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Ben Ner D, Hamzany Y, Reuven Y, Ben-Mordechai N, Bar-On DY, Najman TM, Shoffel-Havakuk H. Too Deep: The Rate of Inappropriate Deep Resections while Practicing a Single Stage Laser Cordectomy. J Voice 2024:S0892-1997(24)00155-3. [PMID: 38811305 DOI: 10.1016/j.jvoice.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/19/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Whenever a cortectomy is indicated, obviating preoperative biopsy and practicing a single-stage-laser-cordectomy (SSLC) may expedite treatment and preserve surgical planes. This may result in more superficial resections and improved vocal function. Yet, SSLC holds a risk for over-treating nonmalignant lesions. Our study aims to evaluate this risk. METHODS A retrospective cohort of patients who underwent SSLC. Cordectomy types were compared with final pathology. Type-1 cordectomy was subcategorized into superficial-type-1 (superficial-lamina-propria preserved) and deep-type-1 (ligament exposed). Superficial-type-1 cordectomy was considered adequate for epithelial lesions not invading the basement membrane: nonmalignant, dysplasia, and carcinoma-in-situ (CIS). Deeper resections for these pathologies were considered inappropriately deep. All resections were considered appropriate for squamous cell carcinoma (SCC). RESULTS Ninety-seven patients who underwent 139 SSLC were included. SCC was found in 30% (N = 42), CIS/severe-dysplasia in 15% (N = 21), mild/moderate-dysplasia in 23% (N = 32), nondysplastic lesions in 31% (N = 43), and lymphoma in 0.5% (N = 1). Superficial-type-1 cordectomy was performed in 64% (N = 89). Altogether, 15 lesions (11%) underwent inappropriately deep resections. Smoking history, current smoking status, prior glottic surgery, radiation or fungal infection, did not increase the rate of inappropriate deep resection. While the general rate of inappropriately deep resection is 11%, for deep-type-1 cordectomy or deeper the rate was 29.4%. The highest rate was associated with deep-type-1 cordectomy, reaching 52.9%. CONCLUSION The general rate of inappropriately deep resection during a SSLC is low. However, when the depth of resection involves exposure of the vocal ligament or deeper, the rate increases. Hence, to avoid unnecessary morbidity, whenever a deep resection is considered, the authors recommend preceding a deeper resection with frozen section sampling.
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Affiliation(s)
- Daniel Ben Ner
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yaniv Hamzany
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yonatan Reuven
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nofar Ben-Mordechai
- Department of Otolaryngology Head and Neck Surgery, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Dvir Yohai Bar-On
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzvi Menachem Najman
- Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Azadeh Ranjbar P, Maxwell PJ, Barna A, Balouch B, Hawkshaw M, Al Omari AI, Lyons K, Alnouri G, Sataloff RT. An Exploration of the Risk Factors, Severity, and Sequelae of Vocal Fold Hemorrhage in a Population of Voice Patients Before and After Diagnosis. J Voice 2023:S0892-1997(23)00181-9. [PMID: 37550112 DOI: 10.1016/j.jvoice.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Vocal fold hemorrhage (VFH) is the rupture (usually acute) of a blood vessel within the true vocal fold. The long-term sequelae of VFH on the mucosal wave (MW) and glottic gap on video stroboscopy remain understudied. The primary objective of this study was to investigate the short-term and long-term consequences of VFH through measured and rated analysis of the mucosal wave and glottic gap. METHODS The presence of VFH and its extent (limited/moderate vs. extensive VFH) were identified. The primary outcome of this study was mucosal wave, which was assessed on an ordinal scale by three blinded raters pre and posthemorrhage. Only patients who had undergone strobovideolaryngoscopy before sustaining VFH were included. Mucosal wave and glottic gap also were measured using image pixel analysis using the open-access tool, ImageJ (NIH, Bethesda, MD). RESULTS Twenty-three subjects were included in this study (mean age 39.78 ± 15.54). Intra-rater reliability for MW ratings was 81.48% ± 6.150% (minimum 77.78%) for all evaluators (κ = 0.519 [0.267-0.772], P < 0.001). Inter-rater reliability analysis revealed 75.56% agreement between evaluators (κ = 0.524 [0.425-0.623], P < 0.001). MWMeasured extrapolated from ImageJ methodology correlated significantly with MWRated (n = 70, r = 0.448, P < 0.001). ΔMWMeasured from baseline to follow-up evaluation were compared for both the initial follow-up visit (FU1) and the second follow-up visit (FU2) [-4.135 ± 31.01 vs. 36.50 ± 39.97, P = 0.025]. Hence, ΔMWMeasured was significantly better by FU2 than FU1, with the larger positive change from baseline representing a greater improvement in the measured mucosal wave. Additionally, there were significant differences in ΔMWRated between those with limited/moderate VFH and those with extensive VFH at FU1. Duration of absolute voice rest correlated significantly with time to VFH resolution. Long-term change in mucosal wave after hemorrhage was assessed using both ΔMWMeasured and MWRated. Based on ΔMWRater, 35.0% of subjects demonstrated ongoing and worse mucosal wave restriction compared to baseline at their most recent follow-up visit. Based on ΔMWMeasured, 50.0% of the subjects showed ongoing and worse mucosal wave restriction compared to baseline at their most recent follow-up visit. CONCLUSION Overall long-term restrictions in MW after hemorrhage were present in 35.0% of the subjects based on ratings and 50.0% of the patients based on the measured MW using ImageJ, demonstrating the importance of ongoing study into this pathology and how to prevent it, especially in PVU and professional singers. Patients presenting with extensive hemorrhage were at risk for more prominent, detectable changes in mucosal wave compared to those with limited/moderate hemorrhage in the short-term, defined by a mean FU time of 3 months, but not long-term, characterized by a mean FU time 6 months or greater. Whether the severity of VFH is a true indicator of mucosal wave alterations requires additional study, as does the reliability and validity of ImageJ mucosal wave and glottic gap measurement techniques.
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Affiliation(s)
| | | | - Alexander Barna
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Bailey Balouch
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Mary Hawkshaw
- Department of Otolaryngology, Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Karen Lyons
- Department of Otolaryngology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Ghiath Alnouri
- Department of Otolaryngology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Robert T Sataloff
- Department of Otolaryngology, Drexel University College of Medicine, Philadelphia, PA, USA; Lankenau Institute for Medical Research, Wynnewood, PA, USA.
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3
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Yılmaz T. Voice After Cordectomy Type I or Type II or Radiation Therapy for Large T 1a Glottic Cancer. Otolaryngol Head Neck Surg 2023; 168:798-804. [PMID: 35943800 DOI: 10.1177/01945998221117453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE T1a glottic cancer can be treated with transoral laser microsurgery (TLM) or radiation therapy (RT). Dysphonia is the major disadvantage of TLM, and preservation of voice appears to be the best advantage of RT compared to TLM. Studies on voice outcomes of both options gave conflicting results, but there is a tendency toward better voice outcome after TLM compared to the past. STUDY DESIGN Nonrandomized retrospective cohort study. SETTING Tertiary referral center. METHODS In total, 172 patients with a cancer lesion involving more than two-thirds of 1 membranous vocal fold underwent cordectomy type I (n = 56) (C1 group) or type II (n = 59) (C2 group) or RT (n = 57) (RT group). GRBASI (grade, roughness, breathiness, asthenia, strain, instability), videolaryngostroboscopy, Voice Handicap Index-30, acoustic analysis including F0, jitter, shimmer, noise to harmonic ratio, cepstral peak prominence, and cepstral spectral index of dysphonia using running speech, and aerodynamic analysis were performed before treatment and 6 and 24 months after treatment. RESULTS Study groups did not differ significantly on pretreatment voice outcomes (P > .05). The RT group had significantly better voice outcomes at 6 months posttreatment compared to the C1 and C2 groups (P < .05). The C1 group had significantly better voice outcomes at 6 months posttreatment compared to the C2 group (P < .05). The C1 group had significantly better voice outcomes at 24 months posttreatment compared to the RT and C2 groups (P < .05). The RT and C2 groups did not differ significantly at 24 months posttreatment (P > .05). CONCLUSION Voice outcomes after C2 are equal to RT. C1 has better voice outcomes than RT. C1 and C2 can be the treatment of choice for large T1a glottic cancers.
