camera indicated that the holmium laser reduced dynamic glottal gap compared with the normal vocal fold, where the other lasers did not.

CONCLUSIONS

The histological and functional analyses of rabbit vocal fold experiments indicated that fiber-based laryngeal laser surgery for vocal fold lesions could be performed relatively safely using a KTP or CO2 laser.

Which is a better management for vocal fold cyst: cold knife or laser resection?

Background

The objective of the study is to compare the conventional microlaryngeal surgery and the CO2 laser in the treatment of cysts of vocal folds, regarding the postoperative quality of voice.

This study was conducted on 53 cases with vocal fold cysts. The cases were randomly allocated into two groups: group 1 (27 cases) was operated by the conventional technique, and group 2 (26 cases) was operated with CO2 laser microlaryngeal operation. At 3-month postoperative, evaluation was done by stroboscopic evaluation of vocal folds, grade of hoarseness, roughness, breathiness, asthenia, and strain (GRBAS) scale and Arabic version of Voice Handicap Index (VHI).

Results

The stroboscope assessment revealed that glottic closure was complete, symmetrical motion, the reappearance of the mucosal wave, normal amplitude, and periodicity in all patients. There is insignificantly different between either group as regards the postoperative scores on VHI and GRBAS scale.

Conclusion

There is insignificantly different when comparing laser to conventional microlaryngeal surgery for excision of vocal fold cysts regarding the quality of voice.

Comparison Between Coblation and Microflap Resection of Leukoplakia of the Vocal Fold

OBJECTIVES

The objective of this study was to compare the recurrence rate and voice improvement of vocal fold leukoplakia (VFL) between microflap resection alone or radiofrequency (RF) Coblation alone.

METHODS

Patients with VFL intraoperatively treated via microflap resection alone or Coblation alone were enrolled. The recurrence rate, voice assessment, and Videostroboscopic images were compared between the two groups.

RESULTS

The recurrence rate at postoperative 12 months was 37.7% (26/69) in the microflap resection group and 7.7% (4/52) in the Coblation group; the difference was significant (P < 0.05). The preoperative and postoperative subjective detection data from the two groups showed significant differences, but the Coblation group recovered better compared to the microflap resection group. No Coblation-related complications were found, including postoperative granulation tissue hyperplasia or anterior commissure adhesion.

CONCLUSIONS

In patients with vocal cord leukoplakia, RF Coblation had a lower recurrence rate and better voice improvement compared with microflap resection.

A Study on Comparison of Conventional Micro Laryngeal Micro Dissection Surgery with Carbon Dioxide Laser in Management of Benign Lesions of Larynx

Dysphonia is a common symptom in benign and pre malignant lesions of larynx affecting vocal cords. Surgical excision is the main stay of treatment. Only a limited number of studies have compared the efficacy of microdissection versus CO2 laser surgery in the larynx. In the present study we have compared conventional micro-laryngeal surgery and carbon dioxide laser assisted microsurgical technique in the management of these lesions. A randomized prospective study was conducted in 88 cases of benign and pre malignant lesions affecting vocal cords were divided randomly to undergo surgery either by conventional micro dissection or CO2 laser assisted techniques in a tertiary care hospital. The groups were assessed through vocal cord morphological observation by videostroboscopy and subjective voice assessment parameters GRBAS score and VHI10 index preoperatively and 2 weeks and 3 months postoperatively by a panel of blinded viewers and listeners. Surgical and recovery times were compared between the two groups. Intraoperative blood loss was compared by gauze visual analogue. Patients recovered remarkably well following both the techniques as denoted by the voice parameters. Peroperative bleeding was observed to be significantly reduced in the laser excision group; operating time was significantly increased in this group. Duration of hospital stay was similar in both groups. No differences in clinical outcomes are identified when comparing microdissection with laser excision of benign lesions.

Development and experiments of a continuum robotic system for transoral laryngeal surgery

PURPOSE

Currently, self-retaining laryngoscopic surgery is not suitable for some patients, and there are dead zones relating to surgical field exposure and operation. The quality of the surgery can also be affected by the long periods of time required to complete it. Teleoperated continuum robots with flexible joints are expected to solve these issues. However, at the current stage of developing transoral robotic surgery systems, their large size affects the precision of surgical operative actions and there are high development and treatment costs.

