HSC Section 6 Nov2016 Green Book

Koszewski et al

Figure 2. Sample pre- and posttreatment images from 2 patients. A, subject 1: A1, pretreatment, normal inspiration; A2, posttreatment, normal inspiration; A3, posttreatment, vocal fold abduction. B, subject 2: B1, pretreatment, vocal fold abduction; B2, pretreatment, normal inspiration; B3, posttreatment, vocal fold abduction; B4, posttreatment, normal inspiration.

MPT. For mean airflow rate, laryngeal resistance, and peak air pressure, patients produced 3 /pa/ syllable trains at comfortable pitch and loudness; the first and last /pa/ token within each train were removed and the average values computed. For phonation threshold pressure, patients produced 3 /pi/ syllable trains, each beginning with a soft whisper, followed by incremental increases in subglottal pressure until comfortable voicing was achieved; the lowest subglottal pressure at which phonation occurred was recorded as the phonation threshold pressure. Acoustic parameters included minimum and maximum funda- mental frequency, phonatory frequency range, and percent jitter. Acoustic data were recorded using the Computerized Speech Lab (model 4150B, KayPENTAX) and Multi-Dimensional Voice Program (model 5105, KayPENTAX). For fundamental frequency values, patients performed ascending and descending glides on the vowel /a/ and were instructed to achieve the lowest and highest frequencies possible, inclusive of falsetto phonation; this was repeated 3 times and the extrema recorded. Phonatory frequency range was calculated as the difference between maximum and minimum fundamental frequency. For percent jitter, patients produced a stable /a/. Dysphonia severity index was calculated as described by Wuyts et al. 20 Subjective voice changes were quantified using pre- and postprocedural scores from the Voice Handicap Index. 21 This instrument mea- sures the impact of one’s voice in 3 separate subcategories: functional, physical, and emotional. Finally, total energy deliv- ered was collected. Although a standardized clinical protocol is followed for collection of voice measures at clinical visits, occasionally

not all voice measures are available in the database. Accordingly, a complete data set including all voice para- meters was not available for every subject. Analyses were performed using the data that were available, and the number of subjects included in each analysis has been speci- fied. A subject was not included in a given analysis of effi- cacy if he or she did not have a measurement of that parameter before and after the procedure. Statistical Analysis Evaluation of treatment efficacy was performed using paired t tests. If data did not meet assumptions for para- metric testing, a Wilcoxon-Mann-Whitney matched pairs signed-rank test was performed. All tests were 2-tailed with a significance level of a = 0.05. As complete data sets were not available for all subjects, sample size for each parameter is reported with the corresponding result.

Results Subject Characteristics

Nineteen patients underwent 25 in-office endoscopic laser treatments of Reinke’s edema between January 2007 and November 2013. All but 1 patient was a woman, and all were smokers at the time of presentation. Average age at pre- sentation was 53.9 6 7.7 years (range, 43-67 years). All but 1 patient had bilateral involvement, with 1 demonstrating polypoid change affecting only 1 vocal fold. Sample pre- and posttreatment images are provided in Figure 2 .

65