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Affiliation(s)
- Taner Yılmaz
- Hacettepe University Faculty of Medicine, Department of Otolaryngology-Head & Neck Surgery, Ankara, Turkey
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4
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Lechien JR, Crevier-Buchman L, Circiu MP, Lisan Q, Hans S. Evolution of Voice Quality in Type 1-2 Transoral CO 2 Laser Cordectomy: A Prospective Comparative Study. Laryngoscope 2021; 132:1421-1426. [PMID: 34704611 DOI: 10.1002/lary.29924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To compare the 12-month evolution of voice quality outcomes in patients who benefited from types 1-2 transoral CO2 laser cordectomy (TLC) for an early-stage vocal fold squamous cell carcinoma (VFSCC). STUDY DESIGN Prospective uncontrolled study. METHODS Sixty patients with cT1 VFSCC were consecutively recruited from a single medical center. Thirty patients benefited from type 1 TLC, while type 2 TCL was performed in 30 patients. The following voice quality outcomes were evaluated at baseline, 3-, 6-, and 12-month post-TLC: voice handicap index (VHI), GRBAS, speech rate, maximum phonation time (MPT), and acoustic parameters. Voice quality evolution was compared between type 1 and type 2 TLC. RESULTS Fifty-seven patients completed the evaluations. Type 1 TLC patients reported significant improvements of VHI, grade of dysphonia, and breathiness at 3-, 6-, and 12-month post-TLC. Speech rate and jitter values improved 6- and 12-month post-TLC. A few voice quality outcomes reported 3- or 6-month post-TLC improvements in type 2 TLC group, while VHI, grade of dysphonia improved at 6- and 12-month post-TLC. MPT significantly decreased at 6- and 12-month post-TLC, while there were no acoustic measurement changes in type 2 TLC. CONCLUSIONS The effect of TLC on voice quality may depend on the type of TLC. Type 1 TLC was associated with faster voice quality improvements compared with type 2 TLC. VHI and dysphonia grade were identified as the most relevant tool of voice changes irrespective to the TLC type. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology, Elsan Hospital, Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, Belgium.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France.,Phonetics and Phonology Lab, CNRS UMR7018, University of Sorbonne-Nouvelle, Paris, France
| | - Marta P Circiu
- Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France
| | - Quentin Lisan
- Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France
| | - Stephane Hans
- Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France.,Phonetics and Phonology Lab, CNRS UMR7018, University of Sorbonne-Nouvelle, Paris, France
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5
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Cohen JT, Goldman T, Paker M, Fridman E. Assessment of Early Stage Glottic Cancer Depth of Resection After Transoral Laser Cordectomy. Otolaryngol Head Neck Surg 2021; 166:901-906. [PMID: 34399642 DOI: 10.1177/01945998211037658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Surgeons generally determine depth of resection during transoral laser cordectomy by visual inspection of the surgical field. Our aim was to examine the correlation between early glottic cancer depth of resection as reported by surgeons in the operation report and depth of resection defined by pathology specimens, using various staining techniques intended to differentiate between the distinct vocal fold layers based on particular collagen deposition. STUDY DESIGN Retrospective study. SETTING A voice and swallowing clinic at a tertiary referral hospital. METHODS We compared depth of cordectomy assessed intraoperatively by surgeons and by pathologists using Picrosirius red stain and collagen I immunohistochemistry stain in 32 patients who underwent transoral laser cordectomy for early glottic cancer. RESULTS For type I, II, and III cordectomy, the respective proportions of patients were 14 (47%), 9 (30%), and 7 (23%) according to surgeons' estimations; 2 (6%), 17 (55%), and 12 (39%) according to Picrosirius red stain; and 3 (11%), 12 (44%), and 12 (45%) according to immunohistochemistry for collagen I. CONCLUSION Surgeons' reported depth of resection did not correlate with depth of resection established by either staining technique. Determining depth of resection necessitates special stains, which should help in the clinical assessment of cordectomy type.