METHODS

We fabricated a flexible joint based on selective laser melting technology and designed a shallow neural network-based kinematic modeling approach for a continuum surgical robot. Then, human model and animal experiments were completed by master-slave teleoperation to verify the force capability and dexterity of the robot, respectively.

RESULTS

As verified by human model and animal experiments, the designed continuum robot was demonstrated to achieve transoral laryngeal surgical field exposure without laryngoscope assistance, with sufficient load capability to finish the biopsy of vocal fold tissue in living animals.

CONCLUSION

The designed continuum robotic system allows the biopsy of vocal fold tissue without laryngoscope assistance. Its stiffness and dexterity indicate the system's potential for applications in the diagnosis and treatment of vocal fold nodules and polyps. The limitations of this robotic system as shown in the experiments were also analyzed.

Laryngeal Leukoplakia: State of the Art Review

Objective

This state-of-the-art article reviews the epidemiology, diagnosis, and management of vocal fold leukoplakia, with focus on recent advances. It focuses on the clinical challenges that otolaryngologists face balancing both oncological efficacy and functional outcomes in leukoplakia and presents the current philosophies and techniques to consider when managing such patients.

Data Sources

PubMed/MEDLINE.

Review Methods

We conducted a detailed review of publications related to vocal cord and laryngeal leukoplakia, dysplasia, hyperkeratosis, leukoplakia endoscopy, and leukoplakia management focusing specifically on oncologic outcomes, voice preservation, current and emerging diagnosis, and management techniques.

Conclusions

There has been a paradigm shift away from performing “vocal cord stripping” procedures that can cause irreversible hoarseness toward voice preservation surgery while achieving comparable oncologic control. Surgical technical and instrumental developments have been designed to maximally treat superficial disease while preserving underling vibratory mucosa. Recent improvements in histopathological grading systems and advances in biomarker classification may allow for improved oncologic risk stratification. Furthermore, improvements in endoscopic imaging capabilities and contact endoscopy are currently being studied for their potential diagnostic significance.

Implications for Practice

To optimally manage vocal fold leukoplakia, the otolaryngologist should become familiar with the oncologic implications of the disease and the importance of obtaining pathologic diagnosis to rule out malignancy. In addition, the surgeon should maintain surgical techniques and knowledge of available instruments and lasers that can assist in surgical management while prioritizing the preservation of vibratory tissue and voice quality. Finally, the surgeon and the patient should understand the clinical importance of routine endoscopic surveillance.

Comparative Study Between Conventional Microlaryngeal Surgery and Carbon Dioxide Laser in Management of Minimal Associated Pathological Lesions of Vocal Folds

The aim of this study is to compare the relatively new CO₂ laser microlaryngeal surgery and conventional cold dissection method in treatment of minimal associated pathological lesions of vocal folds. Eighty patients aged 20-70 years old were randomly divided into two groups, group A (40 patients) was treated by the conventional method and group B (40 patients) was treated with CO₂ laser microlaryngeal surgery. Assessment procedures included GRBAS scale, stroboscopic examination, and Arabic version of voice handicap index. Results stated that improvement of quality of voice after surgery in both techniques had no significant difference. The significant difference was in operative time and bleeding because laser had less time and bleeding. Both techniques had no recurrence within 3-months follow-up.

Utility of Optical Coherence Tomography for Guiding Laser Therapy Among Patients With Recurrent Respiratory Papillomatosis

Importance

Recurrent respiratory papillomatosis (RRP) is a viral-induced disease caused by human papillomavirus and the second leading cause of dysphonia in children; however, neither a cure nor a definitive surgical treatment is currently available for RRP. Although laser therapy is often used in the treatment of RRP, the lack of real-time laser-tissue interaction feedback undermines the ability of physicians to provide treatments with low morbidity. Therefore, an intraoperative tool to monitor and control laser treatment depth is needed.

Objective

To investigate the potential of combining optical coherence tomography (OCT) with laser therapy for patient-tailored laryngeal RRP treatments.

Design, Setting, and Participants

This in vivo study was performed at the Massachusetts Eye and Ear Infirmary from February 1, 2017, to September 1, 2017. Three-dimensional OCT images were acquired before, during, and after photoangiolytic laser therapy in 10 pediatric patients with a history of papilloma growth who presented with lesions and hoarseness.

Main Outcomes and Measures

Whether intraoperative OCT monitoring of changes in optical scattering and absorption provides quantitative information to control thermal damage in tissue.

