HSC Section 6 Nov2016 Green Book

Otolaryngology–Head and Neck Surgery 152(6)

Table 1. Voice Outcome Data. a

Parameter

Pretreatment

Posttreatment

No.

P Value

2 7.0 6 3.3

2 3.0 6 2.6

Dysphonia severity index

12

.003

Acoustic

\ .001

290 6 53 110 6 35 180 6 67

482 6 272 119 6 95 363 6 295 1.66 6 1.10 9.29 6 3.71 6.69 6 2.59 0.27 6 0.13

12 12 12 12

Maximum F 0 Minimum F 0

.147 .003 .004 .674 .049 .536 .918 .069

Frequency range

4.05 6 2.83

Percent jitter

Aerodynamic Maximum phonation time Phonation threshold pressure

8.77 6 4.28 8.21 6 3.10 0.30 6 0.07

13

4 4 4 4

Mean airflow rate Laryngeal resistance

47.36 6 16.97 14.04 6 4.58

46.46 6 24.29 10.92 6 4.07

Peak pressure

Voice handicap index Functional

\ .001

18 6 10 21 6 8 17 6 10 56 6 26

12 6 9 15 6 10 11 6 10 37 6 27

14 14 14 14

Physical

.001 .005

Emotional

\ .001

Total

Abbreviation: F 0 , fundamental frequency. a Data are presented as mean 6 standard deviation. Complete data sets with measurements of all parameters were not available for every subject; sample size is therefore variable.

Safety and Tolerability There were no reported minor or major complications. Five procedures had to be truncated due to patient intolerance. Voice Outcomes Summary data are presented in Table 1 . After treatment, dysphonia severity index changed significantly, with a move toward normal voice ( P = .003). Phonatory frequency range increased ( P = .003), and percent jitter decreased ( P = .004). Phonation threshold pressure decreased ( P = .049), but there were no significant changes in MPT, mean airflow rate, or laryngeal resistance. Total VHI ( P \ .001) as well as each component of the VHI decreased significantly after treatment (functional: P \ .001; physical: P = .001; emo- tional: P = .005; Figure 3 ). Energy Delivered Energy delivery data were available on 21 procedures per- formed to treat bilateral disease. Average energy delivered per procedure was 132 6 68 J (range, 23-268 J). There was no meaningful difference between the amounts of energy delivered with each laser. For KTP procedures, 126 6 63 J (range, 47-246 J) were applied; for PDL procedures, 128 6 75 J (range, 23-268 J) were applied. In 2 procedures for uni- lateral disease, 108 and 45 J were delivered with the KTP and PDL, respectively. Discussion We present a retrospective case series of patients who under- went office-based laser treatment of Reinke’s edema. To our knowledge, this study is the largest such series to date.

Figure 3. Each component, as well as the total Voice Handicap Index, decreased significantly after treatment. Bar height represents average reported voice handicap; error bars represent standard deviation.

The increasingly common use of lasers in otolaryngology reflects a general trend toward rendering treatment in the office rather than the operating suite. Office-based treatments offer several advantages. In addition to avoiding the risks of general anesthesia, including myocardial infarction and stroke, unsedated office-based treatment of patients with airway limitations allows the patient to remain in control of his or her own airway throughout the procedure, reducing the risk of airway compromise during induction of general anesthesia. Office procedures cost less, 18 require less time, and avoid the potential complications of microlaryngoscopy, such as dental injury and dysgeusia. 19 Moreover, attempting

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