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Affiliation(s)
- Jacob T Cohen
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; The Technion, Haifa, Israel
| | - Tal Goldman
- Tissue Diagnosis and Cancer Research Institute, Ha'Emek Medical Center, Afula, Israel
| | - Miki Paker
- Department of Otolaryngology Head and Neck Surgery, Ha'Emek Medical Center, Afula, Israel
| | - Eran Fridman
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; The Technion, Haifa, Israel
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6
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Garrel R, Uro Coste E, Costes-Martineau V, Woisard V, Atallah I, Remacle M. Vocal-fold leukoplakia and dysplasia. Mini-review by the French Society of Phoniatrics and Laryngology (SFPL). Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:399-404. [PMID: 32001196 DOI: 10.1016/j.anorl.2020.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vocal-fold leukoplakia and dysplasia are together designated "epithelial hyperplastic laryngeal lesions" (EHLL). Work-up and follow-up are founded on optical examination with high-definition imaging, stroboscopy and narrow-band imaging. Diagnosis is based on pathology, using the new 2017 WHO classification, dichotomizing "low grade" and "high grade". Statistically, the risk of cancerous progression is 20% within 5 to 10 years of diagnosis, or more in over-65 year-old males; risk for any given patient, however, is unpredictable. Research focuses on the genetic criteria of the lesion and characterization of the tumoral microenvironment. Treatment is exclusively microsurgical. Resection depth is adjusted according to infiltration. EHLL is a chronic disease, necessitating long-term follow-up, which may be hampered by residual dysphonia and surgical sequelae in the vocal folds. Sequelae need to be minimized by good mastery of microsurgical technique and indications. When they occur, biomaterials such as autologous fat and hyaluronic acid can be useful. Tissue bio-engineering is a promising field.
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Affiliation(s)
- R Garrel
- Département d'ORL et CCF, hôpital Gui de Chauliac, 80, avenue Fliche, 34295 Montpellier, France.
| | - E Uro Coste
- CHU Toulouse, département d'anatomopathologie, hôpital de Rangueil, avenue Jean-Poulhes, 31400 Toulouse, France
| | - V Costes-Martineau
- Département d'anatomopathologie, hôpital Gui de Chauliac, 80, avenue Fliche, 34295 Montpellier, France
| | - V Woisard
- CHU département d'ORL et CCF hôpital Larrey, 24, Chemin de Pouvourville - TSA 30030, 31059 Toulouse cedex 9, France
| | - I Atallah
- CHU département d'ORL et CCF, hôpital La tronche, Boulevard de la Chantourne, Grenoble, France
| | - M Remacle
- Département d'ORL et CCF, CHL centre, 4, Rue Ernest Barblé, L-1210 Luxembourg
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7
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Reliability of High-speed Videoendoscopic Ratings of Essential Voice Tremor and Adductor Spasmodic Dysphonia. J Voice 2017; 33:16-26. [PMID: 29246397 DOI: 10.1016/j.jvoice.2017.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/06/2017] [Accepted: 10/11/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The main objectives of this study were to (1) examine intrarater and inter-rater reliabilities in perceptual ratings of vocal fold vibratory patterns and supraglottic characteristics for essential vocal tremor and adductor spasmodic dysphonia (AdSD) using high-speed videoendoscopy (HSV), and (2) to investigate the specificity of the parameters in differentiating these two voice disorders. METHODS HSV recordings of 34 cases diagnosed with essential vocal tremor, AdSD, or AdSD with vocal tremor were evaluated blindly by two voice speech pathologists. The two raters examined all HSV video segments twice across nine supraglottic and vocal fold vibratory characteristics for inter-rater and intrarater reliabilities. A separate consensus rating was then developed, with the results analyzed to explore differentiation. RESULTS Raters demonstrated moderate intrarater reliability with mean Spearman's rho correlation coefficients of 0.68 (rater 1) and 0.73 (rater 2). Moderate inter-rater reliability for the two raters was seen across all parameters with a mean Cohen's kappa coefficient of 0.51. Raters showed higher intrarater and inter-rater reliabilities for supraglottic parameters. Only the presence of tremor differentiated between the two voice disorders in cases with a consistent diagnosis. CONCLUSIONS The high level of concomitance between vocal tremor and AdSD may affect subjective perceptual analysis of supraglottic and vocal fold vibratory patterns. Results indicate similar global involvement of supraglottic laryngeal structures for both vocal tremor and AdSD.