Results

Among the 10 pediatric patients (age range, 4-11 years; 6 male) included in the study, high-resolution OCT images revealed epithelial hyperplasia with clear RRP lesion margins. Images acquired during therapy indicated coagulation deep in tissue, and posttherapy images showed the ability to quantify the amount of tissue ablated by the photoangiolytic laser.

Conclusions and Relevance

Concurrent use of OCT imaging and laser therapy may improve postoperative outcomes for patients with RRP by delivering an optimal, patient-tailored treatment. Additional studies investigating the correlation between optical properties with vocal outcomes are required.

Pressure induced tissue resection in the larynx: A preliminary canine study

OBJECTIVES

The application of laser (light amplification by stimulated emission of radiation) energy in the larynx relies on thermal injury. The impact of this injury on adjacent tissue can be undesirable. Attempts have been made to limit the extent and range of injury to adjacent tissue. The O-Pel Surgical System (Precise Light Surgical, Inc., Campbell, CA), a new technology, utilizes kinetic energy through Pressure Induced Tissue Resection (PITR) (Precise Light Surgical, Inc.) to cut tissue, theoretically eliminating injury to adjacent tissue. The purpose of this study was to evaluate the PSL in canine vocal folds.

METHODS

Four dogs underwent PITR incisions (4 mJ pulses at 200 Hz) on their vocal folds, through mucosa into the muscle. The animals were sacrificed at days 0, 3, 7, and 21 days postsurgery. The larynges were harvested and histology was performed with hematoxylin and eosin, Masson trichrome, and Verhoeff-van Gieson.

RESULTS

At day 0, focal denudation of the epithelium and coagulation necrosis in the lamina propria and adjacent connective tissue are noted. On days 3 and 7, an inflammatory infiltrate of neutrophils is seen within the lamina propria and surrounding connective tissue with minimal edema and early deposition of collagen. At day 21, the mucosa is completely regenerated with the area of previous PITR into the muscle replaced with thick bundles of collagen.

CONCLUSION

The unique PITR characteristics offer a potentially unique cutting technology for laryngeal microsurgery. The current canine study suggests appropriate and rapid healing. With refinements of the tip size of the probe and adjustment of energy, PITR will likely be an appropriate alternate to traditional lasers in laryngeal surgery.

LEVEL OF EVIDENCE

NA. Laryngoscope, 129:2557-2562, 2019.

[The application of the modern technologies for the treatment of precancerous diseases of the larynx]

This article deals with the endolaryngeal methods for the surgical treatment of pre-cancerous diseases of the larynx with the use of up-to-date technologies and anesthetic support. The authors describe the original methods for endolaryngeal interventions based on the use of the CO₂-laser. In addition, the results of the analysis of the data obtained during the immediate and delayed postoperative periods are presented.

[The modern possibilities for the treatment of the patients presenting with benign and tumour-like diseases of the larynx]

Rehabilitation of the patients presenting with benign and tumour-like diseases of the larynx (BLT) is currently a serious challenge for modern otorhinolaryngology in view of the high prevalence of this pathology. Dysphonia is a leading clinical symptom of the diseases that considerably deteriorates the quality of life of the patients. Certain benign conditions of the larynx exhibit a tendency toward malignization. The treatment of the patients presenting with benign and tumour-like diseases of the larynx requires a combined approach including the surgical, therapeutic, and phonopedic modalities for the rehabilitation of the vocal function. This article presents a review of the literature on the modern high-energy techniques for the treatment of the patients presenting with benign and tumour-like diseases of the larynx, The advantages and disadvantages of each method are discussed.

Management of Benign Vocal Fold Lesions: A Survey of Current Opinion and Practice

