2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

TABLE I. Voice Outcomes at Each Time Point Before and After Surgery.

P Value

Preoperative vs. Early Postoperative

Preoperative vs. Late Postoperative

Parameters

Preoperative

Early Postoperative

Late Postoperative

12.67 6 6.16

8.55 6 5.82

12.51 6 6.70

MPT

.002*

.871 .543

156.73 6 38.81

164.13 6 46.80 4.41 6 4.33 10.47 6 8.87 0.27 6 0.21 43.74 6 29.88 15.12 6 11.14 15.64 6 9.48 15.60 6 11.06

153.47 6 40.57

F0

.289

2.99 6 3.14 8.47 6 6.62 0.20 6 0.11

2.69 6 3.40 7.33 6 5.18 0.21 6 0.16

Jitter (%)

.126

.615

Shimmer (%)

.318 .073

.316 .814

NHR

34.60 6 28.81

32.23 6 28.79 11.14 6 9.23 10.79 6 9.35 12.43 6 10.51

VHI

.001*

.940

9.98 6 9.07

Functional

< .001*

.226 .254

12.40 6 10.46 12.21 6 11.42

Physical

.003*

Emotional

.110

.859

1.85 6 0.83 1.74 6 0.73 1.59 6 0.69 1.23 6 0.80 1.30 6 0.75

1.96 6 0.82 1.95 6 0.86 1.89 6 0.86 1.65 6 0.99 1.78 6 0.96

1.50 6 0.90 1.48 6 0.87 1.54 6 0.85 1.07 6 0.89 1.32 6 0.71

Grade

.669 .117

.040* .040*

Roughness

Breathiness

.060

.681

Asthenia

.027* .009*

.254 .883

Strain

* P < .05. F0 5 fundamental frequency; MPT 5 maximal phonation time; NHR 5 noise-to-harmonic ratio; VHI 5 Voice Handicap Index.

the preoperative condition after 6 months. Moreover, Grade and Roughness of GRBAS scale showed signifi- cant improvement. In patients with lesser extent of exci- sion (type I and II), improvement was identified based on Grade and VHI-Physical. The significant correlations of Grade with other parameters at the late postoperative period ( > 6 months) implied that improvement in Grade, which represents overall voice quality on the GRBAS scale, might be considered probable improvement in quality of voice after TLM. Although there may be some controversy over considering the result of the GRBAS scale or VHI as a verification method for voice quality after TLM, several authors have demonstrated that these methods reflect postoperative vocal out- comes. 3,13,16,17,22 On the other hand, quantitative acous- tic measurement using the scales of the CSL–MDVP should be analyzed with caution because they are based on analysis of simple vowel phonation. It may be diffi- cult to demonstrate the quality of voice with parameters based on vowel phonation only, and such analysis may

showed no significant differences (Table III). Analysis of voice quality in patients with unilateral tumor without anterior commissure involvement showed improvement of Grade and Roughness, whereas those with tumor involvement of anterior commissure or bilateral vocal cord revealed a tendency for deteriorated voice quality at the late postoperative period (Table IV). Recurrence was identified in two patients (3.5%) at 51 months and 59 months after initial TLM, respectively. Because of the early detection of recurrence, both patients were treated with TLM without significant morbidity. DISCUSSION The voice outcomes of this study were in accord with those of previous longitudinal studies 16,17 that dem- onstrated immediate ( < 3 months) deterioration with improvement and stabilization of voice 6 months after TLM. Although several parameters of acoustic, percep- tual, and subjective analysis showed significant deterio- ration 3 months after TLM, they were all comparable to

Fig. 1. Comparison of Voice Handicap Index (VHI) scores (A) and Grade (of the Grade, Roughness, Breathiness, Asthenia, Strain scale) (B) before and after laser cordectomy. The P value indicates the statistical significance of change in each scale at early postoperative (Early) and later postoperative (Late) period compared to the preoperative (Preop) time point. Bold values indicate P < .05. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

Laryngoscope 126: September 2016

Lee et al.: Voice After Transoral Laser Microsurgery

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