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8
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Bonilha HS, Desjardins M, Garand KL, Martin-Harris B. Parameters and Scales Used to Assess and Report Findings From Stroboscopy: A Systematic Review. J Voice 2017; 32:734-755. [PMID: 29103609 DOI: 10.1016/j.jvoice.2017.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Laryngeal endoscopy with stroboscopy, a critical component of the assessment of voice disorders, is rarely used as a treatment outcome measure in the scientific literature. We hypothesized that this is because of the lack of a widely used standardized, validated, and reliable method to assess and report laryngeal anatomy and physiology, and undertook a systematic literature review to determine the extent of the inconsistencies of the parameters and scales used in voice treatment outcome studies. STUDY DESIGN Systematic literature review. METHODS We searched PubMed, Ovid, and Cochrane for studies where laryngeal endoscopy with stroboscopy was used as a treatment outcome measure with search terms representing "stroboscopy" and "treatment" guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. RESULTS In the 62 included articles, we identified 141 terms representing 49 different parameters, which were further classified into 20 broad categories. The six most common parameters were magnitude of glottal gap, mucosal wave amplitude, location or shape of glottal gap, regularity of vibration, phase symmetry, and presence and size of specific lesions. Parameters were assessed on scales ranging from binary to 100 points. The number of scales used for each parameter varied from 1 to 24, with an average of four different scales per parameter. CONCLUSIONS There is a lack of agreement in the scientific literature regarding which parameters should be assessed to measure voice treatment outcomes and which terms and scales should be used for each parameter. This greatly diminishes comparison and clinical implementation of the results of treatment outcomes research in voice disorders. We highlight a previously published tool and recommend it for future use in research and clinical settings.
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Affiliation(s)
- Heather Shaw Bonilha
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Maude Desjardins
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina
| | - Kendrea L Garand
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina; Department of Speech Pathology and Audiology, University of South Alabama, Mobile, Alabama
| | - Bonnie Martin-Harris
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina; Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois.
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9
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Hsin LJ, Lin WN, Fang TJ, Lee LA, Kang CJ, Huang BS, Lin CY, Fan KH, Tsang NM, Hsu CL, Chang JTC, Liao CT, Yen TC, Chang KP, Chuang HF, Li HY. Life quality improvement in hoarse patients with early glottic cancer after transoral laser microsurgery. Head Neck 2017; 39:2070-2078. [PMID: 28695624 DOI: 10.1002/hed.24873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/11/2017] [Accepted: 05/29/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the recovery kinetics of voice and quality of life (QOL) over time in patients with early glottic cancer who underwent transoral laser microsurgery (TLM). METHODS A prospective cohort study was conducted in which acoustic and aerodynamic voice assessments and QOL analyses were done using health-related questionnaires (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions [EORTC-QLQ-C30] and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35-questions [EORTC-QLQ-H&N35]) were administered at designated times. RESULTS Most voice laboratory parameters worsened during the first month, then recovered to baseline after 6 months. The QLQ-H&N35 speech subscale was significantly improved. Among the voice laboratory parameters, pretreatment harmonics-to-noise ratio was an independent predictor (P = .041) for improvement on the speech subscale at the endpoint. CONCLUSION Despite an initial deterioration of voice and QOL in the first month, patients who underwent TLM recovered to a plateau since the sixth month and then to better than preoperative status afterward. A greater improvement in QOL was seen in patients with poorer baseline voice quality.
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Affiliation(s)
- Li-Jen Hsin
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Ni Lin
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Ang Lee
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Bing-Shan Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Departmen of Radiation Oncology, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Yu Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Departmen of Radiation Oncology, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kang-Hsing Fan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Departmen of Radiation Oncology, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ngan-Ming Tsang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Departmen of Radiation Oncology, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Lung Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Oncology, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Departmen of Radiation Oncology, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nuclear Medicine and Molecular Imaging, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Feng Chuang
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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10
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Abstract
PURPOSE OF REVIEW To give an overview of the evolvement of transoral laser microsurgery (TLM) in the treatment of early glottic carcinoma and highlight the contribution of recent literature. RECENT FINDINGS The indications and limits of TLM have been well specified. Effects on swallowing have been well documented. Introduction of narrow-band imaging (NBI) and diffusion-weighted magnetic resonance has been shown of additional value for outcome. The first reports on transoral robotic surgery show that it may be of added value in the future. SUMMARY TLM for early glottic carcinoma (Tis-T2) has very good oncological outcomes with indications of higher larynx preservation in TLM than that in radiotherapy. The anterior commissure is a risk factor if involved in the cranio-caudal plane, and reduced vocal fold mobility is a risk factor when this is due to arytenoid involvement. The best voice results are achieved when the anterior commissure can be left intact along with part of the vocal fold muscle although even in larger resections, patient self-reported voice handicap is still limited.