Empirical data are often not available to guide clinical practices in the treatment of benign mucosal lesions of the vocal folds. The purpose of this report is to describe opinions and practices in order to identify areas of consensus and discrepancy and thus guide future inquiry. A 16-item survey mailed to all active US members of the American Academy of Otolaryngology—Head and Neck Surgery (n = 7,321) included questions on the use of voice therapy; diagnostic testing; perioperative use of steroids, antibiotics, and antireflux medications; and use of lasers. Responses used a Likert 5-point scale with end anchors of 1 equaling “never” and 5 equaling “always” and were stratified according to lesion (nodules, polyps, cysts). A 16.5% response rate (n = 1,208) was obtained. A lack of consensus was most evident in the use of voice therapy for lesions other than nodules; antireflux medication; and intravenous steroids. Disagreement was also noted regarding the use of lasers, oral steroids, and antibiotics. Other than voice therapy as initial intervention for nodules, no statistically significant differences by lesion type exist regarding use of voice therapy, laser, or any medication. Prospective clinical trials addressing voice therapy, antireflux medications, steroids, and antibiotics are needed to inform clinical practice. Furthermore, treatment practices appear to be largely independent of lesion type. Therefore, traditional diagnostic categories do not seem to be useful guides to treatment, and may need to be reevaluated in light of improvements in diagnostic technology and surgical technique.

Diode Laser for Laryngeal Surgery: a Systematic Review

Introduction The diode laser has been frequently used in the management of laryngeal disorders. The portability and functional diversity of this tool make it a reasonable alternative to conventional lasers. However, whether diode laser has been applied in transoral laser microsurgery, the ideal parameters, outcomes, and adverse effects remain unclear. Objective The main objective of this systematic review is to provide a reliable evaluation of the use of diode laser in laryngeal diseases, trying to clarify its ideal parameters in the larynx, as well as its outcomes and complications. Data Synthesis We included eleven studies in the final analysis. From the included articles, we collected data on patient and lesion characteristics, treatment (diode laser's parameters used in surgery), and outcomes related to the laser surgery performed. Only two studies were prospective and there were no randomized controlled trials. Most of the evidence suggests that the diode laser can be a useful tool for treatment of different pathologies in the larynx. In this sense, the parameters must be set depending on the goal (vaporization, section, or coagulation) and the clinical problem.

CONCLUSION

The literature lacks studies on the ideal parameters of the diode laser in laryngeal surgery. The available data indicate that diode laser is a useful tool that should be considered in laryngeal surgeries. Thus, large, well-designed studies correlated with diode compared with other lasers are needed to better estimate its effects.

Voice Outcome Following Carbon Dioxide Laser Assisted Microlaryngeal Surgery

Very few studies have been conducted in South Indian population to evaluate glottic function and voice outcome following carbon dioxide (CO2) laser assisted microsurgery for benign lesions of the larynx. This is a descriptive study which aims at assessing the voice outcome (perceptual and acoustic) and vocal fold function (stroboscopic) following CO2 laser excision in benign vocal fold lesions. 50 adult patients with benign laryngeal lesions were selected to undergo CO2 laser excision in super-pulse mode at power setting of 6 watts. Perceptual analysis was done using GRBAS score. Voice analysis was done using Praat software and fundamental frequency, jitter, shimmer and harmonics to noise ratio were assessed. Stroboscopy was done to evaluate vocal fold function using glottic closure and mucosal wave pattern as parameters. Evaluation of these parameters was done pre-operatively and at 2, 6 weeks and 3 months post-operatively. Perceptual analysis revealed a significant improvement in the GRBAS score after surgery (p < 0.001). Acoustic analysis showed that all the parameters improved significantly after surgery (p < 0.001). Stroboscopy showed that vocal fold function improved in 98 % of patients in terms of completeness of glottic closure and regular, periodic mucosal wave. Super-pulse micro-spot carbon dioxide laser is a safe and effective treatment option for benign lesions of vocal folds, with excellent voice outcome.

Diagnostic and therapeutic pitfalls in benign vocal fold diseases

More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis.

Effect of voice therapy after phonomicrosurgery for vocal polyps: a prospective, historically controlled, clinical study

Objective:

This study aimed to evaluate the efficacy of post-operative voice therapy after phonomicrosurgery for vocal polyp removal.

Methods:

The study retrospectively enrolled 55 consecutive patients who had undergone voice therapy after phonomicrosurgery for vocal polyp removal occurring between June 2010 and June 2011. A historical group of 63 similar patients not receiving voice therapy was used as an external control. We compared voice analysis parameters and Voice Handicap Index scores for the two groups.

Results:

Most objective and subjective voice outcome parameters were significantly improved after surgical treatment. Although the study and control groups showed no significant difference regarding objective parameters (using acoustic and aerodynamic analysis) or the subjective parameters assessed using the grade-roughness-breathiness-asthenia-strain scale, the study group had significantly better final Voice Handicap Index scores.