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Affiliation(s)
- E V Sjögren
- Department of ENT and Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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Titze IR. Human Speech: A Restricted Use of the Mammalian Larynx. J Voice 2016; 31:135-141. [PMID: 27397113 DOI: 10.1016/j.jvoice.2016.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/08/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Speech has been hailed as unique to human evolution. Although the inventory of distinct sounds producible with vocal tract articulators is a great advantage in human oral communication, it is argued here that the larynx as a sound source in speech is limited in its range and capability because a low fundamental frequency is ideal for phonemic intelligibility and source-filter independence. METHOD Four existing data sets were combined to make an argument regarding exclusive use of the larynx for speech: (1) range of fundamental frequency, (2) laryngeal muscle activation, (3) vocal fold length in relation to sarcomere length of the major laryngeal muscles, and (4) vocal fold morphological development. RESULTS Limited data support the notion that speech tends to produce a contracture of the larynx. The morphological design of the human vocal folds, like that of primates and other mammals, appears to be optimized for vocal communication over distances for which higher fundamental frequency, higher intensity, and fewer unvoiced segments are used. CONCLUSION The positive message is that raising one's voice to call, shout, or sing, or executing pitch glides to stretch the vocal folds, can counteract this trend toward a contracted state.
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Affiliation(s)
- Ingo R Titze
- National Center for Voice and Speech, The University of Utah, Lead Institution, Salt Lake City, Utah; Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, Iowa.
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Lowell SY, Kelley RT, Busekroos L, Voleti R, Hosbach-Cannon CJ, Colton RH, Mihaila D. The effect of anchors on reliability of endoscopic tremor ratings. Laryngoscope 2016; 127:411-416. [PMID: 27075631 DOI: 10.1002/lary.26034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/22/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to determine the effects of anchors and training on intrarater and inter-rater reliability for visual-perceptual, endoscopic tremor ratings. STUDY DESIGN Prospective cohort study. METHODS Nasoendoscopy recordings of 10 participants with a diagnosis of essential voice tremor were evaluated by five voice specialists using the Vocal Tremor Scoring System. Ratings were performed before, immediately after, and 4 weeks after implementation of a training program with anchor stimuli. Immediate and long-term post-training ratings were performed with simultaneous use of anchor samples for each rating. RESULTS Intrarater reliability showed significant improvement from pretraining to immediate and long-term post-training. Mean correlation coefficients (Spearman's rho) increased from 0.71 at pretraining to 0.84 and 0.90 at immediate and long-term post-training, respectively. Inter-rater reliability was not affected by training with anchors, with mean correlation coefficients ranging from 0.62 at pretraining to 0.58 and 0.64 at immediate and long-term post-training, respectively. CONCLUSIONS Consistent, reproducible ratings are critical for the interpretation and comparison of endoscopic tremor data. Reliability findings from this study indicate that the use of anchor samples as referents for making ordinal judgments about the severity of tremor in oropharyngeal and laryngeal regions was helpful for improving internal standards and consistency but less useful for calibrating across different raters. LEVEL OF EVIDENCE 4 Laryngoscope, 2016 127:411-416, 2017.
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Affiliation(s)
- Soren Y Lowell
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York, U.S.A
| | - Richard T Kelley
- Department of Otolaryngology & Communication Sciences, SUNY Upstate Medical University, Syracuse, New York, U.S.A
| | - Lauren Busekroos
- Department of Otolaryngology & Communication Sciences, SUNY Upstate Medical University, Syracuse, New York, U.S.A
| | - Ramani Voleti
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York, U.S.A
| | - Carly J Hosbach-Cannon
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York, U.S.A
| | - Raymond H Colton
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York, U.S.A
| | - Dragos Mihaila
- Department of Neurology, SUNY Upstate Medical University, Syracuse, New York, U.S.A
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Mau T, Palaparthi A, Riede T, Titze IR. Effect of resection depth of early glottic cancer on vocal outcome: an optimized finite element simulation. Laryngoscope 2015; 125:1892-9. [PMID: 26010240 DOI: 10.1002/lary.25267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS To test the hypothesis that subligamental cordectomy produces superior acoustic outcome than subepithelial cordectomy for early (T1-2) glottic cancer that requires complete removal of the superficial lamina propria but does not involve the vocal ligament. STUDY DESIGN Computer simulation. METHODS A computational tool for vocal fold surgical planning and simulation (the National Center for Voice and Speech Phonosurgery Optimizer-Simulator) was used to evaluate the acoustic output of alternative vocal fold morphologies. Four morphologies were simulated: normal, subepithelial cordectomy, subligamental cordectomy, and transligamental cordectomy (partial ligament resection). The primary outcome measure was the range of fundamental frequency (F0 ) and sound pressure level (SPL). A more restricted F0 -SPL range was considered less favorable because of reduced acoustic possibilities given the same range of driving subglottic pressure and identical vocal fold posturing. RESULTS Subligamental cordectomy generated solutions covering an F0 -SPL range 82% of normal for a rectangular vocal fold. In contrast, transligamental and subepithelial cordectomies produced significantly smaller F0 -SPL ranges, 57% and 19% of normal, respectively. CONCLUSION This study illustrates the use of the Phonosurgery Optimizer-Simulator to test a specific hypothesis regarding the merits of two surgical alternatives. These simulation results provide theoretical support for vocal ligament excision with maximum muscle preservation when superficial lamina propria resection is necessary but the vocal ligament can be spared on oncological grounds. The resection of more tissue may paradoxically allow the eventual recovery of a better speaking voice, assuming glottal width is restored. Application of this conclusion to surgical practice will require confirmatory clinical data. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anil Palaparthi
- National Center for Voice and Speech, University of Utah, Salt Lake City, Utah
| | - Tobias Riede
- National Center for Voice and Speech, University of Utah, Salt Lake City, Utah.,Department of Physiology, Midwestern University, Glendale, Arizona
| | - Ingo R Titze
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, Iowa, U.S.A
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Greulich MT, Parker NP, Lee P, Merati AL, Misono S. Voice outcomes following radiation versus laser microsurgery for T1 glottic carcinoma: systematic review and meta-analysis. Otolaryngol Head Neck Surg 2015; 152:811-9. [PMID: 25837666 DOI: 10.1177/0194599815577103] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 02/20/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Systematic review of literature on patient-reported voice handicap following T1 glottic squamous cell carcinoma treatment using transoral laser microsurgery or radiation therapy. DATA SOURCES PubMed, Web of Science, and Scopus (1997-2013). REVIEW METHODS These data sources were searched for papers reporting Voice Handicap Index (VHI) after treatment of early glottic carcinoma. Review and reference cross-checking were performed using a priori selection criteria. Study data were abstracted and publication quality categorized independently by 2 authors. Corresponding authors were contacted to maximize data for analysis. Meta-analysis was performed only with studies that included both treatment modalities, to reduce heterogeneity and maximize rigor; random effects modeling was used to pool results. RESULTS Eighteen publications were identified that reported VHI data following surgery and radiotherapy for T1 glottic carcinoma. No studies were randomized. When studies that reported multiple T-stages or systematic treatment selection bias were excluded, 8 retrospective cohort studies describing 362 patients were suitable for meta-analysis. Follow-up time (mean, 47 months; range, 1-298 mo) and extent of surgical excision varied across studies. Six studies showed no VHI difference between treatment arms; 2 favored radiotherapy over surgery (1 of which reported transmuscular cordectomy for all surgical patients); and none favored surgery. Meta-analysis showed no significant difference in posttreatment VHI between radiotherapy and surgery (mean difference, -5.52; 95% confidence interval, -11.40, 0.36; heterogeneity I (2) = 61%, P = .01). CONCLUSION VHI scores were comparable following transoral laser microsurgery and radiation therapy for T1 glottic carcinoma in the current literature, suggesting no clinically significant difference in functional voice outcomes between treatment types.