Conclusion:

Following surgery for vocal polyps, post-operative voice therapy can improve patients' vocal discomfort, emotional responses and everyday self-perception.

Vocal fold scars: current concepts and future directions. Consensus report of the Phonosurgery Committee of the European Laryngological Society

Scarring of the vocal folds leads to a deterioration of the highly complex micro-structure with consecutively impaired vibratory pattern and glottic insufficiency. The resulting dysphonia is predominantly characterized by a reduced vocal capacity. Despite the considerable progress in understanding of the underlying pathophysiology, the treatment of scarred vocal folds is still an unresolved chapter in laryngology and phonosurgery. Essential for a successful treatment is an individual, multi-dimensional concept that comprises the whole armamentarium of surgical and non-surgical (i.p. voice therapy) modalities. An ideal approach would be to soften the scar, because the reduced pliability and consequently the increased vibratory rigidity impede the easiness of vibration. The chosen phonosurgical method is determined by the main clinical feature: Medialization techniques for the treatment of glottic gap, or epithelium freeing techniques for improvement of vibration characteristics often combined with injection augmentation or implantation. In severe cases, buccal mucosa grafting can be an option. New developments, include treatment with anxiolytic lasers, laser technology with ultrafine excision/ablation properties avoiding coagulation (Picosecond infrared laser, PIRL), or techniques of tissue engineering. However, despite the promising results by in vitro experiments, animal studies and first clinical trials, the step into clinical routine application has yet to be taken.

Surgical versus non-surgical interventions for vocal cord nodules

BACKGROUND

This is an update of a Cochrane review first published in The Cochrane Library in Issue 2, 2001 and previously updated in 2007 and 2009.Vocal cord nodules are bilateral, benign, callous-like growths of the mid-portion of the membranous vocal folds. They are of variable size and are characterised histologically by thickening of the epithelium with a variable degree of inflammation in the underlying superficial lamina propria. They characteristically produce hoarseness, discomfort and an unstable voice when speaking or singing.

OBJECTIVES

To assess the effectiveness of surgery versus non-surgical interventions for vocal cord nodules.

SEARCH METHODS

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 9 April 2012.

SELECTION CRITERIA

Randomised and quasi-randomised trials comparing any surgical intervention for vocal cord nodules with non-surgical treatment or no treatment.

DATA COLLECTION AND ANALYSIS

No suitable trials were identified.

MAIN RESULTS

No studies fulfilled the inclusion criteria.

AUTHORS' CONCLUSIONS

There is a need for high-quality randomised controlled trials to evaluate the effectiveness of surgical and non-surgical treatment of vocal cord nodules.

Animal model for training and improvement of the surgical skills in endolaryngeal microsurgery

Animal models for training of surgical skills were widely used for a long time in the education of medical practitioners. It is recognized, however, that endolaryngeal microsurgery requires highly refined skills to handle the delicate structures of the vocal folds under the microscope. The availability of fresh human laryngeal specimens is markedly restricted by legal and hygienic issues. The aim of this work was to report on the design of a feasible and effective model to provide the much needed skills in an animal laryngeal model that is as close as possible to the human vocal fold structure. In the initial phase of the research, three animal larynges were studied: porcine/pig, bovine/calf, and ovine/sheep larynges. The pig/porcine larynx was chosen for this experimental training model because it closely resembled the human laryngeal/glottal configurations. A study was carried out on 10 porcine/pig larynges to assess the dimensions of the glottis and study the histology of the layered structure of the vocal fold. The study was pursued to confirm the resemblance of this animal specimen to the human vocal fold. A wooden box with a black finished interior was prepared with an acrylic bed at its floor. This bed allows placement of the porcine/pig larynx. The design of the box allows the endoscopic exposure of the porcine/pig larynx through a rubber diaphragm. The darkness and confinement of the box, apart from the light of the endoscope, approximates the situation in live endoscopy. The operating microscope is then used to expose the glottis. Routine fine microlaryngeal instruments were used for training in the prescribed skills.

Clinical Practice Guideline: Hoarseness (Dysphonia)

Objective:

This guideline provides evidence-based recommendations on managing hoarseness (dysphonia), defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL). Hoarseness affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness.

Purpose:

The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti-reflux medications, reduce inappropriate use of radiographic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. In creating this guideline the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of neurology, speech-language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology–head and neck surgery, pediatrics, and consumers.