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Affiliation(s)
- Matthew T Greulich
- Department of Otolaryngology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Noah P Parker
- The Voice Clinic of Indiana, Carmel, Indiana, USA The Department of Speech and Hearing Sciences, Indiana University, Bloomington, Indiana, USA
| | - Philip Lee
- Department of Otolaryngology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Albert L Merati
- Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA
| | - Stephanie Misono
- Department of Otolaryngology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
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Bonilha HS, Focht KL, Martin-Harris B. Rater methodology for stroboscopy: a systematic review. J Voice 2014; 29:101-8. [PMID: 25261957 DOI: 10.1016/j.jvoice.2014.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/26/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Laryngeal endoscopy with stroboscopy (LES) remains the clinical gold standard for assessing vocal fold function. LES is used to evaluate the efficacy of voice treatments in research studies and clinical practice. LES as a voice treatment outcome tool is only as good as the clinician interpreting the recordings. Research using LES as a treatment outcome measure should be evaluated based on rater methodology and reliability. The purpose of this literature review was to evaluate the rater-related methodology from studies that use stroboscopic findings as voice treatment outcome measures. STUDY DESIGN Systematic literature review. METHODS Computerized journal databases were searched for relevant articles using terms: stroboscopy and treatment. Eligible articles were categorized and evaluated for the use of rater-related methodology, reporting of number of raters, types of raters, blinding, and rater reliability. RESULTS Of the 738 articles reviewed, 80 articles met inclusion criteria. More than one-third of the studies included in the review did not report the number of raters who participated in the study. Eleven studies reported results of rater reliability analysis with only two studies reporting good inter- and intrarater reliability. CONCLUSION The comparability and use of results from treatment studies that use LES are limited by a lack of rigor in rater methodology and variable, mostly poor, inter- and intrarater reliability. To improve our ability to evaluate and use the findings from voice treatment studies that use LES features as outcome measures, greater consistency of reporting rater methodology characteristics across studies and improved rater reliability is needed.
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Affiliation(s)
- Heather Shaw Bonilha
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
| | - Kendrea L Focht
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina
| | - Bonnie Martin-Harris
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Mendelsohn AH, Xuan Y, Zhang Z. Voice outcomes following laser cordectomy for early glottic cancer: a physical model investigation. Laryngoscope 2014; 124:1882-6. [PMID: 24347459 DOI: 10.1002/lary.24563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/15/2013] [Accepted: 12/09/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS The voice effects following laser cordectomy for early glottic cancer are poorly described. We investigated the voice outcomes of subligamentous cordectomy of progressive anterior-posterior extent of excision. STUDY DESIGN Physical phonatory modeling. METHODS The influence of vocal fold surgical defects and corresponding scar was experimentally investigated using a self-oscillating physical model of the vocal folds and compared with the baseline model without defects or scar. RESULTS Results showed that increasing anterior-posterior extent of resection increased phonation threshold pressure and flow rate and reduced excitation of high-order harmonics, resulting in a more breathy and rough voice production. However, it was found that voice production was improved with the placement of scar, which increased both excitation of high-order harmonics and the harmonic-to-noise ratio. CONCLUSIONS Although large anterior-posterior surgical resections resulted in progressive impact on vocal measures, a limited excision of the vocal fold cover surprisingly demonstrated minimal voice changes. Further investigations are required to define the acceptable extent of surgical resection that may result in optimal voice outcomes.
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Affiliation(s)
- Abie H Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A; Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
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Jamal N, Sofer E, Chhetri DK. Treatment considerations for early glottic carcinoma: lessons learned and a primer for the general otolaryngologist. Otolaryngol Head Neck Surg 2013; 150:169-73. [PMID: 24201059 DOI: 10.1177/0194599813512101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this commentary, we review our experience with early glottic carcinomas in an attempt to identify points to consider when developing a treatment protocol and technical considerations in oncologic resection to maintain laryngeal function. We highlight several consistent themes: (1) difficult exposure is not always a contraindication to endoscopic resection; (2) depth of invasion may be apparent only intraoperatively; (3) radiation therapy should be offered for deeply invasive cancers requiring extensive cordectomy or for patients who cannot afford lengthy vocal downtime; however, (4) radiation therapy leads to acute dysphagia and collateral damage to the contralateral vocal fold that is avoided with surgery; (5) good voice can be obtained after healing if resection is limited to intramuscular cordectomy; (6) the key to optimal vocal results is adequate glottal closure; and (7) second look operations are occasionally necessary, and therefore preoperative counseling should include this possibility. Since both surgery and radiation therapy achieve excellent oncologic control, a patient-centered approach is preferred in management.
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Affiliation(s)
- Nausheen Jamal
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
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