Results

The panel made strong recommendations that 1) the clinician should not routinely prescribe antibiotics to treat hoarseness and 2) the clinician should advocate voice therapy for patients diagnosed with hoarseness that reduces voice-related QOL. The panel made recommendations that 1) the clinician should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related QOL; 2) the clinician should assess the patient with hoarseness by history and/or physical examination for factors that modify management, such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer; 3) the clinician should visualize the patient's larynx, or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected; 4) the clinician should not obtain computed tomography or magnetic resonance imaging of the patient with a primary complaint of hoarseness prior to visualizing the larynx; 5) the clinician should not prescribe anti-reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease; 6) the clinician should not routinely prescribe oral corticosteroids to treat hoarseness; 7) the clinician should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist; and 8) the clinician should prescribe, or refer the patient to a clinician who can prescribe, botulinum toxin injections for the treatment of hoarseness caused by adductor spasmodic dysphonia. The panel offered as options that 1) the clinician may perform laryngoscopy at any time in a patient with hoarseness, or may refer the patient to a clinician who can visualize the larynx; 2) the clinician may prescribe anti-reflux medication for patients with hoarseness and signs of chronic laryngitis; and 3) the clinician may educate/counsel patients with hoarseness about control/preventive measures.

Disclaimer:

This clinical practice guideline is not intended as a sole source of guidance in managing hoarseness (dysphonia). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.

Hoarse voice in adults: an evidence-based approach to the 12 minute consultation

BACKGROUND

The hoarse voice is a common presentation in the adult ENT clinic. It is estimated that otolaryngology/voice clinics receive over 50 000 patients with dysphonia each year. Good vocal function is estimated to be required for around 1/3 of the labour force to fulfil their job requirements. The assessment and management of the patient with a hoarse voice is potentially a complex and protracted process as the aetiology is often multi-factorial. This article provides a guide for the clinician in the general ENT clinic to make a concise, thorough assessment of the hoarse patient and engage in an evidence based approach to investigation and management.

METHOD

Literature search performed on 4 October 2008 using EMBASE, MEDLINE, Cochrane databases using subject headings hoarse voice or dysphonia in combination with diagnosis, management, investigation, treatment, intervention and surgery.

RESULTS

General vocal hygiene is beneficial for non organic dysphonia but the evidence base for individual components is poor. There is a good evidence base for the use of voice therapy as first line treatment of organic dysphonia such as vocal fold nodules and polyps. There is little evidence for surgical intervention as first line therapy for most common benign vocal fold lesions. Surgery is, however, the treatment of choice for hoarseness due to papillomatosis. Both CO(2) laser and microdissection are equally acceptable modalities for surgical resection of common benign vocal fold lesions. Laryngopharyngeal reflux is commonly cited as a cause of hoarseness but the evidence base for treatment with gastric acid suppression is poor. Despite the widespread use of proton pump inhibitors for treating laryngopharyngeal reflux, there is high quality evidence to suggest that they are no more effective than placebo.

CONCLUSION

A concise and thorough approach to assessment in the general ENT clinic will provide the diagnosis and facilitate the management of the hoarse voice in the majority of cases. Voice therapy is an important tool that should be utilised in the general ENT clinic and should not be restricted to the specialist voice clinic. If there is no improvement after initial measures, the larynx appears normal and/or the patient has failed initial speech & language therapy, referral to a specialist voice clinic may be helpful. More research is still required particularly with regard to laryngopharyngeal reflux which is often cited as an important cause of hoarseness but is still poorly understood.

Use of lasers in laryngeal surgery

Lasers are a relatively recent addition to laryngeal surgery. Since their invention, laser use and applications have expanded rapidly. In this article, we discuss the benefits and disadvantages of lasers for different procedures, as well as ways to overcome commonly faced clinical problems. The use of lasers in surgery has offered a time- and cost-efficient alternative to cold surgical techniques, and has been used in the treatment of numerous laryngeal pathologies, including stenoses, recurrent respiratory papillomatosis, leukoplakia, nodules, malignant laryngeal disease, and polypoid degeneration (Reinke's edema). However, lasers can incur adjacent tissue damage and vocal fold scarring. These problems can be minimized through understanding the mechanisms by which lasers function and correctly manipulating the parameters under a surgeon's control. By varying fluence, power density, and pulsation, tissue damage can be decreased and lasers can be used with greater confidence. The various types of lasers and their applications to the treatment of specific pathologies are reviewed with the intention of helping surgeons select the best tool for a given procedure. Recent applications of lasers to treat benign laryngeal lesions and severe laryngomalacia demonstrate that additional research must be conducted to realize the full potential of this surgical tool.

Airway obstruction: a rare complication of benign vocal fold polyps

OBJECTIVES

Benign laryngeal polyps usually present with hoarseness and dysphonia. There have been a few reported cases, however, of polyps that caused airway obstruction. Herein we present our series of obstructing laryngeal polyps.

METHODS

A retrospective review was performed of all patients with benign laryngeal lesions treated by the senior author (A.M.S.S.) between 1997 and 2006. Patients who presented with airway obstruction were identified. Detailed information was recorded on the demographics, presenting signs and symptoms, and surgical procedures. Preoperative and postoperative laryngoscopies were reviewed.

RESULTS

Ten patients were identified. There were 7 women and 3 men. The mean age was 49 years (range, 34 to 64 years). All had a history of vocal abuse and smoking, with a mean of 35.2 pack-years (range, 7.5 to 112.5 pack-years). All underwent microlaryngoscopy with excision of the lesions. Jet ventilation or a small endotracheal tube was used to secure the airway. The mean follow-up of 9 patients was 71.2 days (range, 25 to 208 days); 1 patient was lost to followup. An excellent airway and improved voice was achieved in all. Forty-four percent (4 of 9) had persistent dysphonia and a decreased mucosal wave after the operation.

CONCLUSIONS

Benign laryngeal polyps may present with airway obstruction and thus should be included in the differential diagnosis of stridor. Endoscopic treatment can result in an excellent airway, but dysphonia may persist in some cases.

Current State of Scanning Micromanipulator Applications with the Carbon Dioxide Laser

Objectives:

The development of the scanning system AcuBlade has considerably enhanced carbon dioxide laser energy delivery, improving cutting and ablation modes. The scanning system can be applied with the 2 available high-powered pulsed waves, SuperPulse and UltraPulse. This study was conducted to determine whether there are any differences in phonosurgery between the SuperPulse and UltraPulse lasing applications with regard to thermal diffusion into the surrounding tissues, healing time, and clinical results.

Methods:

Thirteen patients with bilateral and similar vocal fold lesions underwent operation — One side in SuperPulse mode and the other side in UltraPulse mode. The parameters for phonosurgery were depth of 0.2 mm, 10 W, single pulse, and 0.10 second for SuperPulse, and 2 passes, 10 W, single pulse, and 0.10 second for UltraPulse.

Results:

Incisions were sharper with UltraPulse, making the surgery easier, but at the first postoperative follow-up visit, after 8 to 10 days, no differences were observed in the presentation, the healing, or the vibration of the 2 vocal folds. Coagulation along the incision line was 25 μm for SuperPulse and 15 μm for UltraPulse (median values).

Conclusions:

In comparison with SuperPulse, the UltraPulse carbon dioxide laser made the procedure easier, but did not improve the clinical outcome.

Perceptual and Acoustic Assessment of Voice Pathology and the Efficacy of Endolaryngeal Phonomicrosurgery

Values for acoustic voice measurements were obtained from 88 normal individuals and 98 pathological cases of mass lesions of vocal fold and 50 cases of unilateral vocal fold paralysis. Overall, all items reflecting perturbations of pitch and amplitude as well as glottal noise were significantly higher in the groups of patients compared with the normal group. The measurement of normalized noise energy (NNE) was found to be an optimum parameter for discrimination of normal/abnormal voices. The voices of patients with vocal fold nodules and vocal fold polyps were analyzed before endolaryngeal phonomicrosurgery (EPM) and 2 weeks after. Statistically significant (p < 0.01) improvement was achieved both in perceptual and acoustic analysis. EPM resulted in a significant decrease of mean jitter, shimmer, and NNE. Clinically, these measures provided documentable and measurable evidence of vocal function and were helpful for comparing patients with normal speakers. They also were useful for a thorough documentation of patient's voice pathology and for evaluation of the presurgical and postsurgical voice status.

Voice quality of prepubescent children with quiescent recurrent respiratory papillomatosis

OBJECTIVE

The purpose of this study was to assess the long-term impact of recurrent respiratory papillomatosis (RRP) and its treatment on voice quality in prepubescent children.

STUDY DESIGN

Case-control study.

METHODS

Prepubescent children with RRP in remission for at least 12 [according to MM section] months were asked to participate. Remission was documented by absence of papillomas on fiberoptic flexible laryngoscopy. An age- and sex-matched control was selected for each patient enrolled. Voice was evaluated using the voice-related quality of life (V-RQOL) questionnaire, perceptual evaluations of voice quality by speech-language pathologists using the GRBAS (grade of hoarseness, roughness, breathiness, asthenia, strain) scale, and acoustic analysis (fundamental frequency, maximal phonation time, and relative average perturbation) using the Visi-Pitch II 3300.

RESULTS

Medical records of 84 patients were reviewed and 15 met study criteria. Five agreed to participate but one was excluded due to the presence of papillomas. The four study patients and four matched controls were between 9- and 11-years old. On the V-RQOL questionnaire, each control rated V-RQOL as normal (10/50) and the average patient group score was within the normal range (11.5/50). On perceptual evaluations, the patient's voices were more hoarse, breathy, and rough compared to controls'. Acoustic analysis showed that patients' voices had a lower average fundamental frequency (F(0)) (200 Hz compared to 243 Hz for controls) and a higher relative average perturbation (RAP) (1.10 compared to 0.77), although only one patient's voice actually had elevated RAP (2.89), which had a large impact on raising the average score for the patient group. The average maximal phonation times were similar for the two groups (7.8s for patients and 7.4s for controls) but lower than average normal scores reported in the literature.

CONCLUSIONS

Although children with RRP do not perceive their voice quality to have a negative impact on V-RQOL, speech-language pathologist evaluations and acoustic measurements show objective differences between the voices of children with quiescent RRP and those of normal, healthy controls.

New computer-guided scanner for improving CO2 laser-assisted microincision

The objective was to clinically test a new computer-guided scanner designed for CO2 laser-assisted microincision. The scanner-assisted beam travels across the target as a straight or curved incision line. Line length and beam penetration can be adjusted. The studied population, 155 cases, encompassed benign lesions as well as early cancers of the larynx. Operating time was compared with that required for similar operations performed with the Acuspot micromanipulator. Laser-produced coagulation thickness at the incision was measured on 41 operative specimens. The scanner-assisted incision and dissection were more accurate and required up to 30% less time than with a manually guided beam. Postoperative follow-up was straightforward. The coagulation thickness was less than 10 microm for phonomicrosurgery and less than 20 microm for other surgical procedures. The scanner-assisted incision is more accurate than that attained manually.

Junior A, Jamur MC, Pinto JA, Fomin DS. Estudo comparativo histológico na prega vocal após incisão com instrumental a frio e com laser de CO2 em modelo animal

Dentre os vários tipos de laser usados em Medicina, o laser de CO2 é o mais usado na Otorrinolaringologia e Cirurgia de Cabeça e Pescoço. As vantagens de seu uso são a diminuição do sangramento, a diminuição do edema no pós-operatório e a facilidade de acesso ao campo operatório, entre outras. Desde os trabalhos de Jako e Strong em 1972(1,2), quando o laser de CO2 passou a ser usado no tratamento de papilomatose laríngea e de lesões malignas glóticas iniciais, suas indicações têm aumetado, principalmente em lesões benignas, a partir da alta tecnologia desenvolvida dos últimos anos como, por exemplo, a diminuição do microspot e o uso do superpulso, reduzindo conseqüentemente seu efeito térmico sobre os tecidos. MÉTODOS: Neste trabalho foram realizadas incisões com instrumental a frio e com laser de CO2 1 watt de modo contínuo e superpulso, em pregas vocais caninas e observado, através de cortes histológicos corados pelo método de Sirius Red, a quantidade de colágeno depositada sobre as mesmas. RESULTADOS: A quantidade de colágeno das pregas vocais foi maior do que no grupo controle, e estatisticamente maior no grupo de animais submetidos a procedimentos com instrumental a frio do que com laser de CO2. Não houve diferença estatística entre o grupo controle e o grupo submetido a incisões com instrumentos a frio. CONCLUSÃO: A microcirurgia de laringe com o laser de CO2, quando este é usado em baixa potência, com pequeno "microspot" e com superpulso, é um método seguro em relação à deposição de colágeno, quando comparado com instrumentos com lâmina a frio, obedecendo os princípios da fonomicrocirurgia.